NCHS Data Brief ■ No. 62 ■ June 2011

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Disease Control and Prevention

National Center for Health Statistics

Key findings

Data from the National 

Hospital Discharge 

Survey, 2008

•	 The	number	and	rate	

per	10,000	population	of	

hospitalizations	for	septicemia	

or	sepsis	more	than	doubled	

from	2000	through	2008.

•	 The	hospitalization	rates	for	

septicemia	or	sepsis	in	2008	

were	similar	for	males	and	

females	and	increased	with	age.	

•	 Patients	under	age	65	and	

aged	65	and	over	who	were	

hospitalized	for	septicemia	

or	sepsis	in	2008	were	sicker	

and	stayed	longer	than	

those	hospitalized	for	other	

conditions.

•	 In	2008,	the	proportion	of	

hospitalized	patients	who	were	

discharged	to	other	short-stay	

hospitals	or	long-term	care	

institutions	was	higher	for	

those	with	septicemia	or	sepsis	

(36%)	than	for	those	with	other	

conditions	(14%).	Seventeen	

percent	of	septicemia	or	sepsis	

hospitalizations	ended	in	death,	

whereas	only	2%	of	other	

hospitalizations	did.	

Inpatient Care for Septicemia or Sepsis: A Challenge 

for Patients and Hospitals

Margaret Jean Hall, Ph.D.; Sonja N. Williams, M.P.H.; 

Carol J. DeFrances, Ph.D.; and Aleksandr Golosinskiy, M.S.

Septicemia	and	sepsis	are	serious	bloodstream	infections	that	can	rapidly	

become	life-threatening.	They	arise	from	various	infections,	including	those	of	

the	skin,	lungs,	abdomen,	and	urinary	tract	(1,2).	Patients	with	these	conditions	

are	often	treated	in	a	hospital’s	intensive	care	unit	(3).	Early	aggressive	

treatment	increases	the	chance	of	survival	(4).	In	2008,	an	estimated	$14.6	

billion	was	spent	on	hospitalizations	for	septicemia,	and	from	1997	through	

2008,	the	inflation-adjusted	aggregate	costs	for	treating	patients	hospitalized	

for	this	condition	increased	on	average	annually	by	11.9%	(5).

Despite	high	treatment	expenditures,	septicemia	and	sepsis	are	often	fatal	(6).	

Those	who	survive	severe	sepsis	are	more	likely	to	have	permanent	organ	

damage	(7),	cognitive	impairment,	and	physical	disability	(8).	Septicemia	is	a	

leading	cause	of	death	(9).	The	purpose	of	this	report	is	to	describe	the	most	

recent	trends	in	care	for	hospital	inpatients	with	these	diagnoses.	

Keywords: National Hospital Discharge Survey • hospitalization • health care 

utilization

Hospitalization rates for septicemia or sepsis more than 

doubled from 2000 through 2008.

Figure 1. Hospitalizations for and with septicemia or sepsis

NOTE: Significant linear trend from 2000 through 2008 for both categories.

SOURCE: CDC/NCHS, National Hospital Discharge Survey, 2000–2008.

0

10

20

30

40

50

Hospitalizations with septicemia or sepsis

Hospitalizations for septicemia or sepsis

2004 2005 2006 2007 2008

Year

2000 2001 2002 2003

Rate per 10,000 population

22.1

37.7

24.0

11.6
NCHS Data Brief ■ No. 62 ■ June 2011

■  2  ■

•	 Hospitalizations for septicemia or sepsis (as a first-listed or principal diagnosis) increased

from 326,000 in 2000 to 727,000 in 2008, and the rate of these hospitalizations more than

doubled from 11.6 per 10,000 population in 2000 to 24.0 per 10,000 population in 2008

(Figure 1). Overall hospitalizations did not increase during this period (10,11).

•	 Hospitalizations with septicemia or sepsis—as the first-listed, principal, or a secondary

diagnosis—increased from 621,000 in 2000 to 1,141,000 in 2008, and the rate of these

hospitalizations increased by 70% from 22.1 per 10,000 in 2000 to 37.7 per 10,000 in

2008 (Figure 1). This rate includes patients (a) hospitalized for septicemia or sepsis, (b)

hospitalized for another diagnosis but who had septicemia or sepsis at the time they were

admitted, and (c) who acquired septicemia or sepsis during their hospital stay.

