Hospitalization Type and Subsequent Severe Sepsis

TitleHospitalization Type and Subsequent Severe Sepsis
Publication TypeJournal Article
Year of Publication2015
AuthorsPrescott, HC, Dickson, RP, Rogers, MAM, Langa, KM, Lwashyna, TJ
JournalAmerican Journal of Respiratory and Critical Care Medicine
Volume192
Issue5
Pagination581
KeywordsDemographics, Health Conditions and Status, Healthcare, Mortality, Other
Abstract

Rationale: Hospitalization is associated with microbiome perturbation (dysbiosis), and this perturbation is more severe in patients treated with antimicrobials. Objectives: To evaluate whether hospitalizations known to be associated with periods of microbiome perturbation are associated with increased risk of severe sepsis after hospital discharge. Methods: We studied participants in the U.S. Health and Retirement Study with linked Medicare claims (1998-2010). We measured whether three hospitalization types associated with increasing severity of probable dysbiosis (non-infection-related hospitalization, infection-related hospitalization, and hospitalization with Clostridium difficile infection CDI ) were associated with increasing risk for severe sepsis in the 90 days after hospital discharge. We used two study designs: the first was a longitudinal design with between-person comparisons and the second was a self-controlled case series design using within-person comparison. Measurements and Main Results: We identified 43,095 hospitalizations among 10,996 Health and Retirement Study-Medicare participants. In the 90 days following non-infectionrelated hospitalization, infection-related hospitalization, and hospitalization with CDI, adjusted probabilities of subsequent admission for severe sepsis were 4.1 (95 confidence interval CI , 3.8-4.4 ), 7.1 (95 CI, 6.6-7.6 ), and 10.7 (95 CI, 7.7-13.8 ), respectively. The incidence rate ratio (IRR) of severe sepsis was 3.3-fold greater during the 90 days after hospitalizations than during other observation periods. The IRR was 30 greater after an infectionrelated hospitalization versus a non-infection-related hospitalization. The IRR was 70 greater after a hospitalization with CDI than an infection-related hospitalization without CDI. Conclusions: There is a strong dose-response relationship between events known to result in dysbiosis and subsequent severe sepsis hospitalization that is not present for rehospitalization for nonsepsis diagnoses.

DOI10.1164/rccm.201503-0483OC
Endnote Keywords

humans/microbiota/self-controlled case series/patient readmission/dysbiosis/CLOSTRIDIUM-DIFFICILE INFECTION/RESPIRATORY SYSTEM/COMMUNITY/PNEUMONIA/CRITICAL CARE MEDICINE/METAANALYSIS/INTESTINAL MICROBIOTA/GUT MICROBIOTA/ANTIBIOTIC-TREATMENT/DISEASE/PREMATURE-INFANTS/FECAL MICROBIOTA TRANSPLANTATION/Enterocolitis, Pseudomembranous - epidemiology/Dysbiosis - epidemiology/Sepsis - epidemiology/Anti-Bacterial Agents - therapeutic use/Hospitalization - statistics/numerical data/Patient Readmission - statistics/numerical data

Endnote ID

999999

Citation Key8260
PubMed ID26016947
PubMed Central IDPMC4595694