Center for Sepsis Epidemiology and Prevention Studies (SEPSIS)

Our research has generated foundational insights into sepsis epidemiology and helped transform how sepsis is measured and monitored in the United States. We have demonstrated important limitations of administrative claims data for tracking sepsis incidence and trends, developed objective electronic health record-based surveillance methods that underpin the CDC's Adult Sepsis Event framework, and produced comprehensive national estimates of sepsis incidence and outcomes in both adults and children using clinical data from hundreds of hospitals. Our work has also provided important insights into the causes and preventability of sepsis-associated deaths and hospital-onset sepsis, helping identify opportunities to improve prevention and care. Building on these contributions, we continue to refine and advance sepsis surveillance methods while investigating sepsis incidence, trends, risk factors, and outcomes across diverse patient populations, infection sources, and causative pathogens, including differences between community-onset and hospital-onset sepsis and bacterial versus viral sepsis.

Our research has helped shape national discussions about how sepsis care should be measured, evaluated, and incentivized. We have highlighted important limitations and unintended consequences of rigid, process-based sepsis mandates, including challenges in defining sepsis onset ("time zero"), assessing bundle compliance, and balancing the urgency of treatment against the potential harms of unnecessary broad-spectrum antibiotic use. Building on these contributions, we are developing and validating more meaningful approaches to healthcare quality measurement, including an electronic health record-based, risk-adjusted sepsis mortality measure grounded in the CDC's Adult Sepsis Event surveillance framework, as well as risk-adjustment models for emerging digital quality measures of healthcare-associated infections in the CDC's National Healthcare Safety Network. Our research also investigates effective care processes and hospital-level strategies for improving sepsis outcomes beyond traditional resuscitation bundles, with the goal of informing evidence-based quality improvement and health policy.

Our research has advanced understanding of the challenges of recognizing, defining, and diagnosing sepsis, a heterogeneous syndrome whose identification is often subjective and uncertain in clinical practice. We have evaluated the performance and limitations of sepsis definitions, screening and early warning tools, and diagnostic biomarkers, helping clarify their utility across different patient populations and clinical settings. Our work has also highlighted variability in clinical judgment and diagnostic uncertainty surrounding suspected sepsis, particularly the challenges of distinguishing true infection from noninfectious conditions and identifying patients at risk for clinical deterioration. Building on these contributions, we continue to investigate approaches to improving the accuracy, consistency, and timeliness of sepsis recognition and diagnosis, with the goal of informing clinical decision-making and strengthening the scientific foundations of sepsis research.

Our research has advanced understanding of effective strategies to prevent and treat sepsis, including approaches to reducing healthcare-associated infections and hospital-onset sepsis. Our large-scale studies have helped clarify the relationship between antibiotic treatment delays and patient outcomes, demonstrating how the urgency of treatment varies according to illness severity. We have also examined the consequences of unnecessarily broad-spectrum antibiotic use and antimicrobial resistance, and evaluated antimicrobial stewardship interventions and electronic health record-based clinical decision support tools to improve antimicrobial prescribing and patient care. Building on these contributions, we continue to investigate strategies to strengthen infection prevention, optimize antimicrobial therapy, and improve sepsis care while minimizing unnecessary treatment and associated harms.