Nosocomial Sepsis as a Burden of the Post-Hospital Sector

Background: Sepsis remains one of the most severe and complex challenges in modern healthcare, characterized by high mortality, multi-organ dysfunction, and substantial socioeconomic burden. According to global estimates, nearly 49 million cases and 11 million deaths annually are associated with sepsis, accounting for approximately 20% of all global deaths. Nosocomial (hospital-acquired) sepsis represents a particularly critical component of this burden, especially in intensive care and emergency settings, where invasive procedures, prolonged hospitalization, antimicrobial resistance, and immunosuppression increase both incidence and mortality.

Objective: This article aims to analyze nosocomial sepsis as a major contributor to post-hospital morbidity, mortality, and rehospitalization, and to explore the role of verbal autopsy and biomarker integration in identifying the hidden epidemiological burden of sepsis.

Methods: A narrative review of international cohort studies, systematic reviews, and meta-analyses was conducted, focusing on hospital-acquired (HA) and ICU-acquired sepsis, rehospitalization rates, long-term mortality, and limitations in cause-of-death registration systems. Particular attention was given to studies evaluating verbal autopsy (VA) as a complementary epidemiological tool and its integration with clinical and biomarker data, including soluble triggering receptor expressed on myeloid cells-1 (sTREM-1).

Results: Evidence indicates that hospital-acquired sepsis is associated with significantly higher mortality compared with community-acquired infections, with increased ICU and hospital length of stay. Rehospitalization rates following sepsis remain high, frequently driven by recurrent infections and post-sepsis complications, and are associated with elevated long-term mortality risk. A substantial proportion of sepsis-related deaths remains underreported due to incomplete documentation, misclassification (e.g., recording multi-organ failure as the primary cause), and deaths occurring shortly after discharge. Verbal autopsy has demonstrated effectiveness in identifying infection-related mortality in settings with limited medical documentation and can reveal previously unrecognized (“hidden”) sepsis burden. Integration of VA data with clinical records and biomarkers such as sTREM-1 may enhance diagnostic accuracy and epidemiological surveillance.

Conclusions: Nosocomial sepsis constitutes a significant and often underestimated burden within the post-hospital sector. Delayed diagnosis, antimicrobial resistance, and incomplete mortality registration systems contribute to underestimation of its true impact. The integration of structured verbal autopsy with biomarker-based assessment represents a promising approach for improving cause-of-death attribution, strengthening epidemiological data, and informing more effective health policy and resource allocation strategies.