Hospital Acquired Infections Among Solid Organ Transplant Recipients Hospitalized in Intensive Care Unit (2018–2024): A Study of the GiViTI Group

Abstract

Introduction: Limited data exist regarding the burden of intensive care unit (ICU)-acquired infections in the early post-solid organ transplant (SOT) period, particularly in multidrug resistant organisms-endemic settings. This study aims at describing the epidemiology, clinical characteristics, and outcomes of patients who developed an ICU-acquired infection following a SOT procedure in Italy from 2018 to 2024. Methods: A multicenter, retrospective study was conducted within the Italian PROSAFE project across 31 ICUs from 2018 to 2024. All adult patients admitted to ICU during the same hospitalization as their organ transplant procedure were included. Bloodstream infections, ventilator associated pneumonia, intra-abdominal infections, and urinary tract infections occurring more than 48 h after ICU admission were retrieved. Results: Among 2210 SOT recipients, 154 (6.9%) developed 193 ICU-acquired infections. Ventilator associated pneumonia was the most frequent (74, 38.3%), followed by bloodstream infections (56, 29%). Multidrug resistant organisms were identified in 34/87 (39%) isolates with available antibiogram. ICU-acquired infections were associated with significantly higher intra-ICU mortality (35/154, 22.4% vs. 49/2056, 2.4%; p < 0.001) and longer ICU stays (24 vs. 4 days; p < 0.001). Patients with infections due to multidrug resistant organisms showed higher mortality and length of stay. Conclusions: ICU-acquired infections occurred in nearly 7% of SOT recipients admitted to ICU following a SOT procedure, with a significant contribute of multidrug resistant organisms. These infections were associated with striking differences in mortality and length of stay. Finally, this study suggested that patients with MDRO infections showed trends toward higher mortality and length of stay.