Abstract Objective There is an amelioration in mortality rates of septic shock patients with malignancies over time, but it remains uncertain in children. Therefore, the authors endeavored to compare the clinical characteristics, treatment needs, and outcomes of septic shock children with or without malignancies. Methods The authors retrospectively analyzed the data of children admitted to the PICU due to septic shock from January 2015 to December 2022 in a tertiary pediatric hospital. The main outcome was in-hospital mortality. Results A total of 508 patients were enrolled. The proportion of Gram-negative bacteria and fungal infections in children with malignancies was significantly higher than those without malignancies. Septic shock children with malignancies had a longer length of stay (LOS) in the hospital (21 vs. 11 days, p<0.001). However, there were no statistically significant differences in the LOS of PICU (5 vs. 5 days, p = 0.591), in-hospital mortality (43.0 % vs. 49.4 %, p = 0.276), and 28-day mortality (49.2 % vs. 44.7 %, p = 0.452). The 28-day survival analysis (p = 0.314) also showed no significant differences. Conclusion Although there are significant differences in the bacterial spectrum of infections, the septic shock children with or without malignancies showed a similar mortality rate. The septic shock children with malignancies had longer LOS of the hospital. time Therefore characteristics needs 201 202 inhospital 50 enrolled Gramnegative Gram negative (LOS 21 (2 vs 1 days p<0.001. p0001 p<0.001 . 0 001 p<0.001) However ( 0.591, 0591 0.591 , 591 0.591) 43.0 430 43 (43. 494 49 4 49. 0.276, 0276 0.276 276 0.276) 28day day 28 49.2 492 2 (49. 447 44 7 44. 0.452. 0452 0.452 452 0.452) 0.314 0314 314 rate 20 p000 p<0.00 00 059 0.59 59 43. (43 027 0.27 27 (49 045 0.45 45 0.31 031 31 p00 p<0.0 05 0.5 (4 02 0.2 04 0.4 0.3 03 3 p0 p<0. 0. p<0 p<