Curr Opin Infect Dis. 2019 Oct;32(5):497-504. doi: 10.1097/QCO.0000000000000583.
Sepsis remains among the leading causes of childhood mortality worldwide. This review serves to highlight key areas of knowledge gain and ongoing controversies pertinent to sepsis in children.
Several recent publications describe the epidemiology of paediatric sepsis, demonstrating the impact on child health in terms of mortality and morbidity, and the shortcomings of current paediatric sepsis definitions. Although emerging data support the importance of organ dysfunction as a hallmark of paediatric sepsis, the understanding of host susceptibility to sepsis and to sepsis severity remains very limited. Next-generation sequencing and host transcriptomics have the potential to provide new insights into the pathogenesis of sepsis and may enable personalized medicine approaches. Despite good observational data indicating benefit of sepsis recognition and treatment bundles, the evidence for the individual bundle components remains scarce, implying an urgent need for large trials.
Recent studies have demonstrated distinct epidemiological patterns pertinent to age groups, healthcare settings, and comorbidities in the era post meningococcal epidemics. Although sepsis quality improvement initiatives have led to substantial outcome improvements, there is urgency for innovative trials to reduce uncertainty around the optimal approach for the recognition and treatment of sepsis in children.
败血症仍然是全球儿童死亡的主要原因之一。本篇综述旨在强调与儿童败血症相关的知识增长和持续存在的争议的关键领域。
最近的几项出版物描述了儿科败血症的流行病学，展示了其对儿童健康的影响，包括死亡率和发病率，以及当前儿科败血症定义的不足。尽管新出现的数据支持器官功能障碍作为儿科败血症的标志的重要性，但对宿主易感性和败血症严重程度的理解仍然非常有限。下一代测序和宿主转录组学有可能为败血症的发病机制提供新的见解，并可能实现个体化医学方法。尽管有良好的观察数据表明败血症识别和治疗包的益处，但个别治疗包成分的证据仍然很少，这意味着迫切需要进行大型试验。
最近的研究表明，在后脑膜炎球菌流行时代，与年龄组、医疗保健环境和合并症相关的败血症具有明显的流行病学模式。尽管败血症质量改进举措导致了显著的结局改善，但仍迫切需要创新性试验来减少对儿童败血症识别和治疗最佳方法的不确定性。
