TY - JOUR
T1 - Life-threatening infections in children in Europe (the EUCLIDS Project)
T2 - a prospective cohort study
AU - EUCLIDS Consortium
AU - Martinón-Torres, Federico
AU - Salas, Antonio
AU - Rivero-Calle, Irene
AU - Cebey-López, Miriam
AU - Pardo-Seco, Jacobo
AU - Herberg, Jethro A.
AU - Boeddha, Navin P.
AU - Klobassa, Daniela S.
AU - Secka, Fatou
AU - Paulus, Stephane
AU - de Groot, Ronald
AU - Schlapbach, Luregn J.
AU - Driessen, Gertjan J.
AU - Anderson, Suzanne T.
AU - Emonts, Marieke
AU - Zenz, Werner
AU - Carrol, Enitan D.
AU - Van der Flier, Michiel
AU - Levin, Michael
AU - Levin, Michael
AU - Coin, Lachlan
AU - Gormley, Stuart
AU - Hamilton, Shea
AU - Herberg, Jethro
AU - Hourmat, Bernardo
AU - Hoggart, Clive
AU - Kaforou, Myrsini
AU - Sancho-Shimizu, Vanessa
AU - Wright, Victoria
AU - Abdulla, Amina
AU - Agapow, Paul
AU - Bartlett, Maeve
AU - Bellos, Evangelos
AU - Eleftherohorinou, Hariklia
AU - Galassini, Rachel
AU - Inwald, David
AU - Mashbat, Meg
AU - Menikou, Stefanie
AU - Mustafa, Sobia
AU - Nadel, Simon
AU - Rahman, Rahmeen
AU - Thakker, Clare
AU - Bokhandi, Sumit
AU - Power, Sue
AU - Barham, Heather
AU - Pathan, Nazima
AU - Ridout, Jenna
AU - de Vries, Esther
AU - Doedens, Rienus A.
AU - Jansen, Nicolaas JG
AU - Kneyber, Martin C.
PY - 2018/6/1
Y1 - 2018/6/1
N2 - 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. Funding: European Union's Seventh Framework programme.
AB - 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. Funding: European Union's Seventh Framework programme.
U2 - 10.1016/S2352-4642(18)30113-5
DO - 10.1016/S2352-4642(18)30113-5
M3 - Article
AN - SCOPUS:85046161618
SN - 2352-4642
VL - 2
SP - 404
EP - 414
JO - The Lancet Child and Adolescent Health
JF - The Lancet Child and Adolescent Health
IS - 6
ER -