Sepsis in Paediatrics Quiz

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Which statement best defines sepsis?

A A systemic inflammatory response to infection, defined by abnormal temperature, heart rate, respiratory rate and white cell count
B The presence of bacteria in the bloodstream causing fever and tachycardia
C Multiple organ dysfunction caused directly by bacterial toxins, without a dysregulated host response
D A life-threatening organ dysfunction caused by a dysregulated host response to infection ✓
E A clinical syndrome of infection with hypotension requiring vasopressors to maintain organ perfusion

The answer is D: A life-threatening organ dysfunction caused by a dysregulated host response to infection

Explanation

Why D is correct

See The Definition of Sepsis. Option D is correct. Sepsis has three linked parts: an infection, a dysregulated host response and life-threatening organ dysfunction. Dysregulated host response means that the body's defence against the infection becomes unbalanced and starts to injure the body's own organs, including organs away from the site of infection. Organ dysfunction means that an organ, such as the brain, lungs or circulation, is no longer doing its job properly. The definition has changed over time. Older criteria used the systemic inflammatory response syndrome (SIRS: abnormal temperature, heart rate, breathing rate or white cell count) together with infection. These features are now regarded as historical inflammatory indicators rather than the definition, and the 2024 Phoenix consensus defines paediatric sepsis as suspected infection with organ dysfunction (a Phoenix Sepsis Score of at least 2). The older term severe sepsis is now redundant, because sepsis already means organ dysfunction. Think of sepsis as the point at which the body's response to a germ becomes more dangerous than the germ itself.

Definition: sepsis is life-threatening organ dysfunction caused by a dysregulated host response to infection
Three parts: an infection, a dysregulated host response and organ dysfunction
Older ideas: systemic inflammatory response syndrome features are now historical indicators, and severe sepsis is a redundant term

Why the other options are incorrect

A. A systemic inflammatory response to infection, defined by abnormal temperature, heart rate, respiratory rate and white cell count: This describes the systemic inflammatory response syndrome with infection, which are older inflammatory criteria; without organ dysfunction it does not meet the current definition of sepsis.
B. The presence of bacteria in the bloodstream causing fever and tachycardia: This describes bacteraemia with its general effects. Bacteria in the blood can be present without organ dysfunction, and a positive blood culture is not needed for the diagnosis of sepsis.
C. Multiple organ dysfunction caused directly by bacterial toxins, without a dysregulated host response: This describes direct bacterial toxicity, but sepsis is defined by a dysregulated host response to infection rather than the direct action of bacterial toxins.
E. A clinical syndrome of infection with hypotension requiring vasopressors to maintain organ perfusion: This describes septic shock, which is a more severe subset of sepsis; sepsis requires organ dysfunction but can occur without hypotension requiring vasopressors, so this option is too narrow.

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1
Which feature is considered a late and particularly serious sign of sepsis in a young child?
2
A 4-year-old child presents to the emergency department with fever, tachycardia and delayed capillary refill. Sepsis is suspected and the child is shocked. Which option best reflects the Paediatric SEPSIS 6 that should be started promptly?

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