Hospital-Acquired Bloodstream Infections in critically ill Patients with Solid Organ Transplants: An ancillary study from the EUROBACT-2 database - 07/11/26

Doi : 10.1016/j.aicoj.2026.100201

Marc Doman ^a, François Barbier ^b, Alexis Tabah ^c,^d,^e, Niccolò Buetti ^f,^g, Murat Akova ^h, Matteo Bassetti ⁱ, Stephane Ruckly ^g,^j, Marc Leone ^k, Michael Thy ^a,^g, Jean-François Timsit ^a,^g, Etienne de Montmollin ^a,^g,⁎

on behalf of the EUROBACT-2 Study Group, the European Society of Intensive Care Medicine (ESICM), the European Society of Clinical Microbiology

the Infectious Diseases (ESCMID) Study Group for Infections in Critically Ill Patients (ESGCIP), and the OUTCOMEREA Network ^¹
The collaborators list is on the appendix.

^a APHP, Department of Intensive Care Medicine, Bichat-Claude Bernard Hospital, Paris, France

^b Medical ICU, Orléans University Hospital, Orléans, France

^c Intensive Care Unit, Redcliffe Hospital, Brisbane, Australia

^d Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia

^e Queensland University of Technology, Brisbane, Queensland, Australia

^f Infection Control Program and WHO Collaborating Centre, Faculty of Medicine, Service PCI, Geneva University Hospitals, Geneva, Switzerland

^g Université Paris Cité, INSERM UMR 1137, F-75018 Paris, France

^h Department of Infectious Diseases, Hacettepe University School of Medicine, Ankara, Turkey

ⁱ Infectious Diseases Clinic, Department of Health Sciences, University of Genoa and Ospedale Policlinico San Martino, Genoa, Italy

^j OUTCOMEREA Research Group, Drancy, France

^k Department of Anaesthesia and Intensive Care Unit, Nord Hospital, Assistance Publique Hôpitaux de Marseille, Aix Marseille Université, Marseille, France

^⁎ Corresponding author.

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Abstract

Background

Hospital-acquired bloodstream infections (HA-BSI) carry high mortality in intensive care units (ICUs). Solid organ transplant (SOT) recipients are often presumed to have worse outcomes and more resistant pathogens, but data focusing on ICU patients with HA-BSI remain limited.

Methods

We performed an ancillary analysis of the EUROBACT-2 cohort, restricted to centers enrolling at least one SOT recipient. Patients with hospital-acquired bloodstream infection (HA-BSI) were classified as non-immunocompromised, SOT recipients, or with another immunosuppression. The primary objective was to assess whether SOT status was independently associated with 28-day mortality. Secondary objectives were to compare day-7 and day-28 outcomes and to describe microbiological characteristics, including resistant phenotypes such as difficult-to-treat (DTR) Gram-negative bacteria, across groups. For all outcomes, day 0 was the day of HA-BSI onset. The association between immune status and 28-day mortality was assessed using a center-stratified Cox model censored at day 28 and adjusted for pre-specified confounders.

Results

Among 613 patients, 378 were non-immunocompromised, 68 were SOT recipients, and 167 had another immunosuppression. The SOFA score at HA-BSI onset was 8 [5–11], 9 [6–12] and 9 [6–13], respectively (p=0.02). Day-28 mortality was 41.0%, 36.8% and 48.5%, respectively (p=0.24). DTR Gram-negative pathogens accounted for 24.3%, 13.8%, and 17.3% (p=0.22) of evaluable Gram-negative episodes, respectively. In adjusted analyses, immune status was associated with 28-day mortality (global p=0.046): HR was 0.87 (95% CI 0.54–1.38) for SOT recipients and 1.39 (95% CI 1.04–1.86) for other immunocompromised patients, compared with non-immunocompromised patients.

Conclusions

In ICU patients with HA-BSI, we found no evidence that SOT recipients had higher 28-day mortality or a more resistant microbiological profile than non-immunocompromised patients, although clinically relevant differences cannot be excluded given the limited number of SOT recipients. Other immunocompromised patients had a higher adjusted 28-day mortality.

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Keywords : Sepsis, Bacteremia, Healthcare associated infections, Intensive Care, Organ transplantation, Immunosuppressive agents