News: Hospital-onset sepsis often attributed to infection, according to recent study

Among 250 hospital-onset sepsis events reviewed across nine hospitals, 79% were attributed to infections. Additionally, out of 100 infection-related cases selected for preventability assessment, 31 were judged potentially preventable. Respiratory infections accounted for more than half of all infection-related sepsis events, with non-ventilator hospital-acquired pneumonia (NV-HAP) representing 44% of cases.

Hospital-onset sepsis was defined as presumed serious infection and acute organ dysfunction beginning on or after the fourth day of hospitalization, as per the Centers for Diseases Control and Prevention’s (CDC) Adult Sepsis Event criteria.

Researchers conducted a retrospective study to determine the underlying causes and preventability of hospital-onset sepsis events among adults aged 18 years or older who were admitted to nine acute care hospitals between January 2021 and December 2023. A total of 5,212 (0.9%) of 558,037 admissions had hospital-onset sepsis; 250 cases were randomly selected for detailed medical record review to ascertain the probability and source of infection. Of the infection-related cases, 100 were selected for preventability assessment using a 6-point Likert scale, with scores 1 to 3 categorized as potentially preventable and 4 to 6 as not likely preventable.

Of 250 hospital-onset sepsis events, 79% were attributed to infections, whereas 21% were linked to noninfectious conditions. Among 198 infection-related cases, respiratory infections were the leading source of sepsis, accounting for 56%. This was driven largely by NV-HAP at 44%, followed by bloodstream infections (17%) and intra-abdominal infections (15%). Only 13% of infection-related cases (25 of 198) fit the definition of currently reportable healthcare-associated infections, and blood cultures confirmed a noncommensal organism in only 22% of cases (44 of 198).

Among cases evaluated for preventability, 31% were classified as potentially preventable. The two most common gaps in care—each present in 38% of flagged events—were inadequate treatment of an already-identified infection before it worsened to sepsis and failure to prevent NV-HAP. Common noninfectious triggers included bleeding, cardiac ischemia or arrhythmia, and hypovolemia.

Editor’s note: To read the full study, click here. To read additional coverage from Medscape, click here.