Community-, healthcare-, and hospital-acquired severe sepsis hospitalizations in the University HealthSystem Consortium.
Open accessAbstract
OBJECTIVES: Severe sepsis poses a major burden on the U.S. healthcare system. Previous epidemiologic studies have not differentiated community-acquired severe sepsis from healthcare-associated severe sepsis or hospital-acquired severe sepsis hospitalizations. We sought to compare and contrast community-acquired severe sepsis, healthcare-associated severe sepsis, and hospital-acquired severe sepsis hospitalizations in a national hospital sample. DESIGN: Retrospective analysis of severe sepsis discharges from University HealthSystem Consortium hospitals in 2012. SETTING: United States. PATIENTS: We used the criteria from Angus et al (discharge diagnoses for both a serious infection and organ dysfunction) to identify severe sepsis hospitalizations. We defined healthcare-associated severe sepsis as severe sepsis hospitalizations with an infection present at admission, where the patient was a nursing home resident, was on hemodialysis, or was readmitted within 30 days of a prior hospitalization. We defined community-acquired severe sepsis as all other severe sepsis patients with an infection present at admission. We defined hospital-acquired severe sepsis as severe sepsis patients where the documented infection was not present at admission. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Prevalence of community-acquired severe sepsis, healthcare-associated severe sepsis, and hospital-acquired severe sepsis, adjusted hospital mortality, length of hospitalization, length of stay in an ICU, and hospital costs. Among 3,355,753 hospital discharges, there were 307,491 with severe sepsis, including 193,081 (62.8%) community-acquired severe sepsis, 79,581 (25.9%) healthcare-associated severe sepsis, and 34,829 (11.3%) hospital-acquired severe sepsis. Hospital-acquired severe sepsis and healthcare-associated severe sepsis exhibited higher in-hospital mortality than community-acquired severe sepsis (hospital acquired [19.2%] vs healthcare associated [12.8%] vs community acquired [8.6%]). Hospital-acquired severe sepsis had greater resource utilization than both healthcare-associated severe sepsis and community-acquired severe sepsis, with higher median length of hospital stay (hospital acquired [17 d] vs healthcare associated [7 d] vs community acquired [6 d]), median length of ICU stay (hospital acquired [8 d] vs healthcare associated [3 d] vs community acquired [3 d]), and median hospital costs (hospital acquired [$38,369] vs healthcare associated [$8,796] vs community acquired [$7,024]). CONCLUSIONS: In this series, severe sepsis hospitalizations included community-acquired severe sepsis (62.8%), healthcare-associated severe sepsis (25.9%), and hospital-acquired severe sepsis (11.3%) cases. Hospital-acquired severe sepsis was associated with both higher mortality and resource utilization than community-acquired severe sepsis and healthcare-associated severe sepsis.
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Hospital-onset sepsis is more clinically complex and harder to predict than community-acquired sepsis.
“prior research suggesting that hospital-onset sepsis is more clinically complex and harder to predict than community-acquired sepsis.23,24”
From Multicenter Prospective Validation of an Updated Proprietary Sepsis Prediction Model (2026) · cites this paper as [24]
The Discussion (page unavailable) says hospital-acquired and community-acquired severe sepsis likely differ in clinical presentation and may require different detection strategies; it also notes that inpatient wards often lack frequent monitoring. This supports a distinction in detection challenges, but the paper does not establish that hospital-onset sepsis is more clinically complex or harder to predict than community-acquired sepsis. (LLM, conf=0.84)
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Enhancing Recovery From Sepsis: A Review
Prescott, H. C., & Angus, D. C. (2018) · JAMA · doi:10.1001/jama.2017.17687 · Cited by 1,059 · see citing works
Rhee, C., Wang, R., Zhang, Z., Fram, D., Kadri, S. S., & Klompas, M. (2019) · Critical Care Medicine · doi:10.1097/ccm.0000000000003817 · Cited by 122 · see citing works
Multicenter Prospective Validation of an Updated Proprietary Sepsis Prediction Model
Wong, A., Currey, D., Schwinne, M., Park-Egan, B., Meyer, S., Gutting, A., Cao, J., Khan, S., Dantes, R., Pan, T., et al. (2026) · JAMA Network Open · doi:10.1001/jamanetworkopen.2026.0181 · Cited by 21 · see citing works
- Authors
- Page, D. B., Donnelly, J. P., & Wang, H. E.
- Affiliations
- University of Alabama (US)
- University of Alabama at Birmingham (US)
- Venue
- Critical Care Medicine
- Published
- 2015-09
- Volume
- 43
- Issue
- 9
- Pages
- 1945-1951
- ISSN
- 0090-3493 (ISSN-L)
- PMC
- PMC4537676
- OpenAlex
- W2317609637
- Cited by
- 157
- References
- 2
- Citations by year
- 2026: 3 · 2025: 11 · 2024: 15 · 2023: 9 · 2022: 25 · 2021: 30 · 2020: 14 · 2019: 17 · 2018: 15 · 2017: 10 · 2016: 8
- FWCI
- 8.63
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Critical Care Medicine (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- Agency for Healthcare Research and Quality (T32HS013852, HS013852)
- National Institute of Nursing Research (R01NR012726)
- Topics
- Health Sciences › Medicine › Epidemiology › Sepsis Diagnosis and Treatment
- Health Sciences › Medicine › Critical Care and Intensive Care Medicine › Nosocomial Infections in ICU
- Health Sciences › Medicine › Infectious Diseases › Infection Control in Healthcare
- Keywords
- severe sepsis, community-acquired sepsis, hospital-acquired sepsis, in-hospital mortality, length of hospital stay, ICU length of stay, hospital costs, resource utilization (health care), sepsis epidemiology, University HealthSystem Consortium, nursing home residents, hemodialysis, hospital readmission, organ dysfunction, serious infections
- MeSH terms
- Aged, Aged, 80 and over, Cross Infection, Female, Homes for the Aged, Hospitals, Humans, Intensive Care Units, Male, Middle Aged, Nursing Homes, Retrospective Studies, United States, Prevalence, Hospital Mortality, Community-Acquired Infections, Sepsis
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