Hospital-Administered Antibiotics Linked to Sepsis Risk

Exposure to antibiotics that disturb the healthy microbiome during a hospital stay can sharply increase the risk of sepsis or septic shock after discharge, according to a new study.

Researchers at the U.S. Centers for Disease Control and Prevention (CDC; Atlanta, GA, USA) conducted a retrospective cohort study of the Truven Health MarketScan hospital drug database, which includes demographic, treatment, and hospital admission and discharge data; the database also includes pharmacy data, making it possible to track antibiotic use. The researchers obtained data on 12.7 million hospital stays in 516 U.S. facilities between 2006 and 2010, including 18,307 stays that were associated with sepsis admission within 90 days of discharge.

The researchers then defined a list of antibiotics with a high risk of disturbing the microbiome, including third- or fourth-generation cephalosporins, fluoroquinolones, lincosamides, beta-lactam/beta-lactamase inhibitor combinations, oral vancomycin, and carbapenems. Earlier cephalosporins, tetracycline, and sulfa drugs were regarded as low-risk, while control antibiotics, such as penicillin, were thought to have limited potential to disrupt the microbiome. The primary endpoint was the risk of sepsis following use of those drugs, compared with no antibiotic use.

The results showed that in 43% of the hospital stays, patients had not been given any antibiotics, while patients got high-, low-, and no-risk drugs in 28%, 24%, and 5% of the stays, respectively. Upon analysis, the odds ratio for sepsis was 1.78 following high-risk drugs, 1.1 following low-risk drugs, and 1.22 after no-risk drugs. Duration of therapy also played a role; regardless of drug type, patients treated for more than 14 days had twice the risk of later sepsis as those given shorter therapy, with an odds ratio of 2.4. The study was presented at the annual IDWeek meeting, held during October 2016 in New Orleans (LA, USA).

“Environmental exposures, such as antibiotics, can lead to a shift in the microbiome with great pathogenic potential. The exact mechanisms remain under investigation,” said lead author James Baggs, PhD, of the CDC. “The study contributes to the growing body of observational evidence and animal data that antibiotics can have broad detrimental effects. Physicians and health authorities have one preventive measure that's currently available - improved antibiotic stewardship.”

IDWeek 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).

Related Links:
U.S. Centers for Disease Control and Prevention