Hospitalization rates for sepsis or septicemia were similar for males and 

females and increased with age. 

)LJXUH5DWHVRIKRVSLWDOL]DWLRQIRUVHSWLFHPLDRUVHSVLVE\VH[DQGDJH

127(65DWHVDUHVLJQLILFDQWO\KLJKHUIRUPDOHVDQGIHPDOHVLQHDFKVXFFHVVLYHDJHJURXS

6285&(&'&1&+61DWLRQDO+RVSLWDO'LVFKDUJH6XUYH\















$OODJHV 8QGHUDJH ± ± DQGRYHU

5DWHSHUSRSXODWLRQ

0DOH )HPDOH

$JHLQ\HDUV

 

 









 

•	 The rate of hospitalizations for septicemia or sepsis was much higher for those aged 65 and

over (122.2 per 10,000 population) than for those under age 65 (9.5 per 10,000 population).

•	 About two-thirds of patients hospitalized for septicemia or sepsis in 2008 were aged 65

and over and had Medicare as their expected source of payment (data not shown). This

proportion has been stable over the past decade.

•	 The septicemia or sepsis hospitalization rate for those aged 85 and over (271.2 per 10,000

population) was about 30 times the rate for those under age 65, and was more than four

times higher than the rate of 65.7 per 10,000 for the 65–74 age group (Figure 2).
NCHS Data Brief ■ No. 62 ■ June 2011

■  3  ■

Patients hospitalized for septicemia or sepsis were more severely ill than 

patients hospitalized for another diagnosis.

)LJXUH3HUFHQWDJHRIKRVSLWDOVWD\VZKHUHWKHSDWLHQWKDGVHYHQRUPRUHGLDJQRVHV



'LIIHUHQFHLVVWDWLVWLFDOO\VLJQLILFDQWDWWKHOHYHO

6285&(&'&1&+61DWLRQDO+RVSLWDO'LVFKDUJH6XUYH\











 6HSWLFHPLDRUVHSVLV 2WKHUFRQGLWLRQV



DQGRYHU 8QGHU

$JHLQ\HDUV



$OODJHV

3HUFHQWDJH













•	 For patients under age 65, those hospitalized for septicemia or sepsis were more than twice

as likely to have seven or more diagnoses than those hospitalized for other conditions

(Figure 3).

•	 For those aged 65 and over, those hospitalized for septicemia or sepsis were 26% more

likely to have seven or more diagnoses than those hospitalized for other conditions.

Patients hospitalized for septicemia or sepsis stayed longer than other 

inpatients.

•	 Those hospitalized for septicemia or sepsis had an average length of stay that was 75%

longer than those hospitalized for other conditions (Figure 4).

•	 Those under age 65 hospitalized for septicemia or sepsis had an average length of stay that

was more than double that of other hospitalizations.

•	 Those aged 65 and over hospitalized for septicemia or sepsis had an average length of stay

that was 43% higher than that of other patients.
NCHS Data Brief ■ No. 62 ■ June 2011

■  4  ■











 6HSWLFHPLDRUVHSVLVKRVSLWDOL]DWLRQV 2WKHUKRVSLWDOL]DWLRQV



DQGRYHU 8QGHU

$JHLQ\HDUV



$OODJHV















'LIIHUHQFHLVVWDWLVWLFDOO\VLJQLILFDQWDWWKHOHYHO

6285&(&'&1&+61DWLRQDO+RVSLWDO'LVFKDUJH6XUYH\

)LJXUH$YHUDJHOHQJWKRIVWD\IRUWKRVHKRVSLWDOL]HGIRUVHSWLFHPLDRUVHSVLVFRPSDUHGZLWKWKRVHKRVSLWDOL]HGIRURWKHU

FRQGLWLRQV /HQJWKRIVWD\LQGD\V

Patients hospitalized for septicemia or sepsis were more than eight times 

as likely to die during their hospitalization. 

