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
JournalAm J Respir Crit Care Med
Date Published2015 Sep 01
ISSN Number1535-4970
KeywordsAged, Aged, 80 and over, Anti-Bacterial Agents, Clostridium difficile, Dysbiosis, Enterocolitis, Pseudomembranous, Female, Hospitalization, Humans, Incidence, Information Storage and Retrieval, Longitudinal Studies, Male, Medicare, Patient Readmission, Retrospective Studies, Risk Factors, Sepsis, United States

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-infection-related 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 infection-related 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.

User Guide Notes

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


Alternate JournalAm. J. Respir. Crit. Care Med.
Citation Key8260
PubMed ID26016947
PubMed Central IDPMC4595694
Grant ListT32 HL007749 / HL / NHLBI NIH HHS / United States
U01 AG009740 / AG / NIA NIH HHS / United States
R01 AG030155 / AG / NIA NIH HHS / United States
P30 AG024824 / AG / NIA NIH HHS / United States
L30 HL120241 / HL / NHLBI NIH HHS / United States