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Life-threatening infections in children in Europe (the EUCLIDS Project): a prospective cohort study

Martinón-Torres, F, Salas, A, Rivero-Calle, I, Cebey-López, M, Pardo-Seco, J, Herberg, JA, Boeddha, NP, Klobassa, DS, Secka, F, Paulus, S, de Groot, R, Schlapbach, LJ, Driessen, GJ, Anderson, ST, Emonts, M, Zenz, W, Carrol, ED, Van der Flier, M, Levin, M, Levin, M , Coin, L, Gormley, S, Hamilton, S, Herberg, J, Hourmat, B, Hoggart, C, Kaforou, M, Sancho-Shimizu, V, Wright, V, Abdulla, A, Agapow, P, Bartlett, M, Bellos, E, Eleftherohorinou, H, Galassini, R, Inwald, D, Mashbat, M, Menikou, S, Mustafa, S, Nadel, S, Rahman, R, Thakker, C, Bokhandi, S, Power, S, Barham, H, Pathan, N, Ridout, J, White, D, Thurston, S, Faust, S, Patel, S, McCorkell, J, Davies, P, Crate, L, Navarra, H, Carter, S, Ramaiah, R, Patel, R, Tuffrey, C, Gribbin, A, McCready, S, Peters, M, Hardy, K, Standing, F, O'Neill, L, Abelake, E, Deep, A, Nsirim, E, Pollard, A, Willis, L, Young, Z, Royad, C, White, S, Fortune, PM, Hudnott, P, Martinón-Torres, F, Salas Ellacuriaga, A, Álvez González, F, Barral-Arca, R, Cebey-López, M, Curras-Tuala, MJ, García, N, García Vicente, L, Gómez-Carballa, A, Gómez Rial, J, Grela Beiroa, A, Justicia Grande, A, Leboráns Iglesias, P, Martínez Santos, AE, Martinón-Torres, N, Martinón Sánchez, JM, Morillo Gutiérrez, B, Mosquera Pérez, B, Obando Pacheco, P, Pardo-Seco, J, Pischedda, S, Rivero-Calle, I, Rodríguez-Tenreiro, C, Redondo-Collazo, L, Serén Fernández, S, Porto Silva, MDS, Vega, A, Vilanova Trillo, L, Reyes, SB, León León, MC, Navarro Mingorance, Á, Gabaldó Barrios, X, Oñate Vergara, E, Concha Torre, A, Vivanco, A, Fernández, R, Giménez Sánchez, F, Sánchez Forte, M, Rojo, P, Ruiz Contreras, J, Palacios, A, Epalza Ibarrondo, C, Fernández Cooke, E, Navarro, M, Álvarez Álvarez, C, Lozano, MJ, Carreras, E, Brió Sanagustín, S, Neth, O, Martínez Padilla, MDC, Prieto Tato, LM, Guillén, S, Fernández Silveira, L, Moreno, D, de Groot, R, van Furth, AM, van der Flier, M, Boeddha, NP, Driessen, GJA, Emonts, M, Hazelzet, JA, Kuijpers, TW, Pajkrt, D, Sanders, EAM, van de Beek, D, van der Ende, A, Philipsen, RLA, Adeel, AOA, Breukels, MA, Brinkman, DMC, de Korte, CCMM, de Vries, E, de Waal, WJ, Dekkers, R, Dings-Lammertink, A, Doedens, RA, Donker, AE, Dousma, M, Faber, TE, Gerrits, GPJM, Gerver, JAM, Heidema, J, Homan-van der Veen, J, Jacobs, MAM, Jansen, NJG, Kawczynski, P, Klucovska, K, Kneyber, MCJ, Koopman-Keemink, Y, Langenhorst, VJ, Leusink, J, Loza, BF, Merth, IT, Miedema, CJ, Neeleman, C, Noordzij, JG, Obihara, CC, van Overbeek - van Gils, ALT, Poortman, GH, Potgieter, ST, Potjewijd, J, Rosias, PPR, Sprong, T, ten Tussher, GW, Thio, BJ, Tramper-Stranders, GA, van Deuren, M, van der Meer, H, van Kuppevelt, AJM, van Wermeskerken, A-M, Verwijs, WA, Wolfs, TFW, Schlapbach, LJ, Agyeman, P, Aebi, C, Berger, C, Giannoni, E, Stocker, M, Posfay-Barbe, KM, Heininger, U, Bernhard-Stirnemann, S, Niederer-Loher, A, Kahlert, C, Hasters, P, Relly, C, Baer, W, Berger, C, Carrol, E, Paulus, S, Frederick, H, Jennings, R, Johnston, J, Kenwright, R, Fink, CG, Pinnock, E, Emonts, M, Agbeko, RS, Anderson, ST, Secka, F, Bojang, KA, Sarr, I, Kebbeh, N, Sey, G, Saidykhan, M, Cole, F, Thomas, G, Antonio, M, Zenz, W, Klobassa, DS, Binder, A, Schweintzger, NA, Sagmeister, M, Baumgart, H, Baumgartner, M, Behrends, U, Biebl, A, Birnbacher, R, Blanke, J-G, Boelke, C, Breuling, K, Brunner, J, Buller, M, Dahlem, P, Dietrich, B, Eber, E, Elias, J, Emhofer, J, Etschmaier, R, Farr, S, Girtler, Y, Grigorow, I, Heimann, K, Ihm, U, Jaros, Z, Kalhoff, H, Kaulfersch, W, Kemen, C, Klocker, N, Köster, B, Kohlmaier, B, Komini, E, Kramer, L, Neubert, A, Ortner, D, Pescollderungg, L, Pfurtscheller, K, Reiter, K, Ristic, G, Rödl, S, Sellner, A, Sonnleitner, A, Sperl, M, Stelzl, W, Till, H, Trobisch, A, Vierzig, A, Vogel, U, Weingarten, C, Welke, S, Wimmer, A, Wintergerst, U, Wüller, D, Zaunschirm, A, Ziuraite, I and Žukovskaja, V (2018) Life-threatening infections in children in Europe (the EUCLIDS Project): a prospective cohort study. The Lancet Child & Adolescent Health, 2 (6). pp. 404-414. ISSN 2352-4642