Table. Hospitalizations for septicemia or sepsis compared with hospitalizations for other diagnoses, by discharge 

disposition, 2008

Characteristic Septicemia or sepsis Other diagnoses

Disposition Percent

Routine1 39 79

Transfer to other short-term care facility1 6 3

Transfer to long-term care institution1 30 10

Died during the hospitalization1 17 2

Other or not stated 8 6

Total 100 100

1

Difference is statistically significant at the 0.05 level.

SOURCE: CDC/NCHS, National Hospital Discharge Survey, 2008.

•	 Only 2% of hospitalizations in 2008 were for septicemia or sepsis, yet they made up 17% of

in-hospital deaths (data not shown).

•	 In-hospital deaths were more than eight times as likely among patients hospitalized

for septicemia or sepsis (17%) compared with other diagnoses (2%). In addition, those

hospitalized for septicemia or sepsis were one-half as likely to be discharged home, twice

as likely to be transferred to another short-term care facility, and three times as likely to be

discharged to long-term care institutions, as those with other diagnoses (Table).
NCHS Data Brief ■ No. 62 ■ June 2011

■  5  ■

•	 For those under age 65, 13% of those hospitalized for septicemia or sepsis died in the

hospital, compared with 1% of those hospitalized for other conditions (data not shown).

•	 For those aged 65 and over, 20% of septicemia or sepsis hospitalizations ended in death

compared with 3% for other hospitalizations (data not shown).

Summary

The hospitalization rate of those with a principal diagnosis of septicemia or sepsis more than

doubled from 2000 through 2008, increasing from 11.6 to 24.0 per 10,000 population. During

the same period, the hospitalization rate for those with septicemia or sepsis as a principal or as a

secondary diagnosis increased by 70% from 22.1 to 37.7 per 10,000 population. Reasons for these

increases may include an aging population with more chronic illnesses; greater use of invasive

procedures, immunosuppressive drugs, chemotherapy, and transplantation; and increasing

microbial resistance to antibiotics (3,6). Increased coding of these conditions due to greater

clinical awareness of septicemia or sepsis (12) may also have occurred during the period studied.

Septicemia or sepsis treatment involves caring for sicker patients who have longer inpatient

stays than those with other diagnoses. Total nationwide inpatient annual costs of treating those

hospitalized for septicemia have been rising and were estimated to be $14.6 billion in 2008

(5). Even with this expenditure, the death rate was high. Patients who do survive severe cases

are more likely to have negative long-term effects on health and on cognitive and physical

functioning (8).

The “Surviving Sepsis Campaign” was an international effort organized by physicians that

developed and promoted widespread adoption of practice improvement programs grounded in

evidence-based guidelines (12). The goal was to improve diagnosis and treatment of sepsis.

Included among the guidelines were sepsis screening for high-risk patients; taking bacterial

cultures soon after the patient arrived at the hospital; starting patients on broad-spectrum

intravenous antibiotic therapy before the results of the cultures are obtained; identifying

the source of infection and taking steps to control it (e.g., abscess drainage); administering

intravenous fluids to correct a loss or decrease in blood volume; and maintaining glycemic (blood

sugar) control (13). These and similar guidelines have been tested by a number of hospitals and

have shown potential for decreasing hospital mortality due to sepsis (12).

Tracking data included in this report over time will enable policymakers and health care

professionals to assess the effects of efforts to decrease disease burden and death from septicemia

and sepsis in the United States.

Definitions

Septicemia or sepsis: Are referred to as bloodstream infection or blood poisoning and are so

closely related that the terms have been used interchangeably in the past (14). Until October 1,

2002, both conditions were identified by a diagnosis code of 038, based on the International 

Classification of Diseases, Ninth Revision, Clinical Modification (ICD–9–CM) (15). After that

time, new ICD–9–CM codes for sepsis (995.91) and severe sepsis (995.92) were added to this

coding system making it possible to distinguish between septicemia and sepsis. To make the

definitions comparable over the entire period studied in this report, it was necessary to use code
NCHS Data Brief ■ No. 62 ■ June 2011

■  6  ■

038 for all years, and codes 995.91 and 995.92 for the years after they were added. For National

Hospital Discharge Survey (NHDS) data, this coding change was reflected in the data in the first

full calendar year after the codes were added (2003).

Hospitalization for septicemia or sepsis: Includes those admitted with a first-listed or principal

septicemia or sepsis diagnosis. In these cases, the main cause or reason for the hospitalization is

one of the ICD–9–CM codes listed above in the first-listed diagnostic field.

