title: Risk factors for 30-day readmission among patients with culture-positive severe sepsis and septic shock: A retrospective cohort study.
abstract: BACKGROUND
  With decreasing mortality in sepsis, attention has shifted to longer-term consequences associated with survivorship. Thirty-day readmission as a component of healthcare utilization is an important outcome.
  
  
  OBJECTIVE
  To examine the frequency of and risk factors for 30-day readmission among patients surviving sepsis.
  
  
  METHODS
  Single-center retrospective cohort.
  
  
  METHODS
  We examined 30-day readmission risk among survivors of hospitalization with culture-positive severe sepsis or septic shock. Extended spectrum β-lactamase (ESBL) organisms were identified via molecular laboratory testing. Healthcare-associated (HCA) was defined by 1 of the following: (1) recent hospitalization, (2) immune suppression, (3) nursing home residence, (4) hemodialysis, (5) prior antibiotics, and (6) index bacteremia hospital-acquired (onset >2 days following admission). Acute kidney injury (AKI) was defined according to the RIFLE (Risk, Injury, Failure, Loss, End-stage) criteria. Logistic regression modeled predictors of 30-day readmission.
  
  
  RESULTS
  Among 1697 sepsis survivors, 543 (32.0%) required 30-day readmission. Readmitted patients had a higher chronic (median Charlson score 5 vs 4, P < 0.001) but not acute (median APACHE [Acute Physiology and Chronic Health Evaluation] II score 15 and 15, P = 0.275) illness burden, and higher prevalence of HCA sepsis (94.2% vs 90.2%, P = 0.014) than nonreadmitted survivors. In logistic regression, 3 factors increased (Organism: ESBL [odds ratio {OR}: 4.50, 95% confidence interval {CI}: 1.43-14.19], RIFLE: Injury or RIFLE: Failure [OR: 1.95, 95% CI: 1.300-2.93], and Organism: Bacteroides spp [OR: 2.04, 95% CI: 1.06-3.95]) and 2 reduced (
  
  
  METHODS
  Urine [OR: 0.58, 95% CI: 0.35-0.98], Organism: Escherichia coli [OR: 0.49, 95% CI: 0.27-0.90]) the odds of 30-day readmission.
  
  
  CONCLUSIONS
  One-third of survivors of severe sepsis/septic shock required 30-day readmission. Mild-to-moderate AKI nearly doubled its risk.
authors.affiliation: Department of Health Services Research, EviMed Research Group, LLC, Goshen, Massachusetts.|University of Massachusetts, Amherst, Massachusetts.
authors.forename: Marya D
authors.initials: MD
authors.lastname: Zilberberg
authors.affiliation: Department of Medicine, Washington Hospital Center, Washington, DC.
authors.forename: Andrew F
authors.initials: AF
authors.lastname: Shorr
authors.affiliation: Department of Pharmacy, St. Louis College of Pharmacy, St. Louis, Missouri.
authors.forename: Scott T
authors.initials: ST
authors.lastname: Micek
authors.affiliation: Department of Medicine, Division of Pulmonary and Critical Care Medicine, Washington University School of Medicine, St. Louis, Missouri.
authors.forename: Marin H
authors.initials: MH
authors.lastname: Kollef
mesh_terms: D058186:Acute Kidney Injury / Q000209:etiology; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D024901:Drug Resistance, Multiple, Bacterial / Q000187:drug effects; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D010359:Patient Readmission / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012307:Risk Factors; D012772:Shock, Septic / Q000150:complications* / Q000382:microbiology; D001618:beta-Lactamases / Q000302:isolation & purification*
chemical_list: D000900:Anti-Bacterial Agents; C405902:GES-1 beta-lactamase; D001618:beta-Lactamases