A new study suggests that a routine hospital stay can disturb the balance of the microbiome so much that it sets up some older individuals for life-threatening sepsis.
Researchers found that older adults are three times more likely to develop sepsis, a systemic catastrophic response to infection, in the first three months after leaving a hospital than at any other time.
Furthermore, the risk for sepsis in that short period after discharge is 30% higher for people whose original hospital stay involved care for any type of infection and 70% higher for those who had Clostridium difficile. In fact, one in 10 C. difficile survivors end up with sepsis within three months of their hospital stay, according to the new study (Am J Respir Crit Care Med 2015 May 27.
The researchers chose to look at the relationship between hospitalization and sepsis because of a growing understanding that antibiotics and other infection treatments change the body’s microbiome, the natural community of bacteria and other organisms that is vital for healthy body function. In turn, C. difficile preys on hospital patients who have a disrupted gut microbiome.
“Our findings could mean that disruption to the microbiome in the hospital may predispose older people to get sepsis later, which is different from what we already know about the acute and chronic effects of microbiome disruption,” said Hallie Prescott, MD, MSc, a critical care physician at the University of Michigan (U-M), in Ann Arbor. “While more work is needed to explore this further, it also opens the possibility that we might be able to prevent sepsis by doing something as simple as helping the microbiome recover rapidly from a hospitalization.”
The study analyzed data from more than 43,000 hospital stays by nearly 11,000 older Americans over a 12-year period. All patients took part in the U-M Health and Retirement Survey, and allowed researchers access to their Medicare records so they could see what happened after each of their hospitalizations. The researchers also analyzed a subset of the patients to see what their odds of sepsis were during other times.
“What is really new here is that we studied dysbiosis—disruption of the microbiome—on the population level rather than on the level of the individual patient,” said Robert Dickson, MD, a U-M critical care physician. “Virtually all sepsis research to date has focused on only the host or the pathogen. This paper raises the possibility that we’ve been ignoring a key third factor: the microbial communities living on and in our vulnerable patients.”
Theodore J. Iwashyna, MD, PhD, the senior author on the study and a physician-scientist at both the University of Michigan and the Veterans Affairs Ann Arbor Center for Clinical Management Research, said the research was important. “We know that a major cause of microbiome disruption is antibiotic use. This study hints—it does not prove, but it hints—that profligate use of antibiotics might not just be bad because of antibiotic resistance. Profligate use of antibiotics might also, via the microbiome, put patients at increased risk of both all kinds of other infections and having a particularly bad response to those infections.”
While researchers are still developing their understanding of what dysbiosis or even a healthy microbiome is, studies like this one could spur further research. They also hope to test diet-based interventions to encourage faster recovery of the microbiome after hospitalization. “There are nearly no strategies proven to prevent sepsis,” Dr. Prescott said.
Sepsis affects as many as 750,000 hospitalized patients in the United States annually, according to the Centers for Disease Control and Prevention. According to the Agency for Healthcare Research and Quality, sepsis is the most expensive cause of hospitalization in the United States, costing more than $24 billion annually.
Caused by a system-wide overreaction to any kind of infection, sepsis can lead to vital organ damage and is fatal to one in every six people diagnosed with it. More people die from sepsis than from prostate cancer, breast cancer and AIDS combined.
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