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

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

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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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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: Rhee, Chanu
Wang, Rui
Zhang, Zilu
Kadri, Sameer S.
Klompas, Michael
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: green
www.ncbi.nlm.nih.gov
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 › Critical Care and Intensive Care Medicine › 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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Epidemiology of hospital-onset versus community-onset sepsis in U.S. hospitals and association with mortality: a retrospective analysis using electronic clinical data.

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