Study links sepsis diagnostic excellence with improved outcomes

A retrospective cohort study published in Clinical Infectious Diseases evaluated whether hospital-level performance in reducing both delayed antibiotic treatment and unnecessary early antibiotic use was associated with hospital mortality or hospice discharge, hospital-free days alive at 28 days, length of stay, and antibiotic days among adults with potential infection. The study, “Sepsis Diagnostic Excellence and its Association with Mortality in Adults with Potential Infection,” was published June 30, 2026.

The authors reported that diagnostic uncertainty in sepsis can contribute to undertreatment, defined as delayed antibiotics, and overtreatment, defined as unnecessary early antibiotics among patients who do not have sepsis. The study assessed whether hospitals with stronger relative performance on both measures had better patient outcomes.

The cohort included 152,779 hospitalized adults at 20 hospitals in Advocate Health and Michigan Medicine from 2022 to 2024. Eligible patients met at least 2 systemic inflammatory response syndrome criteria within 6 hours of presentation. Hospital diagnostic performance was assessed using risk-standardized rates for undertreatment and overtreatment, and “Diagnostic Excellence” was prespecified as top-tertile performance in one measure without bottom-tertile performance in the other.

Among all patients, 49,109 or 32.1%, received antibiotics within 3 hours, and 16,361 or 10.7%, ultimately met sepsis criteria. Undertreatment risk-standardized rates ranged from 29.3% to 46.8%, while overtreatment risk-standardized rates ranged from 21.5% to 37.2%. Four hospitals met the Diagnostic Excellence criteria.

Treatment at Diagnostic Excellence hospitals was associated with lower odds of hospital mortality or hospice discharge compared with non-Diagnostic Excellence hospitals, with an adjusted odds ratio of 0.61. These hospitals were also associated with more hospital-free days alive at 28 days, shorter length of stay, and fewer antibiotic days, although the antibiotic-day difference did not reach statistical significance. The authors concluded that jointly minimizing sepsis undertreatment and overtreatment was associated with improved patient outcomes after adjustment for patient and hospital factors.

Sources: Kowalkowski M, Birken S, Obermiller C, et al. Sepsis diagnostic excellence and its association with mortality in adults with potential infection. Clin Infect Dis. Published online June 30, 2026. doi:10.1093/cid/ciag382