Sepsis hysteria? Not for children – Authors' reply

Thankfully, paediatric sepsis trials in high-income countries have not used mortality as the primary endpoint for many years, citing “affordability”.2 A point-prevalence study of 6925 children across 128 paediatric intensive care units in 26 countries identified 569 children who fulfilled sepsis criteria.3 Of these patients, 439 children (77%) had one or more comorbid conditions that could independently limit survival, including solid organ or stem-cell transplants, malignancy, renal disease, and haematological or immunological conditions. The authors estimated that an intervention trial would take 3 years for 2118 patients to be enrolled from 58 paediatric intensive care units for 80% power to detect a 5% absolute risk reduction in mortality. With respect to low-income and middle-income countries, paediatric mortality rates are indeed higher than in high-income countries; however, what is the true incidence, and in what proportion could antibacterial therapy be potentially life-saving?