Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia.
Clin Infect Dis. 2018 Mar 19;66(7):1004-1012. doi: 10.1093/cid/cix947.
We examined the risk of sepsis within 90 days after discharge from a previous hospital stay by type of antibiotic received during the previous stay.
We retrospectively identified a cohort of hospitalized patients from the Truven Health MarketScan Hospital Drug Database. We examined the association between the use of certain antibiotics during the initial hospital stay, determined a priori, and the risk of postdischarge sepsis controlling for potential confounding factors in a multivariable logistic regression model. Our primary exposure was receipt of antibiotics more strongly associated with clinically important microbiome disruption. Our primary outcome was a hospital stay within 90 days of the index stay that included an International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) discharge diagnosis of severe sepsis (ICD-9-CM code 995.92) or septic shock (785.52).
Among 516 hospitals, we randomly selected a single stay for eligible patients. In 0.17% of these patients, severe sepsis/septic shock developed within 90 days after discharge. The risk of sepsis associated with exposure to our high-risk antibiotics was 65% higher than in those without antibiotic exposure.
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.
我们通过患者在上次住院期间接受的抗生素类型，研究了出院后 90 天内发生脓毒症的风险。
我们通过 Truven Health MarketScan 医院药物数据库，回顾性地确定了一组住院患者队列。我们通过多变量逻辑回归模型，检查了初始住院期间使用某些抗生素（预先确定）与出院后脓毒症风险之间的关联，并控制了潜在的混杂因素。我们的主要暴露是接受与临床重要微生物组破坏更相关的抗生素。我们的主要结局是在指数住院后 90 天内的住院治疗，该住院治疗包括国际疾病分类，第九修订版，临床修正（ICD-9-CM）出院诊断为严重脓毒症（ICD-9-CM 代码 995.92）或脓毒性休克（785.52）。
在 516 家医院中，我们随机选择了合格患者的单个住院治疗。在这些患者中的 0.17％中，在出院后 90 天内发生严重脓毒症/脓毒性休克。与暴露于我们的高风险抗生素相关的脓毒症风险比未暴露于抗生素的患者高 65％。
我们的研究发现，暴露于高风险抗生素或住院期间抗生素使用量增加的患者在出院后 90 天内发生脓毒症的风险增加。鉴于住院患者中使用大量抗生素可能是不必要的，因此这项研究建立在先前的证据基础上，表明医院增加管理措施不仅可以预防抗生素耐药性，艰难梭菌感染和其他不良后果，而且还可能减少与微生物组破坏相关的不必要的后果，包括脓毒症。
