Risk of Subsequent Sepsis Within 90 Days After a Hospital Stay by Type of Antibiotic Exposure

Abstract

Our study identified an increased risk of sepsis within 90 days of discharge among patients with exposure to high-risk antibiotics or increased quantities of antibiotics during hospitalization. Given that 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, Clostridium difficile infection, and other adverse effects, but may also reduce unwanted outcomes potentially related to disruption of the microbiota, including sepsis.

Clostridioides difficile colonization and infection in patients admitted for a first autologous transplantation: Incidence, risk factors, and patient outcomes

“…Since CDI causes mucosal inflammation and disruption, CDI could potentially promote translocation of bacteria into the bloodstream in AHSCT patients with neutropenia. Alternatively, CDI could be a marker for greater microbiota disruption, which has also been associated with sepsis . Some support for an association between CDI and bacteremia has been presented by Roghmann et al who reported an increased risk for VRE bloodstream infections in VRE colonized patients with leukemia and CDI.…”

Therapeutic Potential of the Gut Microbiota in the Management of Sepsis

“…Expanding on these findings, Baggs et al recently showed that exposure to longer durations of antibiotics, additional classes of antibiotics and broader-spectrum antibiotics during hospitalization were each associated with dose-dependent increases in the risk of subsequent sepsis. This association was not found for other causes of hospital readmissions, suggesting that the association between antibiotic exposure and subsequent sepsis is related to microbiome depletion, not to severity of illness [16].…”

Sepsis therapies: learning from 30 years of failure of translational research to propose new leads

“…Preserving the physiological gut microbiome could protect the host from pneumonia (Schuijt et al , ), sepsis (Wilmore et al , ), or melioidosis (Lankelma et al , ) by maintaining the gut barrier (Fox et al , ), enhancing immunity, and protecting the brain (Li et al , ). Clinical data have indirectly shown the impact of the disturbed microbiome on susceptibility to sepsis (Prescott et al, 2015a; Baggs et al , ). Colonization with Enterococci at ICU admission was related to a higher risk of subsequent infection and mortality (Freedberg et al , ).…”