Hospital-Onset Sepsis Was Potentially Preventable in 31% of Cases

Nearly one-third of infection-related hospital-onset sepsis cases reviewed in a retrospective cohort study were judged potentially preventable, according to findings published in JAMA Network Open. Respiratory infections—particularly nonventilator hospital-acquired pneumonia (NV-HAP)—were the most common infectious causes.

Investigators identified hospital-onset sepsis among adults admitted from January 2021 through December 2023 to 9 Mass General Brigham acute care hospitals in New England. Cases met CDC Adult Sepsis Event criteria, requiring presumed serious infection and acute organ dysfunction beginning on hospital day 4 or later. Two physicians reviewed 250 randomly selected events to determine infection likelihood and source.

Of the 250 reviewed events, 198 (79%) were attributed to infection and 52 (21%) to noninfectious conditions. Crude in-hospital mortality was 37%. Respiratory infections accounted for 111 of 198 infection-related events (56%), including 88 cases of NV-HAP (44%). Only 25 infection-related events (13%) met surveillance criteria for currently reportable health care–associated infections.

Three physicians independently assessed preventability in 100 infection-related cases and identified 31 (31%) as potentially preventable. The leading improvement opportunities were suboptimal management of recognized infections before progression to sepsis and gaps in NV-HAP prevention, each accounting for 22 of 58 identified opportunities (38%). Device-related infection-prevention lapses accounted for 5 opportunities (9%).

All 52 noninfectious events were treated with antibiotics, most for at least 4 days. The authors said hospital-onset sepsis surveillance may identify harms missed by existing infection-surveillance programs, but noted the small sample, subjective retrospective preventability assessments, and risk of cognitive bias despite structured consensus adjudication.

Source: Manzoor F, Klompas M, Seetharaman S, Chan C, Rhee C. Underlying causes and preventability of hospital-onset sepsis events. JAMA Netw Open. 2026;9(9):e2634324. doi:10.1001/jamanetworkopen.2026.34324