A contemporary overview of severe community-acquired bacterial infections in pediatric intensive care units.

Abstract

Background: Community-acquired bacterial infections (CABIs) remain a leading cause of pediatric morbidity and mortality. This study aimed to provide a contemporary description of pediatric CABIs requiring admission to pediatric intensive care units (PICUs) in France.

Methods: The CAPRICE study is a prospective, multicenter cohort including all children with suspected CABIs who were admitted to 28 French PICUs from January to December 2024. Demographic, clinical, microbiologic, and outcome data were prospectively collected. The primary outcome was mortality at day 28 and secondary outcomes included sequelae at day 28, PICU length of stay, and total hospital stay. Independent predictors of mortality were identified by multivariable logistic regression.

Results: Among 897 children, the median age was 1.9 years (IQR 0.2-8.8); 55% were male, and 30% had a chronic condition. The leading infections were lower respiratory tract infection (43%), meningitis (20%), and ear-nose-throat infections (13%). Septic shock occurred in 17% of cases. A pathogen was identified in 89% of cases: Bordetella pertussis (22%) and Mycoplasma pneumoniae (15%) were predominant, followed by Streptococcus pneumoniae (13%), and Staphylococcus aureus (11%). In all, 34% patients had viral co-infection and 70% required organ support. Overall mortality was 7%, increasing to 19% with septic shock. Independent predictors of death included multiple organ failure, meningitis, and B. pertussis infection. Sequelae occurred in 15% of survivors.

Conclusions: Severe CABIs in French PICUs in 2024 were mainly caused by B. pertussis and M. pneumoniae, followed by S. pneumoniae and S. aureus. Mortality and morbidity of these infections remain substantial.