Research
Surveillance and Epidemiology
The SEPSIS Center conducts innovative research leveraging electronic health record (EHR) data to enhance sepsis surveillance and conduct impactful large-scale epidemiologic studies. Our faculty's work has catalyzed a paradigm change in how sepsis is monitored by hospitals, researchers, public health officials, and policymakers.
Key contributions include:
- Demonstrating that sepsis estimates based on administrative data are biased by changes in diagnosis and coding practices over time
- Developing an objective EHR-based surveillance definition for sepsis that improves consistency and reliability compared to administrative data and formed the basis of CDC’s “Adult Sepsis Event” surveillance strategy
- Integrating clinical data from hundreds of hospitals to generate CDC’s current best estimates of sepsis incidence and outcomes in the US
- Characterizing changes over time in the prevalence of resistant organisms and broad-spectrum antibiotic use for suspected sepsis in US hospitals
Policy and Quality Measures
SEPSIS Center faculty are leading voices in shaping sepsis policy and quality measures, advocating for a shift from mandatory process-based sepsis bundles to a focus on risk-adjusted sepsis outcomes. Our research has highlighted the potential unintended consequences of rigid sepsis policies and provided critical insights, including:
- Challenges and subjectivity in identifying sepsis time zero, the anchor point for measuring time-sensitive care
- Confounding factors that complicate the relationship between sepsis bundle compliance and patient outcomes
- Lack of improvement in sepsis outcomes following implementation of the national CMS SEP-1 process measure
Building on this foundation, our current CDC-funded work focuses on developing an electronic sepsis outcome measure based on the CDC’s Adult Sepsis Event definition. This measure aims to encourage hospitals to prioritize comprehensive, high-quality sepsis care throughout hospitalization and into post-discharge recovery.
Definitions and Diagnosis
We are exploring strategies to optimize clinical definitions of sepsis and to improve diagnostic accuracy to ensure timely care for patients who need it while minimizing unnecessary antibiotic use in those with sepsis-mimicking conditions. Our faculty’s work has illuminated the challenges and subjectivity inherent in diagnosing sepsis, identified limitations in existing sepsis definitions, and evaluated the role of biomarkers like procalcitonin in enhancing sepsis identification and management.
Antimicrobial Resistance and Stewardship
Our center conducts research to better understand patterns of empiric antibiotic use and de-escalation in patients with suspected sepsis, aiming to advance antibiotic stewardship and optimize patient care. Through collaborations with the Clinical Epidemiology Section in the NIH Clinical Center’s Critical Care Medicine Department, our team has also contributed to major epidemiologic studies defining the burden of antibiotic-resistant pathogens in hospitalized patients and developing novel surveillance metrics for antimicrobial resistance.
Prevention and Treatment Strategies
Our faculty include leading investigators in the CDC Prevention Epicenters Program, which has pioneered innovative strategies to prevent serious infections that lead to sepsis in hospitalized patients (see Harvard Prevention Epicenter page for details). Additionally, we conduct comparative effectiveness research on sepsis treatment strategies, leveraging advanced statistical methods and comprehensive electronic health record datasets to identify evidence-based approaches that improve patient outcomes.