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Cited by 122Sepsis Diagnosis and TreatmentInfection Control in HealthcareNosocomial Infections in ICU

Epidemiology of hospital-onset versus community-onset sepsis in U.S. hospitals and association with mortality: a retrospective analysis using electronic clinical data.

Open access
Rhee, Chanu, Wang, Rui, Zhang, Zilu, Fram, David, Kadri, Sameer S., Klompas, Michael·2019·Critical Care Medicine
DOI 10.1097/ccm.0000000000003817PMC PMC6697188
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Abstract

Objectives: Prior studies have reported that hospital-onset sepsis is associated with higher mortality rates than community-onset sepsis. Most studies, however, have used inconsistent case-finding methods and applied limited risk-adjustment for potential confounders. We used consistent sepsis criteria and detailed electronic clinical data to elucidate the epidemiology and mortality associated with hospital-onset sepsis. Design: Retrospective cohort study. Setting: 136 U.S. hospitals in the Cerner HealthFacts dataset. Patients: Adults hospitalized in 2009–2015. Interventions: None. Measurements and Main Results: We identified sepsis using Centers for Disease Control and Prevention Adult Sepsis Event criteria and estimated the risk of in-hospital death for hospital-onset sepsis versus community-onset sepsis using logistic regression models. In patients admitted without community-onset sepsis, we estimated risk of death associated with hospital-onset sepsis using Cox regression models with sepsis as a time-varying covariate. Models were adjusted for baseline characteristics and severity of illness. Among 2.2 million hospitalizations, there were 95,154 sepsis cases: 83,620 (87.9%) community-onset sepsis and 11,534 (12.1%) hospital-onset sepsis (0.5% of hospitalized cohort). Compared to community-onset sepsis, hospital-onset sepsis patients were younger (median 66 vs 68 yr) but had more comorbidities (median Elixhauser score 14 vs 11), higher Sequential Organ Failure Assessment scores (median 4 vs 3), higher ICU admission rates (61% vs 44%), longer hospital length of stay (median 19 vs 8 d), and higher in-hospital mortality (33% vs 17%) ( p < 0.001 for all comparisons). On multivariate analysis, hospital-onset sepsis was associated with higher mortality versus community-onset sepsis (odds ratio, 2.1; 95% CI, 2.0–2.2) and patients admitted without sepsis (hazard ratio, 3.0; 95% CI, 2.9–3.2). Conclusions: Hospital-onset sepsis complicated one in 200 hospitalizations and accounted for one in eight sepsis cases, with one in three patients dying in-hospital. Hospital-onset sepsis preferentially afflicted ill patients but even after risk-adjustment, they were twice as likely to die as community-onset sepsis patients; in patients admitted without sepsis, hospital-onset sepsis tripled the risk of death. Hospital-onset sepsis is an important target for surveillance, prevention, and quality improvement initiatives.

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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 [23]

    The Results (Patient Characteristics; page not provided) show that hospital-onset sepsis patients had more comorbidities and higher SOFA scores, supporting the description of greater clinical complexity. The Discussion (page not provided) suggests hospital-onset sepsis may be slower to recognize, but it does not establish that it is harder to predict. The paper also distinguishes community-onset sepsis from infections necessarily acquired in the community. (LLM, conf=0.87)

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1 of the 37 references couldn’t be matched to a known paper.

Research works printed but not linked: 1

  1. [26]Rhee C, Zhang Z, Kadri SS: Sepsis Surveillance Using Adult Sepsis Events Simplified eSOFA Criteria Versus Sepsis-3 SOFA Criteria. Crit Care Med In Press. PMC6383796 30768498

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Authors
Rhee, C., Wang, R., Zhang, Z., Fram, D., Kadri, S. S., & Klompas, M.
Affiliations
  • Brigham and Women's Hospital (US)
  • Harvard University (US)
  • National Institutes of Health (US)
ORCID
Venue
Critical Care Medicine
Publisher
Ovid Technologies (Wolters Kluwer Health)
Published
2019-09
Volume
47
Issue
9
Pages
1169-1176
ISSN
0090-3493 (ISSN-L)
DOI
10.1097/ccm.0000000000003817
PMC
PMC6697188
OpenAlex
W2944935359
Cited by
122
References
37
Citations by year
2026: 17 · 2025: 17 · 2024: 18 · 2023: 18 · 2022: 21 · 2021: 18 · 2020: 11 · 2019: 2
FWCI
9.90
Type
journal article
Language
en
Open access
Locations
  • Critical Care Medicine (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
Funders
  • Centers for Disease Control and Prevention (U54CK000484)
  • Agency for Healthcare Research and Quality (K08HS025008)
Topics
  • Health Sciences › Medicine › Epidemiology › Sepsis Diagnosis and Treatment
  • Health Sciences › Medicine › Infectious Diseases › Infection Control in Healthcare
  • Health Sciences › Medicine › Critical Care and Intensive Care Medicine › Nosocomial Infections in ICU
Keywords
community-onset sepsis, sepsis mortality, in-hospital mortality, sepsis epidemiology, hospitalized patients, sepsis risk factors, comorbidities, intensive care unit admission, length of hospital stay, risk adjustment, hospital quality of care, sepsis prevention
MeSH terms
Adult, Aged, Aged, 80 and over, Cross Infection, Female, Humans, Intensive Care Units, Length of Stay, Male, Middle Aged, Retrospective Studies, Severity of Illness Index, United States, Comorbidity, Logistic Models, Proportional Hazards Models, Hospital Mortality, Age Distribution, Community-Acquired Infections, Sepsis, Organ Dysfunction Scores

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