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Abstract

Background: Sepsis and severe focal infections represent a substantial disease burden in children admitted to hospital. We aimed to understand the burden of disease and outcomes in children with life-threatening bacterial infections in Europe.
Methods: The European Union Childhood Life-threatening Infectious Disease Study (EUCLIDS) was a prospective, multicentre, cohort study done in six countries in Europe. Patients aged 1 month to 18 years with sepsis (or suspected sepsis) or severe focal infections, admitted to 98 participating hospitals in the UK, Austria, Germany, Lithuania, Spain, and the Netherlands were prospectively recruited between July 1, 2012, and Dec 31, 2015. To assess disease burden and outcomes, we collected demographic and clinical data using a secured web-based platform and obtained microbiological data using locally available clinical diagnostic procedures.
Findings: 2844 patients were recruited and included in the analysis. 1512 (53·2%) of 2841 patients were male and median age was 39·1 months (IQR 12·4–93·9). 1229 (43·2%) patients had sepsis and 1615 (56·8%) had severe focal infections. Patients diagnosed with sepsis had a median age of 27·6 months (IQR 9·0–80·2), whereas those diagnosed with severe focal infections had a median age of 46·5 months (15·8–100·4; p<0·0001). Of 2844 patients in the entire cohort, the main clinical syndromes were pneumonia (511 [18·0%] patients), CNS infection (469 [16·5%]), and skin and soft tissue infection (247 [8·7%]). The causal microorganism was identified in 1359 (47·8%) children, with the most prevalent ones being Neisseria meningitidis (in 259 [9·1%] patients), followed by Staphylococcus aureus (in 222 [7·8%]), Streptococcus pneumoniae (in 219 [7·7%]), and group A streptococcus (in 162 [5·7%]). 1070 (37·6%) patients required admission to a paediatric intensive care unit. Of 2469 patients with outcome data, 57 (2·2%) deaths occurred: seven were in patients with severe focal infections and 50 in those with sepsis.
Interpretation: Mortality in children admitted to hospital for sepsis or severe focal infections is low in Europe. The disease burden is mainly in children younger than 5 years and is largely due to vaccine-preventable meningococcal and pneumococcal infections. Despite the availability and application of clinical procedures for microbiological diagnosis, the causative organism remained unidentified in approximately 50% of patients.

Item Type: Article
Subjects: R Medicine > RJ Pediatrics > RJ101 Child Health. Child health services
Divisions: Nursing & Allied Health
Publisher: Elsevier BV
Date Deposited: 16 Feb 2021 12:01
Last Modified: 16 Feb 2021 12:01
DOI or Identification number: 10.1016/s2352-4642(18)30113-5
URI: https://researchonline.ljmu.ac.uk/id/eprint/14466

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