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Infection, Acute Kidney Injury Raise 30-Day Readmission Risk for Sepsis Survivors


 

Nearly one-third of hospitalized patients who survive severe sepsis or septic shock require readmission within 30 days, according to a new report in the Journal of Hospital Medicine. Between 660,000 and 750,000 sepsis hospitalizations occur annually, with the direct costs surpassing $24 billion, the paper notes.

The study, which examined 1697 sepsis survivors from 2008 to 2012, links several clinical factors with increased 30-day readmission risk, including infection with Bacteroides spp and extended-spectrum beta-lactamases organisms and puts sepsis survivors with mild-to-moderate acute kidney injury (AKI) at nearly double the risk of readmission.

Study lead author Marya Zilberberg, MD, MPH, notes that efforts to reduce AKI in sepsis survivors might affect patient outcomes but that more research needs to be done to help decrease readmission rates.

“The hypothesis that reducing the occurrence of AKI would in turn reduce the risk of a 30-day hospitalization needs to be validated,” Dr. Zilberberg writes in an email to The Hospitalist. “Furthermore, it is a difficult goal among the critically ill. So, what this means to me is … this quality metric may be yet another that is putting the cart (the metric) before the horse (evidence to support its use).”

Dr. Zilberberg, founder and president of EviMed Research Group, LLC, an evidence-based medicine and outcomes research firm based in Goshen, Mass., says the study’s results were not completely unexpected as resistant infections are associated with worsening of all outcomes, and “we just showed that 30-day readmission was not immune to that,” she notes.

“We are not sure what effective strategies [there] may be to achieve this goal,” she notes. “In general, delivery of best-known care is the best that can be done. The most that can be said from our study is that antimicrobial resistance is bad even vis-à-vis this outcome, so reducing the burden of antimicrobial resistance, in addition to AKI prevention, is a strategy that might impact this outcome, along with many others.”

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