Patients with transplantation have reduced mortality in bacteraemia: Analysis of data from a randomised trial

Hamilton, Fergus, Evans, Rebecca, Ghazal, Peter ORCID: https://orcid.org/0000-0003-0035-2228 and MacGowan, Alasdair 2022. Patients with transplantation have reduced mortality in bacteraemia: Analysis of data from a randomised trial. Journal of Infection 85 (1) , pp. 17-23. 10.1016/j.jinf.2022.05.014

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Abstract

Objectives Infection remains a major complication of organ transplantation. Paradoxically, epidemiological studies suggest better survival from serious infection. We analysed the relationship between organ transplantation and short -term mortality of patients with bloodstream infection. Methods Data on transplantation status was extracted from a large prospective, multi-centre clinical trial in bloodstream infection. Logistic regression for 28-day mortality was performed on the whole cohort and a propensity-matched cohort (3:1). Infective pathogen, focus of infection, and clinical variables were included in the model. Mediation analysis was performed on clinical variables to explore causation. Results 4,178 participants were included in the full cohort, with 868 in the matched cohort, of which 217 received an organ transplant. Haematopoietic stem cell transplants (HSCT) were the most common transplant (n = 99), followed by kidney (n = 70). The most common pathogens were staphylococci and Enterobacterales. Transplantation status was associated with a reduced mortality in both the whole (Odds Ratio, OR 0.53; 95% CI 0.28, 0.77) and matched (OR 0.55, 95% CI 0.34, 0.90) cohort, while steroid use was robustly associated with increased mortality OR 4.4 (95% CI 3.12, 6.20) in the whole cohort and OR 5.24 (95% CI 2.79, 9.84) in the matched cohort. There was no interaction between steroid use and transplant status, so transplant patients on steroids generally had increased mortality relative to those without either. Conclusions Organ transplantation is associated with a near halving of short term mortality in bloodstream infection, including a cohort matched for comorbidities, infective pathogen and focus. Steroid usage is associated with increased mortality regardless of transplant status. Understanding the mechanism and causation of this mortality benefit should be a focus of future research.

Item Type:	Article
Date Type:	Publication
Status:	Published
Schools:	Medicine
Additional Information:	License information from Publisher: LICENSE 1: URL: http://creativecommons.org/licenses/by-nc-nd/4.0/, Start Date: 2023-06-09
Publisher:	British Infection Association
ISSN:	0163-4453
Date of First Compliant Deposit:	17 June 2022
Date of Acceptance:	17 May 2022
Last Modified:	08 May 2023 13:56
URI:	https://orca.cardiff.ac.uk/id/eprint/150467

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