No published reports have stratified pediatric patients with systemic infections according to the new sepsis terminology guidelines. In addition little is known about the outcome of sepsis in developing countries. This large 12-year retrospective study evaluated the outcome of 815 infants and children with sepsis managed in a Latin American pediatric intensive care unit. Of these children 171 (21%) had sepsis, 497 (61%) had severe sepsis and 147 (18%) had septic shock. Multiorgan dysfunction was present in 120 (24%) and 77 (52%) patients with severe sepsis and septic shock, respectively. Infection was bacteriologically proved in 212 (26%) cases, with Staphylococcus aureus and Neisseria meningitidis being the most frequent responsible organisms. Three hundred nineteen (39%) patients died. Case-fatality rates were higher in patients with septic shock, multiorgan dysfunction, sepsis caused by Pseudomonas aeruginosa and meningococcemia than in those without these conditions. Although no difference in mortality was detected between culture-proved and culture-negative sepsis, more patients receiving an inappropriate antimicrobial agent died than those treated with an appropriate drug (53% vs. 34%, P = 0.012). We believe that with the use of the new terminology system a more reliable comparison of data from pediatric sepsis studies and of emerging immunomodulating therapeutic modalities can be achieved.