%0 Journal Article %J Am J Respir Crit Care Med %D 2015 %T Hospitalization Type and Subsequent Severe Sepsis. %A Hallie C Prescott %A Dickson, R. P. %A Mary A M Rogers %A Kenneth M. Langa %A Lwashyna, T. J. %K Aged %K Aged, 80 and over %K Anti-Bacterial Agents %K Clostridioides difficile %K Dysbiosis %K Enterocolitis, Pseudomembranous %K Female %K Hospitalization %K Humans %K Incidence %K Information Storage and Retrieval %K Longitudinal Studies %K Male %K Medicare %K Patient Readmission %K Retrospective Studies %K Risk Factors %K Sepsis %K United States %X

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.

%B Am J Respir Crit Care Med %I 192 %V 192 %P 581-8 %8 2015 Sep 01 %G eng %N 5 %1 http://www.ncbi.nlm.nih.gov/pubmed/26016947?dopt=Abstract %4 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 %$ 999999 %R 10.1164/rccm.201503-0483OC