{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T20:26:03Z","timestamp":1790022363926,"version":"4.0.1"},"reference-count":13,"publisher":"Public Library of Science (PLoS)","issue":"9","license":[{"start":{"date-parts":[[2025,9,24]],"date-time":"2025-09-24T00:00:00Z","timestamp":1758672000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Background<\/jats:title>\n<jats:p>Immunocompromised patients with sepsis face higher mortality than immunocompetent individuals. However, data on bloodstream infections (BSIs) and sepsis among critically ill immunocompromised (CII) patients remain limited. We aimed to describe the epidemiology, outcomes, and mortality risk factors of BSIs in this population.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Methods<\/jats:title>\n<jats:p>We conducted a retrospective cohort study of CII patients admitted to the medical ICU between January 2022 and December 2023 with suspected sepsis or septic shock. Patients with BSIs confirmed by positive blood cultures were identified. Propensity score matching (1:1) without replacement was used to create comparable groups for Cox regression analysis of 30-day all-cause mortality.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Results<\/jats:title>\n<jats:p>Among 211 CII patients (mean age (SD) 61\u2009(16) years, 57% male), 85 (40.3%) had BSIs. The median SOFA and APACHE II scores were 7 (IQR 4\u201311) and 16 (IQR 14\u201320), respectively. Immunosuppression was due to hematologic malignancy (37.4%), solid tumors (27.0%), autoimmune diseases (19.0%), solid organ transplantation (5.7%), and other causes (10.4%). Gram-negative rods predominated (65.9%), notably <jats:italic><jats:italic>P. aeruginosa<\/jats:italic><\/jats:italic> (17%), <jats:italic><jats:italic>E. coli<\/jats:italic><\/jats:italic> (17%), and <jats:italic><jats:italic>K. pneumoniae<\/jats:italic><\/jats:italic> (14%). The overall 30-day mortality rate was 48.8%. In the matched cohort (n\u2009=\u2009170), higher SOFA scores [HR 1.12; 95% CI, 1.04\u20131.20; p\u2009=\u20090.003] and lactate &gt;4 mmol\/L [HR 1.91; 95% CI, 1.06\u20133.42; p\u2009=\u20090.031] were associated with increased mortality. Underlying COPD\/asthma was associated with lower mortality [HR 0.20; 95% CI, 0.06\u20130.66; p\u2009=\u20090.009].<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Conclusion<\/jats:title>\n<jats:p>BSIs are frequent in CII patients and linked to high mortality. Severity of illness and hyperlactatemia predict poor outcomes, while preexisting pulmonary disease may offer a survival benefit.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0332807","type":"journal-article","created":{"date-parts":[[2025,9,24]],"date-time":"2025-09-24T17:36:33Z","timestamp":1758735393000},"page":"e0332807","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":4,"title":["Clinical characteristics, risk factors and outcome of critically ill immunocompromised patients with bloodstream infections and sepsis"],"prefix":"10.1371","volume":"20","author":[{"given":"Nirusdee","family":"Vonineng","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1754-0962","authenticated-orcid":true,"given":"Yuda","family":"Sutherasan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0930-8936","authenticated-orcid":true,"given":"Jackrapong","family":"Bruminhent","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2025,9,24]]},"reference":[{"issue":"11","key":"pone.0332807.ref001","doi-asserted-by":"crossref","first-page":"1181","DOI":"10.1007\/s00134-021-06506-y","article-title":"Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021","volume":"47","author":"L Evans","year":"2021","journal-title":"Intensive 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with type 2 diabetes mellitus, pancytopenia, and bronchopneumonia","volume":"59","author":"BM Liu","year":"2021","journal-title":"J Clin Microbiol"},{"key":"pone.0332807.ref006","doi-asserted-by":"crossref","first-page":"114","DOI":"10.1016\/j.jcrc.2021.03.014","article-title":"Bacteremia in critically ill immunocompromised patients with acute hypoxic respiratory failure: A post-hoc analysis of a prospective multicenter multinational cohort","volume":"64","author":"A Van de Louw","year":"2021","journal-title":"J Crit Care"},{"issue":"1","key":"pone.0332807.ref007","doi-asserted-by":"crossref","first-page":"285","DOI":"10.1186\/s13054-024-05073-0","article-title":"Septic shock in the immunocompromised cancer patient: a narrative review","volume":"28","author":"JL Nates","year":"2024","journal-title":"Crit Care"},{"issue":"3","key":"pone.0332807.ref008","doi-asserted-by":"crossref","first-page":"352","DOI":"10.1016\/j.amjms.2020.10.011","article-title":"Epidemiology, Risk Factors, and Outcome of Bloodstream Infection Within the First Year After Kidney Transplantation","volume":"361","author":"N Siritip","year":"2021","journal-title":"Am J Med Sci"},{"issue":"3","key":"pone.0332807.ref009","doi-asserted-by":"crossref","DOI":"10.1128\/asmcr.00060-24","article-title":"Identification and characterization of an invasive, hyper-aerotolerant Campylobacter jejuni strain causing bacteremia in a pediatric leukemia patient","volume":"1","author":"X Zeng","year":"2025","journal-title":"ASM Case Rep"},{"issue":"6","key":"pone.0332807.ref010","doi-asserted-by":"crossref","first-page":"726","DOI":"10.1007\/s12185-023-03671-2","article-title":"Risk factors associated with infection-related mortality of Bacillus cereus bacteremia in hematologic disorders","volume":"118","author":"T Shimada","year":"2023","journal-title":"Int J Hematol"},{"issue":"7","key":"pone.0332807.ref011","doi-asserted-by":"crossref","first-page":"577","DOI":"10.3390\/jof7070577","article-title":"Species distribution, antifungal susceptibility, and molecular epidemiology of Candida species causing candidemia in a tertiary care hospital in Bangkok, Thailand","volume":"7","author":"S Boonsilp","year":"2021","journal-title":"J Fungi (Basel)"},{"issue":"11","key":"pone.0332807.ref012","doi-asserted-by":"crossref","DOI":"10.1093\/ofid\/ofab529","article-title":"The Performance of Sepsis-3 Criteria to Predict Mortality Among Patients With Hematologic Malignancy and Post-transplant who Have Suspected Infection","volume":"8","author":"O Henig","year":"2021","journal-title":"Open Forum Infect Dis"},{"issue":"1","key":"pone.0332807.ref013","doi-asserted-by":"crossref","first-page":"435","DOI":"10.1186\/s12890-023-02729-5","article-title":"Association between chronic obstructive pulmonary disease and 28-day mortality in patients with sepsis: a retrospective study based on the MIMIC-III database","volume":"23","author":"Y Chen","year":"2023","journal-title":"BMC Pulm Med"}],"container-title":["PLOS One"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0332807","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,9,24]],"date-time":"2025-09-24T17:36:35Z","timestamp":1758735395000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0332807"}},"subtitle":[],"editor":[{"given":"Benjamin M.","family":"Liu","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2025,9,24]]},"references-count":13,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2025,9,24]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0332807","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,9,24]]}}}