Characterizing infections in children after out-of-hospital cardiac arrest.

Abstract

Infections may contribute to the morbidity and mortality associated with pediatric out-of-hospital cardiac arrest (OHCA). The objectives of this study are to (1) estimate the prevalence of infections following pediatric OHCA and (2) explore the association between bacterial infections, clinical characteristics and outcomes. Single-center, retrospective cohort study including children <18 years old admitted to the PICU within 6 h after OHCA between 2017 and 2022. Children were classified as having "definite or probable" or "possible or no" bacterial infections recognized within 48 h of admission using standardized criteria. Clinical characteristics and outcomes were compared between groups using logistic regression. Of 203 included children, 40 (20%) had a "definite or probable" bacterial infection. Children with definite or probable bacterial infections had longer median CPR duration (24 versus 10 min, p < 0.001) and lower rates of survival to hospital discharge (33% versus 70%, p < 0.01) compared to those with possible or no bacterial infection. In a multivariable logistic regression model adjusted for age, CPR duration and baseline respiratory support, definite or probable bacterial infection was associated with lower odds of survival to hospital discharge (aOR 0.39, 95% CI 0.15-1.00, P = 0.05) and ICU discharge (aOR 0.38, 95% CI 0.15-0.98, P = 0.046), though the upper bound of the 95% confidence interval crossed 1 for some analyses. Bacterial infections were commonly identified in the first 48 h of admission after OHCA and may be associated with worse clinical outcomes. Future work should investigate how management of OHCA-associated bacterial infections may improve post-arrest outcomes.