{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,14]],"date-time":"2026-08-14T23:59:55Z","timestamp":1786751995690,"version":"build-2736575974"},"reference-count":44,"publisher":"MDPI AG","issue":"17","license":[{"start":{"date-parts":[[2023,8,25]],"date-time":"2023-08-25T00:00:00Z","timestamp":1692921600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Madrid Government (Comunidad de Madrid-Spain)","award":["970970"],"award-info":[{"award-number":["970970"]}]},{"name":"Universidad Complutense de Madrid\u2019s GEPIECAP","award":["970970"],"award-info":[{"award-number":["970970"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>(1) Background: To analyze the association between hospital-acquired pneumonia (HAP) and in-hospital mortality (IHM) during hospital admission for solid organ transplant in Spain during 2004\u20132021. (2) Methods: We used national hospital discharge data to select all hospital admissions for kidney, liver, heart, and lung transplants. We stratified the data according to HAP status. To examine time trends, we grouped data into three consecutive 6-year periods (2004\u20132009; 2010\u20132015; and 2016\u20132021). We assessed in-hospital mortality (IHM) in logistic regression analyses and obtained odds ratios (ORs) with their 95% confidence intervals (CIs). (3) Results: We identified a total of 71,827 transplants (45,262, kidney; 18,127, liver; 4734, heart; and 4598, lung). Two thirds of the patients were men. Overall, the rate of HAP during admission was 2.6% and decreased from 3.0% during 2004\u20132009 to 2.4% during 2016\u20132021. The highest rate of HAP corresponded to lung transplant (9.4%), whereas we found the lowest rate for kidney transplant (1.1%). Rates of HAP for liver and heart transplants were 3.8% and 6.3%, respectively. IHM was significantly lower during 2016\u20132021 compared to 2004\u20132009 for all types of transplants (ORs (CIs) = 0.65 (0.53\u20130.79) for kidney; 0.73 (0.63\u20130.84) for liver; 0.72 (0.59\u20130.87) for heart; and 0.39 (0.31\u20130.47) for lung). HAP was associated with IHM for all types of transplants (ORs (CIs) = 4.47 (2.85\u20139.08) for kidney; 2.96 (2.34\u20133.75) for liver; 1.86 (1.34\u20132.57) for heart; and 2.97 (2.24\u20133.94) for lung). (4) Conclusions: Rates of HAP during admission for solid organ transplant differ depending on the type of transplant. Although IHM during admission for solid organ transplant has decreased over time in our country, HAP persists and is associated with a higher IHM after accounting for potential confounding variables.<\/jats:p>","DOI":"10.3390\/jcm12175532","type":"journal-article","created":{"date-parts":[[2023,8,25]],"date-time":"2023-08-25T08:42:20Z","timestamp":1692952940000},"page":"5532","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Association between Hospital-Acquired Pneumonia and In-Hospital Mortality in Solid Organ Transplant Admissions: An Observational Analysis in Spain, 2004\u20132021"],"prefix":"10.3390","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2802-033X","authenticated-orcid":false,"given":"Jos\u00e9 M.","family":"de-Miguel-Yanes","sequence":"first","affiliation":[{"name":"Internal Medicine Department, Hospital General Universitario Gregorio Mara\u00f1\u00f3n, Instituto de Investigaci\u00f3n Sanitaria Gregorio Mara\u00f1\u00f3n (IiSGM), Universidad Complutense de Madrid, 28040 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5551-5181","authenticated-orcid":false,"given":"Ana","family":"Lopez-de-Andres","sequence":"additional","affiliation":[{"name":"Department of Public Health & Maternal and Child Health, Faculty of Medicine, Universidad Complutense de Madrid, 28040 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5906-9393","authenticated-orcid":false,"given":"Rodrigo","family":"Jimenez-Garcia","sequence":"additional","affiliation":[{"name":"Department of Public Health & Maternal and Child Health, Faculty of Medicine, Universidad Complutense de Madrid, 28040 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jos\u00e9 Javier","family":"Zamorano-Leon","sequence":"additional","affiliation":[{"name":"Department of Public Health & Maternal and Child Health, Faculty of Medicine, Universidad Complutense de Madrid, 28040 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9897-4847","authenticated-orcid":false,"given":"David","family":"Carabantes-Alarcon","sequence":"additional","affiliation":[{"name":"Department of Public Health & Maternal and Child Health, Faculty of Medicine, Universidad Complutense de Madrid, 28040 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ricardo","family":"Oma\u00f1a-Palanco","sequence":"additional","affiliation":[{"name":"Department of Public Health & Maternal and Child Health, Faculty of Medicine, Universidad Complutense de Madrid, 28040 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Valent\u00edn","family":"Hern\u00e1ndez-Barrera","sequence":"additional","affiliation":[{"name":"Preventive Medicine and Public Health Teaching and Research Unit, Health Sciences Faculty, Rey Juan Carlos University, 