SECTION A: Septicemia,Toxin-andInflammation-MediatedSyndromes PART II Clinical Syndromes and Cardinal Features of Infectious Diseases: Approach to Diagnosis and Initial Management

Arecent population-based study of United States children with severe septicemia (bacterial or fungal infection with at least one acute organ dysfunction) reported a mortality rate of 10.3%. 7 Although this represents a significant improvement over past decades, severe sepsis remains one of the leading causes of death in children, with over 4300 deaths annually (7% of all deaths among children) and estimated annual total costs of $1.97 billion. 8 In a seminal study, Watson et al. 8 analyzed the impact of age, sex, birthweight, underlying disease, and microbiologic etiology on the incidence, mortality, and hospital costs of children who develop septicemia using 1995 hospital discharge and population data from seven states. Table 11-1 shows the annual incidence, case fatality, and national estimates of severe sepsis by age. The incidence is highest in infants (5.16 per 1000), falls significantly in older children (0.20 per 1000 in 10- to 14-year-olds), and also exhibits a sex difference, being 15% higher in boys than in girls (0.60 versus 0.52 per 1000, P < 0.001). 8