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How to Reduce the Risk of Subsequent Sepsis

Antibiotics Linked to Sepsis Risk

Disturbing healthy bacteria during hospital admission associated with later sepsis

Antibiotic Sepsis Risk – Sepsis is a life-threatening condition that arises when the body’s response to infection injures its own tissues and organs. Common signs and symptoms include fever, increased heart rate, increased breathing rate, and confusion.

Antibiotic Sepsis Risk: Exposure to antibiotics during a hospital stay can sharply increase the risk of sepsis or septic shock after discharge.

While sepsis is rare, it’s nearly 80% more likely after treatment with certain “high-risk” antibiotics, compared with no antibiotic therapy, according to James Baggs, PhD, of the Centers for Disease Control and Prevention (CDC).

But the risk is elevated regardless of what antibiotics are used and rises with the duration of treatment, Baggs reported at the annual IDWeek meeting. The meeting brings together four organizations that focus on infectious disease —   the Infectious Diseases Society of America (IDSA), the Society for Healthcare Epidemiology of America(SHEA), the HIV Medicine Association (HIVMA), and the Pediatric Infectious Diseases Society (PIDS).


Microbiome – the combined genetic material of the microorganisms in a particular environment

The study is “interesting because it brings together a number of really hot topicsantibiotic use, sepsis, and this whole concept of the good bacteria in our bodies, the microbiome,” commented Arjun Srinivasan, MD, of the CDC, and the conference program chair for SHEA.

Srinivasan told reporters the study builds on intriguing data from animals that has suggested, “if you mess up their microbiome” with antibiotics, they are much more susceptible to serious infection and sepsis.

Using Antibiotics When Necessary

Baggs and colleagues, he said, have shown that in humans, the same is true: “There really is a tremendous disturbance in the healthy bacteria when we get an antibiotic that can have a significant downside.”

It’s “one more call to focus our efforts on using antibiotics only when we need them,” he said.

Antibiotic Type and Treatment Lengths

The primary endpoint of the analysis was the risk of sepsis following use of those drugs compared with no antibiotic use, Baggs said, but they also looked at the risk associated with other antibiotics and the risk associated with longer versus shorter treatment lengths.

Low Risk: One set of drugs, including earlier cephalosporins, tetracycline, and sulfa drugs, was regarded as low-risk, while control antibiotics, such as penicillin, were thought to have limited potential to disrupt the microbiome.

High Risk: Compared to antibiotics with a high risk of disturbing the microbiome: third- or fourth-generation cephalosporins, fluoroquinolones, lincosamides, beta-lactam/beta-lactamase inhibitor combinations, oral vancomycin, and carbapenems.


Improved Antibiotic Stewardship

Physicians and health authorities have one preventive measure that’s currently available: “improved antibiotic stewardship.”

Baggs cautioned that, while the study had a large population and many years of data, it is based on an administrative database with a potential for misclassification. He noted that the study could not account for antibiotic exposures outside the hospital setting and captured only sepsis patients admitted to the same hospital they had recently left.


Dr. Kris Dinucci