Sepsis can kill even previously healthy people if recognized too late, finds study
More sepsis awareness among the general public and first responders could benefit more people
A recent study University of Michigan led study finds that ten percent of patients hospitalized with sepsis were previously healthy—and many of those who ultimately died did so because it was too late to intervene.
The work, led by Rachel Hechtman, M.D., Hallie Prescott, M.D., and their team, focused on healthy patients as a way to tease out the effects of advanced age, comorbidities and other common risk factors on sepsis outcomes.
Using data from 66 hospitals in Michigan from more than 25,000 patients with sepsis, the team identified a subset as previously healthy, lacking major health conditions such as cancer, chronic pulmonary disease and heart failure.
Previously healthy patients tended to have less organ failure upon arrival at the hospital and more COVID-19 related sepsis (the study included data from 11/2020 – 10/2024).
Treatment for these patients differed as well, with less adherence to sepsis management practices, such as blood culture collection and timely delivery of antibiotics.
Those who unfortunately died tended to be older, and had more acute respiratory dysfunction, altered mental status and shock upon admission to the hospital.
During their course of treatment, these patients also received vasopressors and invasive mechanical ventilation more often than survivors, notes the authors.
Most of their deaths were deemed to be unpreventable due to how sick they were when they arrived at the hospital.
Overall, almost 10% of previously healthy patients with sepsis died within 90 days of hospitalization.
The study, notes the team, identifies system level opportunities to reduce the rate of death in patients with sepsis.
“Efforts to increase sepsis awareness among the public and first responders would benefit everyone. Some of these tragic deaths among previously healthy people might have been avoided if their illness had been prevented through vaccination or recognized and treated early before they got sick enough to come to the hospital,” said Hechtman.
Additional authors: Megan E. Heath, Ph.D.; Jennifer K. Horowitz, M.A.; Elizabeth McLaughlin, M.S., RN; Patricia J. Posa, R.N., B.S.N., M.S.A., CCRN; John Blamoun, M.D.; Paul Bozyk, M.D.; Megan Cahill, D.O., M.B.A., FACOEP; Rania Esteitie, M.D., FCCP, ATSF; Kevin Furlong, D.O.; Namita Jayaprakash, MB, BcH BAO, MRCEM; Jessica Jones, PharmD; Maximiliano Tamae-Kakazu, M.D.; Joan Nagelkirk, M.D.; Thomas Pfotenhauer, D.O.; Derek C. Angus, M.D., M.P.H., FRCP; Scott A. Flanders, M.D.; Elizabeth S. Munroe, M.D.
Funding/disclosures: This study was supported by Blue Cross Blue Shield of Michigan and Blue Care Network as part of the Blue Cross Blue Shield of Michigan Value Partnerships program. R. K. H. and H. C. P. were supported by the National Institutes of Health [Grant T32HL007749-31].
Paper cited: “Epidemiologic Characteristics and Management of Sepsis Among Previously Healthy Patients,” CHEST Critical Care. DOI: 10.1016/j.chstcc.2025.100148
Journal
CHEST Critical Care
Article Title
Epidemiologic Characteristics and Management of Sepsis Among Previously Healthy Patients
Hospitals, sanitation linked to spread of antibiotic resistance in Guatemala
Washington State University
PULLMAN, Wash. — In Guatemalan communities, a recent visit to a health clinic or hospital — not antibiotic use — is the strongest predictor of carrying bacteria resistant to critical antibiotics, according to a new study led by Washington State University.
Previous research in Guatemala’s Western Highlands found nearly 46% of residents were colonized in the gastrointestinal tract with bacteria known as extended-spectrum cephalosporin-resistant Enterobacterales (ESCrE). These bacteria, often E. coli, can render the commonly used and important antibiotic ceftriaxone ineffective, complicating care for infections such as pneumonia or urinary tract infections. The new study, published in Scientific Reports, examined 951 residents from the same region to identify factors linked to ESCrE colonization.
“By identifying the most important risk factors for carrying these resistant bacteria, we can begin to target interventions where they will have the most impact,” said Dr. Brooke Ramay, the study’s lead author and an assistant research professor in the WSU College of Veterinary Medicine’s Paul G. Allen School for Global Health. “This knowledge is critical not only for protecting communities in Guatemala but also for addressing the global threat posed by antibiotic resistance.”
While most studies on antimicrobial resistance have focused on infection and mortality, this research examined colonization — when bacteria live in or on a person without causing illness.
“We’re colonized with all types of bacteria, including antibiotic-resistant bacteria,” Ramay said. “Being colonized isn’t necessarily harmful, but it means you can carry and spread these bacteria to others in the community or in health care facilities. And when these bacteria get into the wrong place — your bloodstream, urinary tract or other vulnerable sites, for example — they can cause serious infections.”
While the study doesn’t prove that health care visits cause colonization, it’s likely that exposure to hospitals and clinics increases the chance of picking up resistant bacteria through contact with surfaces, medical equipment, water or staff. It’s also possible that people who need medical care already have health conditions like chronic illness, diarrhea or malnutrition that make them more vulnerable to colonization.
“People who had reported going to a health care facility or a hospital for treatment for any type of illness had a much higher risk of being colonized in the gastrointestinal tract with these bacteria,” Ramay said. “This could be due to exposure to the health care environment facilitating transmission. Alternatively, this might be because inflammatory processes occurring in the gut of sick individuals make it easier for these bacteria to colonize. We are exploring this further in ongoing studies.”
The study also found urban residents and households without trash pickup were roughly twice as likely to carry the bacteria compared to rural residents or those with waste services. People using piped or well water were about 1.5 times more likely to be colonized than those using bottled water, possibly due to bacterial biofilms in water infrastructure or contamination during storage.
Contrary to common assumptions, the study found no significant link between colonization and self-reported antibiotic use.
“We’ve seen this in other projects as well,” she said. “In Guatemala, we observe significant effects of antibiotic use on antibiotic resistance in environments with improved hygiene. In households with poor hygiene, transmission factors play a much greater role in colonization risk.”
The research was completed in collaboration with the Centers for Disease Control and Prevention and University del Valle de Guatemala as part of the broader Antimicrobial Resistance in Communities and Hospitals (ARCH) study partnership, which has research projects in six countries. ARCH studies have shown a wide range of ESCrE prevalence, ranging from 34 to 52 percent in Kenya, 29 percent in Chile, 72 percent in India, 24 to 26 percent in Botswana, 78 percent in Bangladesh and 46 percent in Guatemala. WSU is leading the ARCH efforts in both Guatemala and Kenya.
While resistant bacteria remain rare in the U.S., global travel and trade could mean they are just a flight away.
“These bacteria and the resistance genes they carry do not respect borders,” Ramay said. “By understanding and addressing colonization risk factors abroad, we can help slow their spread everywhere.”
Journal
Scientific Reports
Method of Research
Observational study
Article Title
Risk factors associated with community colonization of extended-spectrum cephalosporin-resistant Enterobacterales from an antibiotic resistance in communities and hospitals (ARCH) study, Guatemala
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