COMMENTARY

No Return Trips: Hospitals Under Pressure to Lower Readmissions

Shmuel Shoham, MD

Disclosures

April 23, 2015

In This Article

Infections and the Posthospital Syndrome

This phenomenon now has a name. The term "posthospital syndrome" has been coined to describe an acquired, transient period of vulnerability to a range of adverse health events.[4] The perturbations associated with acute illness can substantially alter host/pathogen interactions, and often the time and circumstances required for an infection to develop are reached only after discharge. Table 2 lists factors that may contribute to infections after discharge from hospital.

Table 2. Factors That Increase Risk for Infection or Medication Side Effects

Factor Resulting Impairment Possible Outcome
Surgical procedure Surgical wounds Surgical site infection
Indwelling catheters Breaks in anatomic barriers Catheter-associated infections
Encephalopathy and frailty Aspiration of oropharyngeal contents; skin breakdown Pneumonia; soft-tissue infections
Anesthetics/sedatives Decreased airway clearance Pneumonia
Corticosteroids and immunosuppressants Multiple host immune defects Increased rate and severity of infection
Antibiotics Change in microbiome CDAD
Gastric acid suppression Change in microbiome Pneumonia; CDAD[5,6]
Malnourishment Multiple immune defects and impaired wound healing Increased rate and severity of infection
Imprecise medical plan hand-off to caregiver Underuse or overuse of key medications; failure to monitor for medication side effects Recrudescent or new infection; drug toxicity[7,8]
CDAD = Clostridium difficile-associated disease

Comments

3090D553-9492-4563-8681-AD288FA52ACE
Comments on Medscape are moderated and should be professional in tone and on topic. You must declare any conflicts of interest related to your comments and responses. Please see our Commenting Guide for further information. We reserve the right to remove posts at our sole discretion.
Post as:

processing....