{
  "abstract": "Purpose: Corticosteroids are suggested for selected patients with septic shock, but their association with outcomes has not been specifically investigated in patients with hospital-acquired bloodstream infections (HA-BSI). We explored the association between hydrocortisone use and day-28 mortality in this population. Methods: Data from the prospective EUROBACT-2 study were used to assess the association between hydrocortisone use and day-28 mortality in ICU patients with HA-BSI and sepsis. Patients receiving hydrocortisone were compared with patients not receiving hydrocortisone. A 1:1 propensity score matching procedure was performed using nearest-neighbour matching without replacement and a caliper of 0.2 standard deviation of the logit propensity score, followed by multivariable logistic regression with cluster-robust standard errors by matched pair. Results: Among 2,401 analyzed patients, 608 (25%) received hydrocortisone during the HA-BSI episode. The final propensity score included age, sex, Charlson comorbidity score, ICU admission diagnosis, SOFA score without cardiovascular component, septic shock, country of inclusion, lactate at HA-BSI diagnosis, and ICU-acquired versus non-ICU-acquired HA-BSI. Matching yielded 521 pairs (1,042 patients). In the multivariable model, hydrocortisone use was associated with increased day-28 mortality in the overall matched cohort (OR 1.448; 95% CI 1.096–1.914; p = 0.009). This association was observed in patients with sepsis without shock (OR 1.697; 95% CI 1.051–2.740; p = 0.031) and in the female subgroup (OR 1.718; 95% CI 1.055–2.796; p = 0.030), but not in patients with septic shock or in those receiving norepinephrine-equivalent dose ≥0.25 µg/kg/min. Conclusion: Hydrocortisone use was not associated with improved day-28 survival in ICU patients with HA-BSI. In the matched analysis, hydrocortisone use was associated with higher day-28 mortality in the overall cohort, whereas no significant association was observed in patients with septic shock or high-dose norepinephrine. These findings are observational and hypothesis-generating and should not be interpreted causally.",
  "abstract_shown": true,
  "affiliations": [
    "Department of Anesthesiology and Intensive Care Unit, Hospital Nord, Assistance Publique Hôpitaux Universitaires de Marseille, Marseille, France",
    "Centre d’Etudes et de Recherches sur les services de santé et qualité de vie EA 3279, Aix Marseille Université, Marseille, France",
    "Intensive Care Unit, Redcliffe Hospital, Brisbane, Australia",
    "Queensland University of Technology, Brisbane, Queensland, Australia",
    "Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia",
    "Université de Paris, INSERM, IAME UMR 1137, Paris, France",
    "ICUREsearch, Biometry, Fontaine, France",
    "Infection Antimicrobials Modeling Evolution U 1137, INSERM, Université Paris-Cité, Paris, France",
    "Infection Control Program and WHO Collaborating Centre on Patient Safety, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland",
    "Medical and Infectious Diseases Intensive Care Unit, AP-HP, Bichat-Claude Bernard University Hospital, Paris, France",
    "OUTCOME REA network, Drancy, France"
  ],
  "article_type": "Research Article",
  "arxiv": null,
  "author_total": 11,
  "authors": [
    {
      "affs": [
        0
      ],
      "name": "Gary Duclos"
    },
    {
      "affs": [
        1
      ],
      "name": "Mohamed Boucekine"
    },
    {
      "affs": [
        2
      ],
      "name": "Alexis Tabah"
    },
    {
      "affs": [
        3
      ],
      "name": "Stéphane Ruckly"
    },
    {
      "affs": [
        4
      ],
      "name": "Niccolò Buetti"
    },
    {
      "affs": [
        5
      ],
      "name": "Jean François Timsit"
    },
    {
      "affs": [
        6
      ],
      "name": "Marc Leone"
    },
    {
      "affs": [
        7
      ],
      "name": "EUROBACT-2 Study Group"
    },
    {
      "affs": [
        8
      ],
      "name": "ESICM"
    },
    {
      "affs": [
        9
      ],
      "name": "ESCMID ESGCIP"
    },
    {
      "affs": [
        10
      ],
      "name": "the OUTCOMEREA Network"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/dmjsmrdxyxe5e.bib",
  "cited_by": 0,
  "doi": "10.1371/journal.pone.0356721",
  "fulltext_url": null,
  "id": "dmjsmrdxyxe5e",
  "issns": [
    "1932-6203"
  ],
  "landing_url": "https://doi.org/10.1371/journal.pone.0356721",
  "language": null,
  "licence": "CC-BY-4.0",
  "licence_label": "CC BY 4.0",
  "licence_source": "journal",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "openalex",
      "2713|Sepsis Diagnosis and Treatment"
    ],
    [
      "plos",
      "/Biology and life sciences/Anatomy/Body fluids/Blood"
    ],
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      "plos",
      "/Biology and life sciences/Biochemistry/Hormones/Catecholamines/Norepinephrine"
    ],
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      "plos",
      "/Biology and life sciences/Biochemistry/Hormones/Lipid hormones/Cortisol"
    ],
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      "/Biology and life sciences/Biochemistry/Hormones/Steroid hormones/Cortisol"
    ],
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      "plos",
      "/Medicine and health sciences/Anatomy/Body fluids/Blood"
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      "/Medicine and health sciences/Clinical medicine/Signs and symptoms/Sepsis"
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      "/Medicine and health sciences/Health care/Health care facilities/Hospitals/Intensive care units"
    ],
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      "/Medicine and health sciences/Hematology/Bloodstream infections"
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      "/Medicine and health sciences/Medical conditions/Respiratory disorders/Respiratory infections"
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      "/Medicine and health sciences/Pulmonology/Respiratory disorders/Respiratory infections"
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      "/Physical sciences/Chemistry/Chemical compounds/Organic compounds/Amines/Catecholamines/Norepinephrine"
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  "pdf_url": "https://journals.plos.org/plosone/article/file?id=10.1371/journal.pone.0356721&type=printable",
  "pmcid": null,
  "pmid": null,
  "published": "2026-09-15",
  "publisher": "Public Library of Science",
  "ris": "https://research.draconitic.com/paper/dmjsmrdxyxe5e.ris",
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  "subjects": [
    {
      "field": "medicine",
      "origin": "plos:anatomy",
      "subfield": "physiology"
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  "title": "Association between hydrocortisone use and outcomes in sepsis patients with hospital-acquired bloodstream infections: An ancillary analysis of the EUROBACT-2 cohort",
  "title_text": "Association between hydrocortisone use and outcomes in sepsis patients with hospital-acquired bloodstream infections: An ancillary analysis of the EUROBACT-2 cohort",
  "type": "peer-reviewed",
  "updated_at": "2026-10-30T12:17:49Z",
  "url": "https://research.draconitic.com/paper/dmjsmrdxyxe5e",
  "venue": "PLOS One",
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}