No Return Trips: Hospitals Under Pressure to Lower Readmissions

Shmuel Shoham, MD


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


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