Etiology and Outcomes of Bloodstream Infections by Immunosuppression Type: A Population-Based Laboratory Surveillance Study.
6 affiliations
- 1Division of Infection Medicine, Department of Clinical Sciences, Faculty of Medicine, Lund University, Lund, Sweden.
- 2Department of Infectious Diseases, Helsingborg Hospital, Helsingborg, Sweden.
- 3Clinical Infection Medicine, Department of Translational Medicine, Lund University, Malmö, Sweden.
- 4Department of Clinical Microbiology, Skåne University Hospital, Lund, Sweden.
- 5Department of Infectious Diseases, Skåne University Hospital, Lund, Sweden.
- 6Department of Infectious Diseases, Skåne University Hospital, Malmö, Sweden.
Abstract
Background
An increasing proportion of the population receives immunosuppressive treatment. There is a lack of guidelines for bloodstream infections (BSIs) in this group. This study aims to provide a comprehensive analysis of the etiology and outcomes in BSI associated with underlying immunosuppression.Methods
This population-based laboratory surveillance study included all positive blood cultures in southern Sweden, from 2013 through 2023. Immunosuppression was defined using diagnostic codes, medications, and laboratory data. We defined 6 categories of immunosuppression: antineoplastic treatment, neutropenia, immunosuppressant medication, organ transplants, primary immunodeficiency, and human immunodeficiency virus infection.Results
In total, 8058 of 47 552 (16.9%) BSI episodes were associated with underlying immunosuppression. This proportion increased over time (rate ratio, 1.019 per year [95% confidence interval {CI}, 1.012-1.027], P < .001). Immunosuppression was associated with a higher degree of Enterococcus faecium (odds ratio [OR], 3.16 [95% CI, 2.63-3.78]) and Pseudomonas spp (OR, 2.51 [95% CI, 2.16-2.91]) etiology. Intrinsic cephalosporin resistance was more frequent in BSI episodes with underlying immunosuppression (OR, 1.45 [95% CI, 1.36-1.55]). The 30-day mortality rate was higher in BSI episodes with underlying immunosuppression, at 17.9% (1439/8044), compared to 12.5% (4880/39 089) in episodes without immunosuppression (OR, 1.54 [95% CI, 1.45-1.64]).Conclusions
This study provides an updated summary of etiology and outcomes in BSI associated with immunosuppression. Underlying immunosuppression is increasingly prevalent among patients with BSI and is associated with resistance to cephalosporins and increased short-term mortality. Clinical guidelines for the management of BSI in immunosuppressed patients are warranted.
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BibTeX
@article{ljungquist2026etiology,
title = {{Etiology and Outcomes of Bloodstream Infections by Immunosuppression Type: A Population-Based Laboratory Surveillance Study.}},
author = {Oskar Ljungquist and Fredrik Resman and Karl Oldberg and Anna Bläckberg and Torgny Sunnerhagen and Gustav Torisson},
journal = {Open forum infectious diseases},
year = {2026},
month = oct,
doi = {10.1093/ofid/ofag655},
url = {https://europepmc.org/article/MED/42910401},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - Etiology and Outcomes of Bloodstream Infections by Immunosuppression Type: A Population-Based Laboratory Surveillance Study.
AU - Oskar Ljungquist
AU - Fredrik Resman
AU - Karl Oldberg
AU - Anna Bläckberg
AU - Torgny Sunnerhagen
AU - Gustav Torisson
PY - 2026
DA - 2026/10/21
JO - Open forum infectious diseases
DO - 10.1093/ofid/ofag655
UR - https://europepmc.org/article/MED/42910401
AB - Background An increasing proportion of the population receives immunosuppressive treatment. There is a lack of guidelines for bloodstream infections (BSIs) in this group. This study aims to provide a comprehensive analysis of the etiology and outcomes in BSI associated with underlying immunosuppression.Methods This population-based laboratory surveillance study included all positive blood cultures in southern Sweden, from 2013 through 2023. Immunosuppression was defined using diagnostic codes, medications, and laboratory data. We defined 6 categories of immunosuppression: antineoplastic treatment, neutropenia, immunosuppressant medication, organ transplants, primary immunodeficiency, and human immunodeficiency virus infection.Results In total, 8058 of 47 552 (16.9%) BSI episodes were associated with underlying immunosuppression. This proportion increased over time (rate ratio, 1.019 per year [95% confidence interval {CI}, 1.012-1.027], P < .001). Immunosuppression was associated with a higher degree of Enterococcus faecium (odds ratio [OR], 3.16 [95% CI, 2.63-3.78]) and Pseudomonas spp (OR, 2.51 [95% CI, 2.16-2.91]) etiology. Intrinsic cephalosporin resistance was more frequent in BSI episodes with underlying immunosuppression (OR, 1.45 [95% CI, 1.36-1.55]). The 30-day mortality rate was higher in BSI episodes with underlying immunosuppression, at 17.9% (1439/8044), compared to 12.5% (4880/39 089) in episodes without immunosuppression (OR, 1.54 [95% CI, 1.45-1.64]).Conclusions This study provides an updated summary of etiology and outcomes in BSI associated with immunosuppression. Underlying immunosuppression is increasingly prevalent among patients with BSI and is associated with resistance to cephalosporins and increased short-term mortality. Clinical guidelines for the management of BSI in immunosuppressed patients are warranted.
SN - 2328-8957
ER -