Risk of subsequent sepsis within 90 days after a hospital stay by type of antibiotic exposure.
Abstract
BACKGROUND: We examined the risk of sepsis within 90 days after discharge from a previous hospital stay by type of antibiotic received during the previous stay. METHODS: We retrospectively identified a cohort of hospitalized patients from the Truven Health MarketScan Hospital Drug Database. We examined the association between the use of certain antibiotics, determined a priori, during the initial hospital stay and risk of post-discharge sepsis controlling for potential confounding factors in a multivariable logistic regression model. Our primary exposure was receipt of antibiotics more strongly associated with clinically important microbiome disruption. Our primary outcome was a hospital stay within 90 days of the index stay that included an ICD-9-CM discharge diagnosis of severe sepsis (995.92) or septic shock (785.52). RESULTS: Among 516 hospitals, we randomly selected a single stay for eligible patients. Of those, 0.17% developed severe sepsis/septic shock within 90 days after discharge. The risk of sepsis associated with exposure to our high risk antibiotics was 65% higher compared to those without antibiotic exposure. CONCLUSIONS: Our study identified an increased risk of sepsis within 90 days of discharge among patients with exposure to high risk or increased quantities of antibiotics during hospitalization. Given a significant proportion of inpatient antimicrobial use may be unnecessary, this study builds on previous evidence suggesting that increased stewardship efforts in hospitals may not only prevent antimicrobial resistance, CDI and other adverse effects, but also reduce unwanted outcomes potentially related to disruption of the microbiota, including sepsis.
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Potential harms of unnecessary antimicrobials include allergic or hypersensitivity reactions, kidney injury, thrombocytopenia, Clostridioides difficile infection, and antimicrobial resistance.
“These include a range of adverse events such as allergic or hypersensitivity reactions, kidney injury, thrombocytopenia, Clostridioides difficile infection, and antimicrobial resistance [101–106].”
From Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021 (2021) · cites this paper as [101]
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- Authors
- Baggs, J., Jernigan, J. A., Halpin, A. L., Epstein, L., Hatfield, K. M., & McDonald, L. C.
- Affiliations
- Centers for Disease Control and Prevention (US)
- Corresponding author
- Baggs, James
- ORCID
- Venue
- Clinical Infectious Diseases
- Publisher
- Oxford University Press (OUP)
- Published
- 2017-11-09
- Volume
- 66
- Issue
- 7
- Pages
- 1004-1012
- ISSN
- 1058-4838 (ISSN-L)
- 1537-6591
- PMC
- PMC7909479
- OpenAlex
- W2777682558
- Cited by
- 190
- References
- 43
- Citations by year
- 2026: 14 · 2025: 27 · 2024: 27 · 2023: 31 · 2022: 26 · 2021: 20 · 2020: 24 · 2019: 11 · 2018: 10
- FWCI
- 9.33
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Clinical Infectious Diseases (publishedVersion, public-domain)
- PubMed (publishedVersion)
- Funders
- National Institutes of Health (CC999999)
- Topics
- Life Sciences › Immunology and Microbiology › Applied Microbiology and Biotechnology › Antibiotic Use and Resistance
- Health Sciences › Medicine › Epidemiology › Sepsis Diagnosis and Treatment
- Health Sciences › Medicine › Oncology › Neutropenia and Cancer Infections
- Keywords
- sepsis, septic shock, antibiotic exposure, antimicrobial stewardship, microbiome disruption, hospital readmission, Clostridium difficile infection, antimicrobial resistance
- MeSH terms
- Gastrointestinal Microbiome, Adolescent, Adult, Aged, Aged, 80 and over, Anti-Bacterial Agents, Cross Infection, Female, Hospitalization, Humans, Length of Stay, Male, Middle Aged, Patient Discharge, Retrospective Studies, Risk Factors, Severity of Illness Index, Shock, Septic, United States, Sepsis, Young Adult
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