title: Subsequent infections in survivors of sepsis: epidemiology and outcomes.
abstract: OBJECTIVE
  Sepsis is a devastating condition with considerable mortality. The causes of long-term mortality are poorly understood. To test the hypothesis that patients with sepsis are more susceptible to recurrent infections and death due to infectious complications, we investigated the outcomes of patients who survived sepsis, with regard to the incidence of recurrent infections and mortality.
  
  
  METHODS
  A retrospective study of the patients admitted to the intensive care unit (ICU) for sepsis from 2001 to 2002 who achieved 30-day survival (sepsis survivors [SSs], N = 78) and a control group of patients admitted to the ICU for noninfectious conditions with a similar severity of illness (N = 50) was performed. The primary end point was the number of recurrent infections in the first year posthospitalization.
  
  
  RESULTS
  The SSs group had higher rates of infections following hospital discharge compared to controls. Using a multivariable model, having survived sepsis was the strongest predictor of the development of subsequent infections (rate ratio [RR]: 2.83, P= .0006), the need for rehospitalization for infection in the year after the initial hospitalization (RR: 3.78, P = .0009), and postdischarge mortality (hazard ratio = 3.61, P = .003).
  
  
  CONCLUSIONS
  Critically ill patients who survive sepsis have an increased risk of recurrent infections in the year following their septic episode that is associated with increased mortality.
authors.affiliation: Division of Pulmonary, Critical Care, and Sleep Medicine, University of California, Los Angeles, CA, USA.
authors.forename: Tisha
authors.initials: T
authors.lastname: Wang
authors.forename: Ariss
authors.initials: A
authors.lastname: Derhovanessian
authors.forename: Sharon
authors.initials: S
authors.lastname: De Cruz
authors.forename: John A
authors.initials: JA
authors.lastname: Belperio
authors.forename: Jane C
authors.initials: JC
authors.lastname: Deng
authors.forename: Guy Soo
authors.initials: GS
authors.lastname: Hoo
mesh_terms: D018806:APACHE; D000368:Aged; D016022:Case-Control Studies; D002908:Chronic Disease / Q000453:epidemiology; D015897:Comorbidity; D023381:Endpoint Determination; D005260:Female; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data*; D015141:Los Angeles / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010343:Patient Admission / Q000706:statistics & numerical data; D010359:Patient Readmission / Q000706:statistics & numerical data*; D012121:Respiration, Artificial / Q000706:statistics & numerical data; D012189:Retrospective Studies; D018805:Sepsis / Q000150:complications / Q000453:epidemiology* / Q000401:mortality; D012720:Severity of Illness Index; D017741:Survivors / Q000706:statistics & numerical data*; D062606:Tertiary Care Centers; D016896:Treatment Outcome; D014481:United States; D014493:United States Department of Veterans Affairs
keywords: immunosuppression; outcomes; sepsis