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Войти в исследования Frontiers in pediatrics · 2026
Supportive care and in-hospital mortality among children with suspected sepsis in Bamako, Mali.
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Still William L, Keita Adama Mamby, Tapia Milagritos D, Cherukumilli Sumanth, Liang Yuanyuan, Stafford Kristen A, Onwuchekwa Uma, Juma Jane, Sow Samba O, Kotloff Karen L, Bhutta Adnan
Аннотация
INTRODUCTION: Sepsis causes significant pediatric hospitalizations and deaths globally. The impact of supportive care interventions remains under-studied in sub-Saharan Africa, where mortality is greatest.
METHODS: We conducted a prospective cohort study of children under five years hospitalized with study-defined suspected invasive bacterial infection and ≥2 adapted systemic inflammatory response syndrome (SIRS) criteria at l'Hôpital Gabriel Touré (HGT), a tertiary care center in Bamako, Mali, between January 2021 and July 2024. Associations between supportive care therapies (antibiotics, intravenous fluids, and supplemental oxygen) and in-hospital mortality were evaluated using multivariable logistic regression and time-varying Cox proportional hazards models adjusted for prespecified demographic and clinical covariates.
RESULTS: Among 1,569 enrolled children, 165 (10.5%) had a culture positive for a putative pathogen; 516 (32.9%) died during hospitalization. Most patients received antibiotics (86.4%), while 56.0% received intravenous fluids and 28.7% received supplemental oxygen. Antibiotics and intravenous fluids were not significantly associated with mortality after adjustment. Receipt of supplemental oxygen was associated with higher odds of in-hospital death (aOR: 2.09, 95% CI: 1.50, 2.91), an association potentially reflecting confounding by indication due to greater illness severity among children receiving oxygen.
CONCLUSIONS: In this observational cohort with high in-hospital mortality from suspected pediatric sepsis, supportive care therapies were not associated with improved survival after multivariable adjustment. These findings may reflect confounding by indication and a high burden of antimicrobial resistance that may limit the effectiveness of empiric antibiotic therapy. Reducing pediatric sepsis mortality in resource-limited settings will require improved access to microbiologically active antibiotics alongside context-appropriate pediatric critical care interventions.
METHODS: We conducted a prospective cohort study of children under five years hospitalized with study-defined suspected invasive bacterial infection and ≥2 adapted systemic inflammatory response syndrome (SIRS) criteria at l'Hôpital Gabriel Touré (HGT), a tertiary care center in Bamako, Mali, between January 2021 and July 2024. Associations between supportive care therapies (antibiotics, intravenous fluids, and supplemental oxygen) and in-hospital mortality were evaluated using multivariable logistic regression and time-varying Cox proportional hazards models adjusted for prespecified demographic and clinical covariates.
RESULTS: Among 1,569 enrolled children, 165 (10.5%) had a culture positive for a putative pathogen; 516 (32.9%) died during hospitalization. Most patients received antibiotics (86.4%), while 56.0% received intravenous fluids and 28.7% received supplemental oxygen. Antibiotics and intravenous fluids were not significantly associated with mortality after adjustment. Receipt of supplemental oxygen was associated with higher odds of in-hospital death (aOR: 2.09, 95% CI: 1.50, 2.91), an association potentially reflecting confounding by indication due to greater illness severity among children receiving oxygen.
CONCLUSIONS: In this observational cohort with high in-hospital mortality from suspected pediatric sepsis, supportive care therapies were not associated with improved survival after multivariable adjustment. These findings may reflect confounding by indication and a high burden of antimicrobial resistance that may limit the effectiveness of empiric antibiotic therapy. Reducing pediatric sepsis mortality in resource-limited settings will require improved access to microbiologically active antibiotics alongside context-appropriate pediatric critical care interventions.