959. Importance of Toxic Shock Syndrome in Pediatric Septic Shock Clinical Decision-Making
Session: Oral Abstract Session: Pediatric Epidemiology: Outbreaks and Surveillance
Friday, October 28, 2016: 11:45 AM
Room: 288-290

Background: Rapid recognition and appropriate therapy for pediatric septic shock is essential.  However, conventional treatment approaches may not provide optimal management if the underlying cause is staphylococcal or streptococcal toxic shock syndrome (TSS).  To determine the contribution of toxic shock syndrome to the overall burden of pediatric septic shock and document the clinical and demographic characteristics of pediatric TSS in the US, we analyzed all cases of pediatric septic shock reported to the Pediatric Health Information Systems (PHIS) database between 2009 and 2013.

Methods: The study population comprised inpatients 1 to 18 years of age at 34 PHIS hospitals.  ICD-9 codes were used to define the cohort of patients with septic shock, and identify cases and possible cases of staphylococcal and streptococcal TSS. 

Results: Over the 5 year period, 8,226 cases of pediatric septic shock were identified, of which 909 (11.1%) were specifically classified as TSS and an additional 562 (6.8%) were possible TSS cases. Staphylococcal TSS was more common (83% of TSS) than streptococcal TSS (17%). Though staphylococcal TSS occurred more commonly in females (69%) and at an older age (median 14 years) than non-TSS septic shock (49% female; 9 years), many cases occurred in males and younger children as well.  Compared to non-TSS septic shock, TSS was present more often at the time of admission, associated with significantly lower fatality rate and disease severity, and shorter length of stay.  Treatment for TSS included significantly greater use of clindamycin, vancomycin and IVIG, with less use of vasopressors.

Conclusion: TSS contributes significantly to the burden of pediatric septic shock in the US, emphasizing the importance of including TSS in septic shock treatment protocols.  While certain well established risk factors for TSS such as older age and female gender were reconfirmed in our dataset, we also note a significant number of cases in other demographics, suggesting that the diagnosis of TSS should be entertained in all children presenting with septic shock – and in particular in patients with a potential focus of staphylococcal or streptococcal infection (including menstruation and tampon use), scarletiniform rash, or strawberry tongue.


James Gaensbauer, MD, MScPH, Pediatric Infectious Disease, Children's Hospital Colorado/University of Colorado School of Medicine, Aurora, CO; Pediatric Infectious Disease, Denver Health and Hospital Authority, Denver, CO, Meghan Birkholz, MSPH, Epidemiology, Children's Hospital of Colorado, Aurora, CO, Michael Smit, MD, MSPH, Pediatric Infectious Diseases, Hasbro Children's Hospital, Providence, RI, Rogelio Garcia-Jacques, MD, Pediatric Intensive Care, Denver Health Hospital Authority, Denver, CO and James Todd, MD, FIDSA, Epidemiology, Children's Hospital Colorado, Aurora, CO


J. Gaensbauer, None

M. Birkholz, None

M. Smit, None

R. Garcia-Jacques, None

J. Todd, None

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