{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T18:04:01Z","timestamp":1789495441197,"version":"build-2803163510"},"reference-count":17,"publisher":"Public Library of Science (PLoS)","issue":"9","license":[{"start":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T00:00:00Z","timestamp":1789430400000},"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>Purpose<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>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\u20131.914; p\u2009=\u20090.009). This association was observed in patients with sepsis without shock (OR 1.697; 95% CI 1.051\u20132.740; p\u2009=\u20090.031) and in the female subgroup (OR 1.718; 95% CI 1.055\u20132.796; p\u2009=\u20090.030), but not in patients with septic shock or in those receiving norepinephrine-equivalent dose \u22650.25 \u00b5g\/kg\/min.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec004\">\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pone.0356721","type":"journal-article","created":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T17:24:01Z","timestamp":1789493041000},"page":"e0356721","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["Association between hydrocortisone use and outcomes in sepsis patients with hospital-acquired bloodstream infections: An ancillary analysis of the EUROBACT-2 cohort"],"prefix":"10.1371","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3305-0077","authenticated-orcid":true,"given":"Gary","family":"Duclos","sequence":"first","affiliation":[{"name":"Hospital Nord, Assistance Publique H\u00f4pitaux Universitaires de Marseille","place":["Marseille, France"],"department":["Department of Anesthesiology and Intensive Care Unit"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohamed","family":"Boucekine","sequence":"additional","affiliation":[{"name":"Centre d\u2019Etudes et de Recherches sur les services de sant\u00e9 et qualit\u00e9 de vie EA 3279, Aix Marseille Universit\u00e9","place":["Marseille, France"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexis","family":"Tabah","sequence":"additional","affiliation":[{"name":"Redcliffe Hospital","place":["Brisbane, Australia"],"department":["Intensive Care Unit"]},{"name":"Queensland University of Technology","place":["Brisbane, Queensland, Australia"]},{"name":"The University of Queensland","place":["Brisbane, Queensland, Australia"],"department":["Faculty of Medicine"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"St\u00e9phane","family":"Ruckly","sequence":"additional","affiliation":[{"name":"Universit\u00e9 de Paris, INSERM, IAME UMR 1137","place":["Paris, France"]},{"name":"ICUREsearch, Biometry","place":["Fontaine, France"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Niccol\u00f2","family":"Buetti","sequence":"additional","affiliation":[{"name":"Infection Antimicrobials Modeling Evolution U 1137, INSERM, Universit\u00e9 Paris-Cit\u00e9","place":["Paris, France"]},{"name":"Infection Control Program and WHO Collaborating Centre on Patient Safety, Geneva University Hospitals and Faculty of Medicine","place":["Geneva, Switzerland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jean Fran\u00e7ois","family":"Timsit","sequence":"additional","affiliation":[{"name":"AP-HP, Bichat-Claude Bernard University Hospital","place":["Paris, France"],"department":["Medical and Infectious Diseases Intensive Care Unit"]},{"name":"OUTCOME REA network","place":["Drancy, France"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marc","family":"Leone","sequence":"additional","affiliation":[{"name":"Hospital Nord, Assistance Publique H\u00f4pitaux Universitaires de Marseille","place":["Marseille, France"],"department":["Department of Anesthesiology and Intensive Care Unit"]},{"name":"Aix Marseille University","place":["Marseille, France"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"EUROBACT-2 Study Group","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"ESICM","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"ESCMID ESGCIP","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"the OUTCOMEREA Network","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2026,9,15]]},"reference":[{"key":"pone.0356721.ref001","doi-asserted-by":"crossref","DOI":"10.1097\/CCM.0000000000005357","article-title":"International guidelines for management of sepsis and septic shock 2021","volume":"49","author":"L Evans","year":"2021","journal-title":"Crit Care Med"},{"issue":"23","key":"pone.0356721.ref002","doi-asserted-by":"crossref","first-page":"1931","DOI":"10.1056\/NEJMoa2215145","article-title":"Hydrocortisone in severe community-acquired pneumonia","volume":"388","author":"PF Dequin","year":"2023","journal-title":"N Engl J Med"},{"issue":"2","key":"pone.0356721.ref003","doi-asserted-by":"crossref","first-page":"111","DOI":"10.1056\/NEJMoa071366","article-title":"Hydrocortisone therapy for patients with septic shock","volume":"358","author":"CL Sprung","year":"2008","journal-title":"N