Background
Methods
Data collection
Statistical analysis
Results
Clinical characteristics
Case No | Age (yr)/ sex | Presenting complaints | Septic focus | Microorganisms | Culture site | Pulmonary treatment | Extra-pulmonary treatment | PICU admission | Duration of hospital stay, (days) | Outcome |
---|---|---|---|---|---|---|---|---|---|---|
1 | 2.5/F | Fever, RD | Unknown | Staph.aureus | Blood | Antibiotics, oxygen | No | No | 14 | Survived |
2 | 13/M | Fever, chest pain, RD | Septic hip arthritis | MRSA | Pleural fluid, Sputum, Pus | Antibiotics, oxygen, intercostal chest tubes | Drainage of hip joint twice | Yes | 75 | Survived |
3 | 7.5/M | Fever, chest pain, RD | Septic hip arthritis | MRSA | Pericardial fluid and Blood,Pus | Antibiotics, oxygen | Drainage of hip joint- Pericardiocentesis | Yes | 30 | Survived |
4 | 10/M | Fever, chest pain, RD, leg swelling | Septic thrombophlebitis of left leg | No growth | Blood | Antibiotics, oxygen | No | Yes | 45 | Survived |
5 | 11/F | Fever, Chest pain | Soft tissue infection | Staph.aureus | Pleural fluid, Sputum, Blood | Antibiotics, oxygen | No | Yes | 45 | Survived |
6 | 4/M | Fever, chest pain, RD, Rt leg swelling | Septic thrombophlebitis of right leg | MRSA | Blood | Antibiotics, oxygen, intercostal chest tubes | No | No | 60 | Survived |
7 | 3/M | Fever, RD, Pallor | Infective endocarditis | Staph.aureus | Blood, Pleural fluid | Antibiotics, oxygen, intercostal chest tubes | Arrange for cardiac surgery | Yes | 20 | died |
8 | 14/F | Fever, RD | Venous- catheter infection | MRSA | Blood, Central line culture | Antibiotics, oxygen | Hemodialysis | Yes | 45 | Survived |
9 | 1.5/M | Fever, RD, Pallor, swelling of left elbow | Septic elbow arthritis | Staph.aureus | Blood, Pleural fluid | Antibiotics, oxygen, intercostal chest tubes | Drainage joint | Yes | 30 | Survived |
10 | 15/F | Fever, chest pain, RD | Infective endocarditis | MRSA | Blood | Antibiotics, oxygen | Surgical removal of vegetations on TV with TV replacement | Yes | 75 | Survived |
11 | 14/M | Fever, chest pain, RD, left leg swelling | Septic thrombophlebitis of left leg | MRSA | Blood | Antibiotics, oxygen, intercostal chest tubes | Steroids and immunosuppressive therapy | Yes | 45 | Survived |
12 | 13/M | Fever, RD, left leg swelling | Septic thrombophlebitis of left leg | NA | NA | Antibiotics, oxygen | No | Yes | 1 | died |
13 | 14/F | Fever, chest pain, RD, Back pain | L3 vertebral osteomyelitis | Klebsiella | Pleural fluid, BAL | Antibiotics, oxygen | No | Yes | 60 | Survived |
14 | 16/F | Fever, chest pain, RD,pallor | Soft tissue infection | Staph.aureus | Blood | Antibiotics, oxygen | Steroids and immunosuppressive therapy | No | 21 | Survived |
15 | 13/M | Fever, RD | Septic hip arthritis | MRSA | Blood | Antibiotics, oxygen | Drainage of joint | No | 45 | Survived |
16 | 8/M | Fever, RD, chest pain | Septic knee arthritis | MRSA | Blood | Antibiotics, oxygen, intercostal chest tubes, Decortication | Drainage of joint | Yes | 51 | Survived |
17 | 1/F | Fever, RD, Pallor | Soft tissue infection, venous- catheter infection | MRSA | Blood | Antibiotics, oxygen, intercostal chest tubes, Decortication | Drainage of skin abscess | Yes | 55 | Survived |
Microbiological results and antibiotics susceptibility
Variables | Frequency (N = 17) | Percentage % | Outcome | |||
