title: Hospitalization Type and Subsequent Severe Sepsis.
abstract: BACKGROUND
  Hospitalization is associated with microbiome perturbation (dysbiosis), and this perturbation is more severe in patients treated with antimicrobials.
  
  
  OBJECTIVE
  To evaluate whether hospitalizations known to be associated with periods of microbiome perturbation are associated with increased risk of severe sepsis after hospital discharge.
  
  
  METHODS
  We studied participants in the U.S. Health and Retirement Study with linked Medicare claims (1998-2010). We measured whether three hospitalization types associated with increasing severity of probable dysbiosis (non-infection-related hospitalization, infection-related hospitalization, and hospitalization with Clostridium difficile infection [CDI]) were associated with increasing risk for severe sepsis in the 90 days after hospital discharge. We used two study designs: the first was a longitudinal design with between-person comparisons and the second was a self-controlled case series design using within-person comparison.
  
  
  RESULTS
  We identified 43,095 hospitalizations among 10,996 Health and Retirement Study-Medicare participants. In the 90 days following non-infection-related hospitalization, infection-related hospitalization, and hospitalization with CDI, adjusted probabilities of subsequent admission for severe sepsis were 4.1% (95% confidence interval [CI], 3.8-4.4%), 7.1% (95% CI, 6.6-7.6%), and 10.7% (95% CI, 7.7-13.8%), respectively. The incidence rate ratio (IRR) of severe sepsis was 3.3-fold greater during the 90 days after hospitalizations than during other observation periods. The IRR was 30% greater after an infection-related hospitalization versus a non-infection-related hospitalization. The IRR was 70% greater after a hospitalization with CDI than an infection-related hospitalization without CDI.
  
  
  CONCLUSIONS
  There is a strong dose-response relationship between events known to result in dysbiosis and subsequent severe sepsis hospitalization that is not present for rehospitalization for nonsepsis diagnoses.
authors.affiliation: 1 Department of Internal Medicine and.|2 Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan.
authors.forename: Hallie C
authors.initials: HC
authors.lastname: Prescott
authors.affiliation: 1 Department of Internal Medicine and.
authors.forename: Robert P
authors.initials: RP
authors.lastname: Dickson
authors.affiliation: 1 Department of Internal Medicine and.|2 Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan.
authors.forename: Mary A M
authors.initials: MA
authors.lastname: Rogers
authors.affiliation: 1 Department of Internal Medicine and.|2 Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan.|3 VA Center for Clinical Management Research, HSR&D Center of Innovation, Ann Arbor, Michigan; and.|4 Institute for Social Research, Ann Arbor, Michigan.
authors.forename: Kenneth M
authors.initials: KM
authors.lastname: Langa
authors.affiliation: 1 Department of Internal Medicine and.|2 Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan.|3 VA Center for Clinical Management Research, HSR&D Center of Innovation, Ann Arbor, Michigan; and.|4 Institute for Social Research, Ann Arbor, Michigan.
authors.forename: Theodore J
authors.initials: TJ
authors.lastname: Iwashyna
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D016360:Clostridioides difficile; D064806:Dysbiosis / Q000453:epidemiology*; D004761:Enterocolitis, Pseudomembranous / Q000453:epidemiology*; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D015994:Incidence; D016247:Information Storage and Retrieval; D008137:Longitudinal Studies; D008297:Male; D006278:Medicare; D010359:Patient Readmission / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012307:Risk Factors; D018805:Sepsis / Q000453:epidemiology*; D014481:United States / Q000453:epidemiology
chemical_list: D000900:Anti-Bacterial Agents
keywords: dysbiosis; humans; microbiota; patient readmission; self-controlled case series