Inpatient High-Risk Antibiotic Use Increases Subsequent Risk of Sepsis
An increased risk of sepsis was found in patients exposed to certain antibiotics during inpatient hospitalization.
According to a recent study published in Clinical Infectious Diseases, the use of high-risk antibiotics during hospitalization is associated with an increased risk for sepsis within 90 days of hospital discharge.
In this retrospective cohort study, single hospital stays were randomly selected from a large database and considered index stays. Patients with sepsis during or prior to the index stay or who died within 90 days of discharge were excluded. The researchers evaluated the association between high-risk antibiotic exposure during hospitalization and sepsis resulting in a hospital stay within 90 days of initial discharge.
High-risk antibiotics included 3rd or 4th generation cephalosporins, fluoroquinolones, lincosamides, beta-lactam/beta-lactamase inhibitor combinations, oral vancomycin, and carbapenems.
Among more than 12 million randomly selected hospital stays, 0.17% had severe sepsis or septic shock within 90 days of discharge from the first hospital stay. Cases of severe sepsis resulted in a mean length of stay of 13.1 days and 38% mortality during hospitalization.
Patients with any infection or with Clostridium difficile infection during their index stay had a higher rate of subsequent severe sepsis compared with those without infection or C difficile (P <.001 for both).
In a multivariable logistic regression model, high-risk antibiotic exposure during the index stay was associated with an increased risk for sepsis within 90 days of discharge compared with no antibiotic exposure (odds ratio [OR] 1.65), whereas low-risk antibiotics (OR 1.07) and control antibiotics (OR 1.22) were not as strongly associated. Furthermore, exposure to ≥4 antibiotic classes (OR 2.23) or ≥14 days of antibiotic therapy (OR 2.17) were also associated with increased risk for sepsis compared with no antibiotics.
In an interview with Infectious Disease Advisor, James Baggs, MD, medical officer, Division of Healthcare Quality Promotion at the Centers for Disease Control and Prevention and lead author on the study, explained that, “Antibiotics are essential treatments for many hospitalized patients. More than half of hospitalized patients receive an antibiotic, but an estimated 30% to 50% of antibiotic use in hospitals is inappropriate.”
Dr Baggs concluded that the study, “further suggests that increased hospital stewardship may not only prevent antimicrobial resistance, Clostridium difficile infection, and other adverse effects, but [may] also reduce other unwanted outcomes possibly related to disruption of the microbiota, including sepsis.”
Baggs J, Jernigan JA, Halpin AL, Epstein LH, Hatfield KM, McDonald LC. Risk of subsequent sepsis within 90 days of a previous hospital stay by type of antibiotic exposure [published online November 9, 2017]. Clin Infect Dis. doi: 10.1093/cid/cix947