@article {8260, title = {Hospitalization Type and Subsequent Severe Sepsis.}, journal = {Am J Respir Crit Care Med}, volume = {192}, year = {2015}, month = {2015 Sep 01}, pages = {581-8}, publisher = {192}, 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-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.

}, keywords = {Aged, Aged, 80 and over, Anti-Bacterial Agents, Clostridioides 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}, issn = {1535-4970}, doi = {10.1164/rccm.201503-0483OC}, author = {Hallie C Prescott and Dickson, R. P. and Mary A M Rogers and Kenneth M. Langa and Lwashyna, T. J.} }