Care delivery related to sepsis in a SARS-CoV-2 pediatric intensive care unit

ABSTRACT

INTRODUCTION: Caring for critically ill children with known or suspected severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections requires significant changes to usual pediatric intensive care unit operations related to infection control policies and frequent evolution of clinical care practice. We hypothesized that patients with known or suspected SARS-CoV-2 would more often experience delays in timely antibiotic administration. METHODS: We performed a retrospective cohort study including all children with suspected sepsis admitted to our tertiary PICU from March 16 through June 18, 2020. Suspected sepsis was defined by an order for a broadspectrum antibiotic and blood culture. Children with known or suspected SARS-CoV-2 were defined by admission to the Pediatric Special Treatment Unit (PSTU), an isolation unit within the PICU dedicated to care of SARS-CoV-2 patients. The primary outcome of median time to antibiotic administration was compared using the Mann-Whitney-U test. Secondary outcomes included the proportion of antibiotics administered within 1 hour of the order and sepsis pathway utilization. Fisher's exact test was used for comparison of secondary outcomes. RESULTS: A total of 155 sepsis episodes were evaluated, including 14 with known/suspected SARS-CoV-2 and 141 with non-SARS-CoV-2 sepsis. Median time to antibiotic administration was 70.5 minutes in known/suspected SARSCoV- 2 versus 103 minutes in non-SARS-CoV-2 sepsis (NS). Secondary outcomes were also not different between groups. Known/suspected SARS-CoV-2 patients received 36% of new antibiotics within 60 minutes as compared to 46% of non-SARS-CoV-2 patients. Pathway utilization was 29% in known/suspected SARS-CoV-2 and 23% in non-SARSCoV- 2 patients. CONCLUSIONS: Despite significant operational changes enacted to care for SARS-CoV-2 patients, time to antibiotic administration and utilization of the sepsis pathway were no different than in non-SARS-CoV-2 patients with suspected sepsis. Operational challenges may have been overcome by a staffing model that emphasized attending physicians as well as a higher nurse to patient ratio for this population.