(897) Pediatric Sepsis and Impact of Supportive Care Therapies in Bamako, Mali

Introduction: The burden of pediatric sepsis is high in low and middle-income countries. Clinical management may be suboptimal, and there is conflicting evidence on the effectiveness of common treatments like fluid resuscitation and oxygen therapy. L’Hopital Gabriel Touré (HGT) is the primary pediatric hospital in Bamako, the capital of Mali. We conducted a prospective, observational study among infants and young children presenting to the Emergency Department at HGT with Systemic Inflammatory Response Syndrome (SIRS) to determine whether supportive therapies (antibiotics, intravenous fluids [IVF] and supplemental oxygen) are associated with lower odds of in-hospital mortality.

Methods: Eligible children were aged ≤5 years and met study criteria for SIRS at HGT (≥2 SIRS criteria with suspected bacterial infection). Standardized case report forms were used to record therapy received, anthropometry, clinical signs of severe sepsis, malaria smear result, pathogen isolated from blood or body fluid, clinical diagnosis, and vital status at discharge for each patient. A multivariable logistic regression model was used to analyze associations between supportive therapies received at HGT and in-hospital death.

Results: Among 22,297 children aged ≤5 years screened between January 2021 and June 2023, 1,212 patients with study-defined SIRS were enrolled, of which 385 (31.8%) died at HGT. Most patients received antibiotics (86.1%) and IVF (60.2%) while fewer patients received oxygen therapy (29.0%). Neither antibiotics nor IVF significantly impacted mortality (antibiotics adjusted OR [aOR]: 1.23, 95% CI: 0.77, 1.93; IVF aOR: 1.17, 95% CI: 0.87, 1.59). Supplemental oxygen use increased odds of death (aOR: 2.71, 95% CI: 1.85, 3.95), even when limited to patients with oxygen saturation < 90%, dyspnea, and/or chest indrawing (aOR: 3.27, 95% CI: 1.72, 6.24).

Conclusions: Nearly 1 in 3 Malian infants and children admitted with study-defined SIRS do not survive their hospitalization despite receiving antibiotics, IVF, and supplemental oxygen. Further investigation is needed to determine the impact of more aggressive, timely therapy in low resource settings, such as accelerated triage and transport, availability of reliable ventilatory support, and algorithms for antibiotic selection based on local susceptibility patterns.