Engl J Med"},{"key":"pone.0356721.ref004","doi-asserted-by":"crossref","first-page":"797","DOI":"10.1056\/NEJMoa1705835","article-title":"Adjunctive glucocorticoid therapy in patients with septic shock","volume":"378","author":"B Venkatesh","year":"2018","journal-title":"N Engl J Med"},{"issue":"1","key":"pone.0356721.ref005","doi-asserted-by":"crossref","first-page":"478","DOI":"10.1186\/s13054-023-04762-6","article-title":"Targeting the host response in sepsis: current approaches and future evidence","volume":"27","author":"C Bode","year":"2023","journal-title":"Crit Care"},{"issue":"9","key":"pone.0356721.ref006","doi-asserted-by":"crossref","first-page":"809","DOI":"10.1056\/NEJMoa1705716","article-title":"Hydrocortisone plus fludrocortisone for adults with septic shock","volume":"378","author":"D Annane","year":"2018","journal-title":"N Engl J Med"},{"issue":"2","key":"pone.0356721.ref007","doi-asserted-by":"crossref","first-page":"178","DOI":"10.1007\/s00134-022-06944-2","article-title":"Epidemiology and outcomes of hospital-acquired bloodstream infections in intensive care unit patients: the EUROBACT-2 international cohort study","volume":"49","author":"A Tabah","year":"2023","journal-title":"Intensive Care Med"},{"key":"pone.0356721.ref008","doi-asserted-by":"crossref","first-page":"233","DOI":"10.1016\/j.jcrc.2020.11.002","article-title":"Vasopressor dose equivalence: a scoping review and suggested formula","volume":"61","author":"S Goradia","year":"2021","journal-title":"J Crit Care"},{"issue":"1","key":"pone.0356721.ref009","doi-asserted-by":"crossref","first-page":"29","DOI":"10.1186\/s13054-023-04322-y","article-title":"An updated \u201cnorepinephrine equivalent\u201d score in intensive care as a marker of shock severity","volume":"27","author":"Y Kotani","year":"2023","journal-title":"Crit Care"},{"key":"pone.0356721.ref010","doi-asserted-by":"crossref","first-page":"264","DOI":"10.1016\/j.jclinepi.2021.08.001","article-title":"Tutorial on directed acyclic graphs","volume":"142","author":"JC Digitale","year":"2022","journal-title":"J Clin Epidemiol"},{"issue":"3","key":"pone.0356721.ref011","doi-asserted-by":"crossref","first-page":"399","DOI":"10.1080\/00273171.2011.568786","article-title":"An introduction to propensity score methods for reducing the effects of confounding in observational studies","volume":"46","author":"PC Austin","year":"2011","journal-title":"Multivariate Behav Res"},{"issue":"6","key":"pone.0356721.ref012","doi-asserted-by":"crossref","DOI":"10.1161\/CIRCINTERVENTIONS.122.012700","article-title":"Deferred versus performed revascularization for left main coronary disease with hemodynamic significance","volume":"16","author":"T Warisawa","year":"2023","journal-title":"Circ Cardiovasc Interv"},{"issue":"1","key":"pone.0356721.ref013","article-title":"Focused update: guidelines on use of corticosteroids in sepsis, acute respiratory distress syndrome, and community-acquired pneumonia","volume":"52","author":"D Chaudhuri","year":"2024","journal-title":"Crit Care Med"},{"key":"pone.0356721.ref014","doi-asserted-by":"crossref","DOI":"10.1101\/2024.03.07.24303926","article-title":"Corticosteroids for infectious critical illness: a multicenter target trial emulation stratified by predicted organ dysfunction trajectory","author":"S Rajendran","year":"2024"},{"issue":"3","key":"pone.0356721.ref015","doi-asserted-by":"crossref","first-page":"746","DOI":"10.3390\/microorganisms11030746","article-title":"Interactions between gender and sepsis-implications for the future","volume":"11","author":"I Lakbar","year":"2023","journal-title":"Microorganisms"},{"key":"pone.0356721.ref016","doi-asserted-by":"crossref","DOI":"10.1056\/EVIDoa2300034","article-title":"Patient-level meta-analysis of low-dose hydrocortisone in adults with septic shock","volume":"2","author":"R Pirracchio","year":"2023","journal-title":"NEJM Evid"},{"issue":"3","key":"pone.0356721.ref017","doi-asserted-by":"crossref","first-page":"221","DOI":"10.1016\/S2213-2600(24)00405-3","article-title":"Predicting benefit from adjuvant therapy with corticosteroids in community-acquired pneumonia: a data-driven analysis of randomised trials","volume":"13","author":"JM Smit","year":"2025","journal-title":"Lancet Respir Med"}],"container-title":["PLOS One"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0356721","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T17:24:08Z","timestamp":1789493048000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0356721"}},"subtitle":[],"editor":[{"given":"Iddya","family":"Karunasagar","sequence":"first","affiliation":[{"name":"Nitte University","place":["INDIA"]}],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2026,9,15]]},"references-count":17,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2026,9,15]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0356721","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,15]]}}}