---|---|---|---|---|---|---|
Survived (n = 15) | Died (n = 2) | |||||
Age – Mean (Range) years
| 9.4 (1–16) | |||||
Sex
| Male | 10 | 58.8% | 8 | 2 | |
Female | 7 | 41.2% | 7 | 0 | ||
Clinical manifestations
| Fever & Shortness of breath | 17 | 100% | 15 | 2 | |
Chest pain | 9 | 52.9% | 9 | 0 | ||
Pallor | 5 | 29.4% | 4 | 1 | ||
Limb swelling | 4 | 23.5% | 3 | 1 | ||
Back pain | 1 | 5.9% | 1 | 0 | ||
Septic focus
| Unknown | 1 | 5.9% | 1 | 0 | |
Septic arthritis | 5 | 29.4% | 5 | 0 | ||
Septic thrombophlebitis | 4 | 23.5% | 3 | 1 | ||
Infective endocarditis | 2 | 11.8% | 1 | 1 | ||
Central venous catheter | 1 | 5.9% | 1 | 0 | ||
L3 vertebral osteomyelitis | 1 | 5.9% | 1 | 0 | ||
Soft tissue infection | 2 | 11.8% | 2 | 0 | ||
Soft tissue infection, Central venous catheter | 1 | 5.9% | 1 | 0 | ||
Microorganism
| No growth | 2 | 11.8% | 1 | 1 | |
Staph.aureus | 5 | 29.4% | 4 | 1 | ||
MRSA | 9 | 52.9% | 9 | 0 | ||
Klebsiella pneumoniae | 1 | 5.9% | 1 | 0 | ||
Ineffective empirical antibiotics
| 11 | 64.7% | 9 | 2 | ||
Comorbid condition
| No | 13 | 76.5% | 11 | 2 | |
Inherited thrombophilia | 1 | 5.9% | 1 | 0 | ||
Chronic kidney disease | 1 | 5.9% | 1 | 0 | ||
Systemic lupus erythematosus | 2 | 11.8% | 2 | 0 | ||
Pulmonary treatment
| Antibiotic, Oxygen | 10 | 58.8% | 9 | 1 | |
Antibiotic, Oxygen, chest tube | 6 | 35.3% | 5 | 1 | ||
Antibiotic, Oxygen, chest tube, Decortication | 1 | 5.9% | 1 | 0 | ||
Extrapulmonary treatment
| No | 7 | 41.2% | 5 | 2 | |
Drainage of joint | 4 | 23.5% | 4 | 0 | ||
Drainage of joint and Pericardiocentesis | 1 | 5.9% | 1 | 0 | ||
Cardiac surgery | 1 | 5.9% | 1 | 0 | ||
Hemodialysis | 1 | 5.9% | 1 | 0 | ||
Pulse steroids | 2 | 11.8% | 2 | 0 | ||
Drainage of skin abscess | 1 | 5.9% | 1 | 0 | ||
PICU admission
| 12 | 70.5% | 10 | 2 | ||
Anticoagulants
| 12 | 70.5% | 10 | 2 | ||
Joint U/S
| Joint effusion | 6 | 35.3% | 6 | 0 | |
CT findings
| Bilateral lesions | 16 | 94.1% | 14 | 2 | |
Nodular lesions | 16 | 94.1% | 14 | 2 | ||
Cavitation | 16 | 94.1% | 14 | 2 | ||
Pleural effusion | 10 | 58.8% | 9 | 1 | ||
Pneumothorax | 7 | 41.2% | 6 | 1 | ||
Consolidation | 12 | 70.6% | 10 | 2 | ||
PCR for COVID-19
| 1 | 5.9% | 0 | 1 |
Radiological findings in SPE patients
Echocardiography findings
Duplex findings
Abdominal U/S
Joint U/S
CT chest findings
Laboratory findings
Variables | Mean (Range) | Logistic regression analysis |
---|---|---|
OR (95% CI) | ||
Laboratory investigations | ||
Hb (gm/dl) | 8.9 (5.6–12.6) | 0.80 (0.29–2.22) |
TLC (109/L) | 15.5 (2.1–25.4) | 1.01 (0.80–1.28)* |
Platelet (109/L) | 326.5 (51–973) | 1.05 ( 0.99- 1.12)* |
Lymphocytes (109/l) | 2.9 (0.9–7.2) | 16.77 ( 0.51- 553.16)* |
Platelet/ Lymphocyte ratio | 115.1 (17.5–246.2) | 1.02 (0.99- 1.05)* |
Neutrophils (109/l) | 11.6 (0.9–20.2) | 0.98 (0.76- 1.27) |
Neutrophil/ Lymphocyte ratio | 4.6 (0.8–12) | 0.59 (0.30–1.14) |
Monocytes (109/l) | 0.8 (0.1–1.8) | 0.67 (0.02–20.92) |
Monocyte/ Lymphocyte ratio | 0.3 (0.1–0.9) | 0.00 ( 0.00- 3.44) |
CRP(mg/L) | 130.7 (46–279) | 1.01 (0.98–1.04)* |
ESR 1st hr (mm) | 97.5 (54–140) | 1.02 ( 0.96–1.08)* |
Blood urea (mg/dl) | 43.9 (19–95) | 0.95 (0.88–1.01) |
Serum albumin (gm/dl) | 3.1 (2–3.6) | 6.96 (0.29- 164.47)* |
D.dimer (ug/ml) | 4.1 (0.78–10) | 0.79 (0.44–1.43) |
PT (sec) | 18.1 (14–48) | 0.84 (0.63–1.11) |