New antipsychotic prescription and recurrent infections among adult sepsis survivors: A population-based cohort study.

Purpose: Antipsychotic agents, which may increase the risk of infection through dopaminergic dysregulation, are prescribed to a fraction of patients following critical illness. We compared the rate of recurrent sepsis among patients who filled a prescription for antipsychotics with high- or low-D affinity.

Methods: Population-based cohort with active comparator design. We included sepsis survivors older than 65 years with intensive care unit admission and new prescription of antipsychotics in Ontario 2008-2019. The primary outcome were recurrent sepsis episodes within 1 year of follow-up. Patients who filled a prescription within 30 days of hospital discharge for high-D affinity antipsychotics (e.g., haloperidol) were compared with patients who filled a prescription within 30 days of hospital discharge for low-D affinity antipsychotics (e.g., quetiapine). Multivariable zero-inflated Poisson regression models with robust standard errors adjusting for confounding at baseline were used to estimate incidence rate ratios (IRR) and 95% confidence intervals (CI).

Results: Overall, 1879 patients filled a prescription for a high-D and 1446 patients filled a prescription for a low-D affinity antipsychotic. Patients who filled a prescription for a high-D affinity antipsychotic did not present a higher rate of recurrent sepsis during 1 year of follow-up, compared with patients who filled a prescription for a low-D affinity antipsychotic (IRR: 1.12; 95% CI: 0.94, 1.35).

Conclusions: We did not find conclusive evidence of a higher rate of recurrent sepsis associated with the prescription of high-D affinity antipsychotics (compared with low-D affinity antipsychotics) by 1 year of follow-up in adult sepsis survivors with intensive care unit admission.