September 11, 2019
Individuals with hospital-onset sepsis have a 2-fold higher risk of mortality compared with those who have community-onset sepsis, according to a new analysis.
To reach this conclusion, the researchers analyzed electronic clinical data on 2,216,032 hospitalizations of patients aged 20 years or older who had been admitted at any one of 136 US hospitals from January 2009 to September 2015.
The researchers used the Centers for Disease Control and Prevention Adult Sepsis Event criteria to identify sepsis cases among these hospitalizations. In turn, cases that had clinical indicators of “presumed serious infection” and “concurrent organ dysfunction” were included.
The researchers identified 95,154 sepsis cases. Of these, 83,620 (87.9%) were cases of community-onset sepsis and 11,534 (12.1%) were cases of hospital-onset sepsis.
Hospital-onset sepsis complicated 1 in 200 hospitalizations. Patients who experienced the complication had higher in-hospital mortality (33%) compared with patients with community-onset sepsis (17%).
While patients with hospital-onset sepsis were more likely to have more comorbidities, higher Sequential Organ Failure Assessment scores, higher intensive care unit admission rates, and longer lengths of stay in the hospital, these patients were still twice as likely to die than those with community-onset sepsis, even after the researchers adjusted for risk.
If a patient were admitted to the hospital without sepsis but developed hospital-onset sepsis, he or she had triple the risk of mortality.
“These findings underscore the importance of targeting hospital-onset sepsis with surveillance, prevention, and quality improvement efforts,” the researchers concluded.
Rhee C, Wang R, Zhang Z, Fram D, Kadri SS, Klompas M; CDC Prevention Epicenters Program. Epidemiology of hospital-onset versus community-onset sepsis in U.S. hospitals and association with mortality: a retrospective analysis using electronic clinical data. Crit Care Med. 2019;47(9):1169-1176. doi:10.1097/CCM.0000000000003817.