Hospitalization with septicemia or sepsis: Includes those with one or more of the ICD–9–CM

codes listed above in any of the seven diagnostic fields gathered for this survey. This includes

cases in which the septicemia or sepsis is one of the following: (a) the reason for the admission

(first-listed or principal), (b) present at admission but not the reason for admission, or (c) acquired

while in the hospital.

Rate: Refers to the number of hospitalizations per unit of population (i.e., per 10,000 population).

Using rates removes the influence of different population sizes (e.g., for males and females

in one year, or of different population sizes over multiple years) so that data can be compared

across these groups. For 2000–2008, rates were calculated using U.S. Census Bureau 2000-based

postcensal civilian population estimates.

Data source and methods

Data for this report are from NHDS, a national probability sample survey of discharges from

nonfederal short-stay hospitals or general hospitals in the United States, conducted annually by

the Centers for Disease Control and Prevention’s (CDC) National Center for Health Statistics

(NCHS), Division of Health Care Statistics (DHCS). NHDS uses a modified three-stage

design. Units selected at the first stage consist of either hospitals or geographic areas, such as

counties, groups of counties, or metropolitan statistical areas. Within a sampled geographic area,

hospitals are selected. At the last stage, systematic random sampling is used to select discharges

within sampled hospitals. Survey data on hospital discharges were obtained from the hospitals’

administrative data and are also used for billing purposes. These data are a very rich source of

utilization information; however, administrative data do not contain in-depth clinical information

and so are limited in their ability to address some medical care issues. Note that if an individual

is admitted to the hospital multiple times during the survey year, that individual will be counted

more than once in NHDS.

Because of the complex multistage design of NHDS, the survey data must be inflated or weighted

to produce national estimates. Estimates of inpatient care presented in this report exclude

newborns. More details about the design of NHDS have been published (10).

Trend data from the 2000–2008 NHDS were used for Figure 1. The other figures were based upon

the recently released 2008 NHDS data.

A weighted least squares regression method (16) was used to test the significance of the time

trends shown in Figure 1. Differences among the subgroups were evaluated with two-tailed t tests

using p < 0.05 as the level of significance. Terms that express differences such as higher, lower,

largest, smallest, leading, increased, or decreased, were only used when the differences were

statistically significant. When a comparison is described as similar it means that no statistically

significant difference was found. All comparisons reported in the text were statistically significant
NCHS Data Brief ■ No. 62 ■ June 2011

■  7  ■

unless otherwise indicated. Comparisons presented in figures or the Table but not mentioned

in the text may or may not be statistically significant. Data analyses were performed using the

statistical packages SAS version 9.2 (SAS Institute, Cary, N.C.) and SUDAAN version 10.0

(Research Triangle Institute, Research Triangle Park, N.C.).

About the authors

Margaret Jean Hall, Sonja N. Williams, Carol J. DeFrances, and Aleksandr Golosinskiy are with

CDC’s NCHS, DHCS.

References

1.	 MedlinePlus Medical Encyclopedia. Septicemia. U.S. National Library of Medicine. National

Institutes of Health. Available from: http://www.nlm.nih.gov/medlineplus/ency/article/001355.

htm.

2.	 MedlinePlus Medical Encyclopedia. Sepsis. U.S. National Library of Medicine. National

Institutes of Health. Available from: http://www.nlm.nih.gov/medlineplus/ency/article/000666.

htm.

3.	 National Institute of General Medical Sciences. National Institutes of Health. Sepsis fact

sheet. 2009. Available from: http://www.nigms.nih.gov/Publications/factsheet_sepsis.htm

[Accessed 11/16/10].

4.	 Mayo Clinic staff. Sepsis: Definition. Mayo Foundation for Medical Education and Research.

Available from: http://www.mayoclinic.com/print/sepsis/DS01004 [Accessed 11/16/10].

5.	 Agency for Healthcare Research and Quality. HCUP facts and figures: Statistics on hospitalbased care in the United States, 2008. Available from: http://www.hcup-us.ahrq.gov/reports/

factsandfigures/2008/TOC_2008.jsp.

