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Hospital-Onset Sepsis Twice as Deadly as Community-Onset Sepsis, Study Finds

Hospital-onset (HO) sepsis is twice as deadly as community-onset (CO) sepsis and increases the risk of death 3-fold even after controlling for comorbidities and severity of illness, according to the results of a cohort study comprising 2.3 million adult patients.

Investigators, who presented their findings at the Society of Critical Care Medicine’s 48th Critical Care Congress, analyzed electronic health record data from 136 US hospitals in the Cerner HealthFacts dataset between 2005 and 2015 and applied the US Centers for Disease Control and Prevention’s Adult Sepsis Event criteria to identify cases of sepsis.

HO sepsis accounted for 1 in 8 cases, investigators found, noting that when compared with CO sepsis patients, HO sepsis patients were younger (median age 66 vs 68), had more comorbidities (heart failure [26 vs 22%], renal disease [23 vs 20%], and cancer [17 vs 11%], for example), higher rates of intra-abdominal infections (20 vs 15%), higher Sequential Organ Failure Assessment scores at sepsis onset (median 4 vs 3), and longer hospital length-of-stay (media 19 vs 8 days).

“The simplest explanation is that patients who develop sepsis in the hospital are sicker at baseline, with more serious underlying comorbidities, severe types of infections, and organ dysfunction at the time of sepsis onset,” Chanu Rhee, MD, MPH, assistant professor of Population Medicine at Harvard Medical School’s Harvard Pilgrim Health Care Institute and lead author of the study, told Contagion®.

“However, even after adjusting for these factors, we still observed a significantly higher risk of death compared to community-onset sepsis. This suggests that other factors, such as differences in the care of these patients, may also contribute,” Dr. Rhee continued. “Other studies have suggested that there may be delays in the recognition and care of patients who develop sepsis in the hospital as opposed to presenting to the hospital with sepsis.”

Dr. Rhee, whose body of work focuses on sepsis epidemiology, diagnosis, treatment, and prevention, hopes his latest research will raise awareness of the significant burden of HO sepsis and lead to more surveillance, prevention, and quality improvement efforts.
“More research is required to understand the specific types of infections that lead to hospital-onset sepsis and their preventability,” Dr. Rhee told Contagion®. “We also need to carefully examine differences in the processes of care for patients with hospital-onset versus community-onset sepsis. If, for example, there are systematic delays in sepsis recognition and treatment in patients already in the hospital, then this points the way to targeted quality improvement efforts.” 

The study, “The epidemiology of hospital-onset sepsis using clinical data from 136 US hospital,” was presented on Sunday, February 17, 2019, at the Society of Critical Care Medicine’s 48th Critical Care Congress in San Diego, California.
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