Readmissions for Recurrent Sepsis: New or Relapsed Infection?*

Abstract

Objective Sepsis hospitalizations are frequently followed by hospital readmissions, often for recurrent sepsis. However, it is unclear how often sepsis readmissions are for relapsed/recrudescent versus new infections. The aim of this study was to assess the extent to which 90-day readmissions for recurrent sepsis are due to infection of the same site and same pathogen as the initial episode. Design Retrospective cohort study. Setting University of Michigan Health System. Patients All hospitalizations (May 15, 2013 to May 14, 2015) with a principal ICD-9-CM diagnosis of septicemia (038.x), severe sepsis (995.92) or septic shock (785.52), as well as all subsequent hospitalizations and sepsis readmissions within 90 days. We determined organism and site of sepsis through manual chart abstraction. Interventions None Measurements and Main Results We identified 472 readmissions within 90 days of sepsis, of which 137 (29.1%) were for sepsis. In sepsis readmissions, the site and organisms were most commonly urinary (29.2%), gastrointestinal (20.4%), gram negative (29.9%), gram positive (16.8%) and culture negative (30.7%). 94 (68.6%) readmissions were for infection at the same site as initial sepsis hospitalization. 19% of readmissions were confirmed to be same site and same organism. However, accounting for the uncertainty from culture-negative sepsis, as many as 53.2% of readmissions could plausibly due to infections with both the same organism and same site. Conclusions Of the patients readmitted with sepsis within 90 days, two thirds had infection at the same site as their initial admission. Just 19% had infection confirmed to be from the same site and organism as the initial sepsis hospitalization. Half of readmissions were definitively for new infections, while an additional 34% were unclear since cultures were negative in one of the hospitalizations.

Rate and risk factors for rehospitalisation in sepsis survivors: systematic review and meta-analysis

“…Using this information, overall certainty of evidence was assessed as per GRADE system of assessment of evidence about prognosis (see main results) [24] EHR electronic health record, MC multi-centre, SC single-centre Table 2). The relationship between infection at index sepsis admission and the infection diagnosis at rehospitalisation was reported in one study as recurrent or unresolved in nearly 50% of cases [52], often secondary to opportunistic pathogens like Pseudomonas aeruginosa and Candida species in another study [55], and same site as index sepsis admission in 68% of rehospitalisation events in another study [32]. Infection-related rehospitalisation was the most common rehospitalisation event in sepsis survivors.…”

“…Similar to all-cause rehospitalisation, the risk factors for infection-related rehospitalisation were older age, prolonged hospitalisation, and nursing home residence [55]. In three studies, infectionrelated rehospitalisation episodes were associated with greater risk of death [32,52,55] when compared to noninfection-related hospitalisations.…”

“…Between one-third and two-thirds of rehospitalisation episodes in sepsis survivors were coded as sepsis [29,32,52] (Table 2).…”

Epidemiology of Readmissions After Sepsis Hospitalization in Children

“…Thus, infection or sepsis are likely to be the leading causes of readmission in pediatric sepsis survivors, a finding consistent with previous studies in adults. 13 Potential reasons include inadequate duration of antimicrobial therapy (an unrecognized reservoir of infection) and preexisting or persistent immune dysfunction. The latter may be due to epigenetic changes or persistent alterations in the microbiome.…”

“…10 Recent work has revealed that sepsis is the leading cause of readmissions in adults, 4 but the epidemiology, causes, and health care spending for readmissions after pediatric sepsis remain poorly understood. In particular, the frequency of readmissions due to infections is of interest because previous studies indicated that immunosuppression, 11 alterations in the microbiome, 12 and partially treated infections 13 may be common among patients with sepsis.…”