Infections in a Children's Hospital Autopsy Population
Jeffery Springer, Randall Craver. Louisiana State University Health Science Center, New Orleans, LA
Background: Despite advances in antimicrobial therapy, infections/inflammatory lesions may frequently cause or contribute to death in children.
Design: We retrospectively reviewed all autopsies performed at a children's hospital from 1986-2009 and categorized infectious complications as 1)underlying cause of death,2) mechanism of death complicating another underlying cause of death,3)contributing to death 4) agonal or infections immediately before death 5) incidental. Infectious complications were then separated into 3-8 year groups to identify trends over the years.
Results: There were 1369 deaths over 24 years, 608 (44%) underwent autopsy at the hospital, another 122 (8.9%) were coroner's cases not performed at the hospital. There were 691 infectious conditions in 401 children (66%, 1.72 infections/infected patient).There were no differences in the percentage of autopsies with infections over the years, although the number of total infections decreased in the last 8 year period. The number of infections /patient varied over the different time groups. By categories, there were 85 (12.3%), 237(34.3%), 231 (33.4%), 82 (11.9%), and 56(8.1%) infections. The distribution remained similar over the time groups, with the exception of more category 2 and less category 3 infections in 2002-2009 compared to 1994-2001.Leading infectious diseases/complications include bronchopneumonia (188), sepsis (144),acute meningitis (35), pneumonitis (33- including 19 with specific viral agents identified),peritonitis (29), tracheobronchitis (24), necrotizing enterocolitis (19), gastritis (15) disseminated Candida (15), and lymphocytic myocarditis (14). Sepsis was significantly less frequent (p=.0041) in 2002-2009 compared with earlier periods. 159 agents of sepsis in 144 patients included 67 Gram positive cocci, 70 Gram negative rods, 7 other, 15 clinical. Enterococcus was the most common(22). Bacterial meningitis was significantly more frequent in the first time period (p=.0061) compared to the later periods. Strep. pneumoniae was the overall most frequent cause(10).
Conclusions: 66% of pediatric autopsies at a Children's Hospital had an inflammatory lesion, and was stable over the time studied. Most are the mechanism of death or a significant contributing factor, rather than the underlying cause of death. The decrease in meningitis after the 1986-1993 period may be partially attributed to the H. flu vaccine. The decline in deaths with sepsis may be due to increased awareness, education, and standardization of treatment in the institution for recognition and treatment of septic shock.
Tuesday, March 5, 2013 1:00 PM
Poster Session IV # 282, Tuesday Afternoon