Epidemiology and risk factors for nosocomial bloodstream infections in solid organ transplants over a 10‐year period

Background Bloodstream infections ( BSI s) are a leading cause of morbidity and mortality in solid organ transplantation ( SOT ). We sought to determine the types of nosocomial BSI s and risk factors for them in SOT . Methods Prospectively collected databases of all SOT and nosocomial BSI s occurring at our institution for a 10‐year period were reviewed. Results From 2003–2012, we observed 157 nosocomial BSI episodes in 2257 SOT s, the majority of which were caused by staphylococci and enterococci (67.5%). The most common sources of BSI were central line, organ space, respiratory, and gastrointestinal. Kidney transplant patients had the lowest risk of acquiring a BSI compared with other SOT types. Lung transplant patients were at increased risk of methicillin‐resistant Staphylococcus aureus BSI and heart transplant patients were at increased risk of a Candida albicans BSI , when compared to other organ transplant types. When coagulase‐negative Staphylococcus (Co NS ) or C. albicans was isolated, the central line was most often the source. The implementation of central‐line bundles during the study period correlated temporally with a decreased rate of Co NS BSI . Over the 10‐year period, vancomycin‐resistant enterococci became the most common enterococcal BSI . Donor‐positive cytomegalovirus status was associated with an increased risk of BSI , when compared to donor‐negative patients. Conclusions This study demonstrates the common sources, risk factors, and causative organisms of BSI , which can guide empiric antibiotic choices, and highlights areas where preventative interventions could be targeted to prevent nosocomial BSI in SOT .