6.	 Angus DC, Linde-Zwirble WT, Lidicker J, Clermont G, Carcillo J, Pinsky MR.

Epidemiology of severe sepsis in the United States: Analysis of incidence, outcome, and

associated costs of care. Crit Care Med 29(7):1303–10. 2001.

7.	 Chang HJ, Lynm C, Glass RM. Sepsis. JAMA 304(16):1856. 2010.

8.	 Iwashyna TJ, Ely EW, Smith DM, Langa KM. Long-term cognitive impairment and

functional disability among survivors of severe sepsis. JAMA 304(16):1787–94. 2010.

9.	 Xu JQ, Kochanek KD, Murphy SL, Tejada-Vera B. Deaths: Final data for 2007. National

vital statistics reports; vol 58 no 19. Hyattsville, MD: National Center for Health Statistics. 2010.

Available from: http://www.cdc.gov/nchs/data/nvsr/nvsr58/nvsr58_19.pdf.

10.	 Hall MJ, DeFrances CJ, Williams SN, et al. National Hospital Discharge Survey: 2007

summary. National health statistics reports; no 29. Hyattsville, MD: National Center for Health

Statistics. 2010. Available from: http://www.cdc.gov/nchs/data/nhsr/nhsr029.pdf.

11.	 Unpublished data from annual National Hospital Discharge Survey data files. 2000–2008.
NCHS Data Brief ■ No. 62 ■ June 2011

12.	 Levy MM, Dellinger RP, Townsend SR, Linde-Zwirble WT, Marshall

JC, Bion J, et al. The Surviving Sepsis Campaign: Results of an international

guideline-based performance improvement program targeting severe sepsis.

Intensive Care Med 36(2):222–31. 2010.

13.	 Dellinger RP, Levy MM, Carlet JM, Bion J, Parker MM, Jaeschke R, et

al. Surviving Sepsis Campaign: International guidelines for management of

severe sepsis and septic shock: 2008. Crit Care Med 36(1):296–327. 2008.

Erratum in Crit Care Med 36(4):1394–6. 2008.

14.	 Al-Khafaji AH, Sharma S, Eschun G. Multisystem organ failure of

sepsis. EMedicine Critical Care. Available from: http://emedicine.medscape.

com/article/169640-overview [Accessed 11/23/10].

15.	 U.S. Department of Health and Human Services. Centers for Disease

Control and Prevention and Centers for Medicare & Medicaid Services.

Official version. International Classification of Diseases, Ninth Revision,

Clinical Modification, sixth edition. DHHS Pub No. (PHS)06–1260. 2006.

16.	 Gillum BS, Graves EJ, Kozak LJ. Trends in hospital utilization: United

States, 1988–92. National Center for Health Statistics. Vital Health Stat

13(124). 1996. Available from: http://www.cdc.gov/nchs/data/series/sr_13/

sr13_124.pdf.

Suggested citation

Hall MJ, Williams SN, DeFrances CJ,

Golosinskiy A. Inpatient care for septicemia

or sepsis: A challenge for patients and

hospitals. NCHS data brief, no 62.

Hyattsville, MD: National Center for Health

Statistics. 2011.

Copyright information

All material appearing in this report is in

the public domain and may be reproduced

or copied without permission; citation as to

source, however, is appreciated.

National Center for Health 

Statistics

Edward J. Sondik, Ph.D., Director

Jennifer H. Madans, Ph.D., Associate 

Director for Science

Division of Health Care Statistics

Jane E. Sisk, Ph.D., Director

U.S. DEPARTMENT OF

HEALTH & HUMAN SERVICES

Centers for Disease Control and Prevention

National Center for Health Statistics

3311 Toledo Road

Hyattsville, MD 20782

OFFICIAL BUSINESS

PENALTY FOR PRIVATE USE, $300

To receive this publication regularly, contact the

National Center for Health Statistics by

calling 1–800–232–4636

E-mail: cdcinfo@cdc.gov

Internet: http://www.cdc.gov/nchs

FIRST CLASS MAIL 

POSTAGE & FEES PAID 

CDC/NCHS

PERMIT NO. G-284

ISSN 1941–4927 (Print ed.)

ISSN 1941–4935 (Online ed.)

DHHS Publication No. (PHS) 2011–1209

CS223969

T39347 (06/2011)