OBJECTIVES : Sepsis is defined as life-threatening organ dysfunction caused by a dysregulated host response to infection. It is a life-threatening condition affecting more than one million patients per year in the United States. Chronic comorbid conditions that alter the immune system could also lead to sepsis. The objective of the present study was to examine comorbidities, complications, common pathogens, infections, and treatments of sepsis.

METHODS : This retrospective study examined data from a U.S. electronic health record database (Cerner Health Facts®). All inpatient visits (age ≥ 18 years) between 2012-2016 with a principal ICD9/10 diagnosis of sepsis were included in the analysis. Chronic comorbid medical conditions, complications, and infections were characterized by corresponding ICD9/10 diagnosis codes. Laboratory test results and medications were examined to analyze treatment patterns.

RESULTS : The study included 510,720 sepsis-related visits (50.2% female), with 49.7% of the cohort over 65 years old. Septic shock was present in 16.2% of visits, while 14.2% were in severe stage. The most prevalent comorbid conditions were chronic obstructive pulmonary disease (33.9%) and diabetes (33.5%). Organ failure was a major complication seen in 59.5% of visits. Urinary tract infection (31.4%) and pneumonia (31.2%) were observed to be the most common infections. The top pathogen identified was gram-negative rod/bacillus (13.7%), followed by E. coli (12.3%). During susceptibility testing for gram-negative rod/bacillus, aminoglycosides were the most commonly tested (2,816 tests). Gram-negative rod/bacillus was highly susceptible to quinolones (96.6%; 1,792 of 1,856 tests) and was most resistant to aminopenicillins (54.4%; 992 of 1,824 tests). IV hydration / fluid challenges (79.5%) and antibiotics (73.2%) were most commonly used for the treatment of sepsis. Within antibiotics, vancomycin (28.1%), levofloxacin (21.6%), and ceftriaxone (20.9%) were prescribed often.

CONCLUSIONS : This large database analysis provides insights on the pathogenesis, comorbidities and most often employed diagnosis/treatment strategies for sepsis.