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Readmissions for Recurrent Sepsis: New or Relapsed Infection?*

DeMerle, Kimberley Marie MD1; Royer, Stephanie C. MD2,3; Mikkelsen, Mark E. MD, MS4; Prescott, Hallie C. MD, MSc1,5

doi: 10.1097/CCM.0000000000002626
Clinical Investigations

Objectives: 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 International Classification of Diseases, Ninth revision, Clinical Modification 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%). Ninety-four readmissions (68.6%) were for infection at the same site as initial sepsis hospitalization. Nineteen percent 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, whereas an additional 34% were unclear since cultures were negative in one of the hospitalizations.

1Department of Internal Medicine, University of Michigan, Ann Arbor, MI.

2Division of Hospital Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH.

3Department of Internal Medicine, University of Cincinnati Medical Center, Cincinnati, OH.

4Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.

5VA Center for Clinical Management Research, Ann Arbor, MI.

*See also p. 1788.

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Supported, in part, by grants K08 GM115859 (to H.C.P.) from the National Institutes of Health.

The funders were not involved in the design and conduct of the study; collection, management, analysis, and interpretation of the data; and preparation, review, or approval of the article. The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs or the US government.

Drs. DeMerle, Mikkelsen, and Prescott received support for article research from the National Institutes of Health (NIH). Dr. DeMerle received funding from the NIH (K08 GM115859). Dr. Royer received funding from Pfizer. Dr. Prescott’s institution received funding from the NIH and the American Thoracic Society Foundation, and she disclosed government work.

Drs. DeMerle and Prescott acquired the data, designed the study, analyzed the data, interpreted the data, and drafted the article. Drs. Royer and Mikkelsen interpreted the data and revised the article critically for intellectual content. Dr. DeMerle had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

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