837: Clinical Characteristics and Treatment Patterns Among Younger Versus Older Adults With Sepsis

Introduction: While sepsis occurs across the age spectrum, it is rare among younger adults. We therefore hypothesized that presenting features and treatment patterns may differ between younger vs older adults because of the relative rarity of sepsis in younger adults. Methods: We conducted a retrospective cohort study of adult patients (age≥18 years) hospitalized with community-onset sepsis between January 2022-December 2024 at 67 hospitals participating in the Michigan Hospital Medicine Safety Consortium’s sepsis initiative (HMS-Sepsis). Granular clinical data were abstracted into the centralized HMS-sepsis registry by trained abstractors at each hospital. We compared presenting features and receipt of guideline-concordant care between younger (age 18-26 years) vs. older adults (age ≥27 years) using t-test and Chi-squared tests, as appropriate. Results: Among 44,253 community-onset sepsis hospitalizations in 2022-2024, 538 (1.2%) occurred in younger adults. Compared to older adults, younger adults were more likely to present with chills/rigors (38.1% vs 27.0%, p< 0.01) and fever (69.5% vs. 50.2%, p< 0.01) and had fewer acute organ dysfunctions on presentation (median 1 IQR 1-2 vs 2 IQR 1-3, p< 0.01). Overall compliance with the HMS-sepsis early management bundle was similar between younger versus older adults (31.3% vs. 27.7%; p=0.06). However, younger adults were less likely to have timely lactate measurement (69.1% vs 74.3%, p< 0.01); less likely to have blood culture collection (63.3% vs 71.1%, p< 0.01); and less likely to have timely antibiotic administration when hypotensive (58.0% vs 67.0%, p=0.11). By contrast, younger adults were more likely to have ≥30ml/kg fluid resuscitation when indicated (75.9% vs 63.5%; p< 0.01). Conclusions: Despite a higher prevalence of classical infectious symptoms at presentation, younger adults with community-onset sepsis were less likely to receive sepsis diagnostics including lactate and blood culture, may be less likely to receive timely antibiotics, but more likely receive fluid resuscitation. Efforts to improve use of sepsis diagnostics may be valuable for younger adults.