Pathophysiological Responses to Bloodstream Infection in Critically Ill Transplant Recipients Compared With...

Area of Science:

• Critical Care Medicine
• Infectious Diseases
• Transplant Surgery

Background:

• Bloodstream infections (BSI) are challenging to diagnose in immunosuppressed transplant recipients.
• Systemic inflammatory response syndrome (SIRS) criteria may require modification for this population.

Purpose of the Study:

• Compare BSI responses in critically ill transplant and non-transplant recipients.
• Modify SIRS criteria for improved BSI screening in transplant patients.

Main Methods:

• Analyzed large datasets from intensive care units (ICU) at UVA and Pitt.
• Developed multivariable models using 27 clinical variables.
• Employed Bayesian inference to adjust SIRS criteria for transplant recipients.

Main Results:

• Univariate responses to BSI were comparable between transplant and non-transplant recipients.
• Models demonstrated good predictive performance (AUCs ranging from 0.75 to 0.82).
• An upper temperature threshold of 37.5°C improved SIRS reclassification for transplant recipients.

Conclusions:

• Critically ill transplant and non-transplant recipients exhibit similar responses to BSI.
• Modified SIRS criteria, specifically a 37.5°C fever threshold, enhance BSI screening accuracy in transplant recipients.