28933 Alcorc\u00f3n, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6881-2289","authenticated-orcid":false,"given":"Jose Luis","family":"del-Barrio","sequence":"additional","affiliation":[{"name":"Preventive Medicine and Public Health Teaching and Research Unit, Health Sciences Faculty, Rey Juan Carlos University, 28933 Alcorc\u00f3n, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4543-573X","authenticated-orcid":false,"given":"Javier","family":"de-Miguel-Diez","sequence":"additional","affiliation":[{"name":"Respiratory Care Department, Hospital General Universitario Gregorio Mara\u00f1\u00f3n, Instituto de Investigaci\u00f3n Sanitaria Gregorio Mara\u00f1\u00f3n (IiSGM), Universidad Complutense de Madrid, 28040 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7509-1953","authenticated-orcid":false,"given":"Natividad","family":"Cuadrado-Corrales","sequence":"additional","affiliation":[{"name":"Department of Public Health & Maternal and Child Health, Faculty of Medicine, Universidad Complutense de Madrid, 28040 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2023,8,25]]},"reference":[{"key":"ref_1","unstructured":"World Health Organization (2023, April 29). The Spanish Transplant Organization. Global Observatory on Donation and Transplantation. Available online: https:\/\/www.transplant-observatory.org\/."},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"de Miguel-Yanes, J.M., Jim\u00e9nez-Garc\u00eda, R., de Miguel-D\u00edez, J., Hern\u00e1ndez-Barrera, V., M\u00e9ndez-Bail\u00f3n, M., Mu\u00f1oz-Rivas, N., and L\u00f3pez-De-Andr\u00e9s, A. (2018). In-hospital outcomes for solid organ transplants according to type 2 diabetes status: An observational, 15-year study in Spain. Int. J. Clin. Pract., e13283.","DOI":"10.1111\/ijcp.13283"},{"key":"ref_3","doi-asserted-by":"crossref","unstructured":"Lopez-De-Andres, A., Lopez-Herranz, M., Hernandez-Barrera, V., De-Miguel-Diez, J., De-Miguel-Yanes, J.M., Carabantes-Alarcon, D., Albaladejo-Vicente, R., Villanueva-Orbaiz, R., and Jimenez-Garcia, R. (2021). Sex differences in hospital-acquired pneumonia among patients with type 2 diabetes mellitus patients: Retrospective cohort study using hospital discharge data in Spain (2016\u20132019). Int. J. Environ. Res. Public Health, 18.","DOI":"10.3390\/ijerph182312645"},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"de Miguel-Yanes, J.M., Lopez-De-Andres, A., Jim\u00e9nez-Garcia, R., Hernandez-Barrera, V., de Miguel-Diez, J., Carabantes-Alarcon, D., Perez-Farinos, N., and W\u00e4rnberg, J. (2021). Incidence, outcomes and sex-related disparities in pneumonia: A matched-pair analysis with data from Spanish hospitals (2016\u20132019). J. Clin. Med., 10.","DOI":"10.3390\/jcm10194339"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1186","DOI":"10.1016\/j.cmi.2019.04.003","article-title":"Is hospital-acquired pneumonia different in transplant recipients?","volume":"25","author":"Gudiol","year":"2019","journal-title":"Clin. Microbiol. Infect."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1989","DOI":"10.1111\/j.1600-6143.2007.01882.x","article-title":"Pneumonia after lung transplantation in the RESITRA Cohort: A multicenter prospective study","volume":"7","author":"Ussetti","year":"2007","journal-title":"Am. J. Transplant."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"119","DOI":"10.1002\/phar.2481","article-title":"Immunosuppression trends in solid organ transplantation: The future of individualization, monitoring, and management","volume":"41","author":"Pilch","year":"2021","journal-title":"Pharmacotherapy"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"e61","DOI":"10.1093\/cid\/ciw353","article-title":"Management of adults with hospital-acquired and ventilator-associated pneumonia: 2016 clinical practice guidelines by the Infectious Diseases Society of America and the American Thoracic Society","volume":"63","author":"Kalil","year":"2016","journal-title":"Clin. Infect. Dis."},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Ljungman, P., Snydman, D., and Boeckh, M. (2016). Transplant Infections, Springer.","DOI":"10.1007\/978-3-319-28797-3"},{"key":"ref_10","unstructured":"Ministerio de Sanidad (2023, January 21). Conjunto M\u00ednimo B\u00e1sico de Datos, Available online: https:\/\/www.sanidad.gob.es\/estadEstudios\/estadisticas\/estadisticas\/estMinisterio\/SolicitudCMBD.htm."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"373","DOI":"10.1016\/0021-9681(87)90171-8","article-title":"A new method of classifying prognostic comorbidity in longitudinal studies: Development and validation","volume":"40","author":"Charlson","year":"1987","journal-title":"J. Chronic Dis."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"832","DOI":"10.1111\/tid.12610","article-title":"Early intravenous immunoglobulin replacement in hypogammaglobulinemic heart transplant recipients: Results of a clinical trial","volume":"18","author":"Sarmiento","year":"2016","journal-title":"Transpl. Infect. Dis."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"726","DOI":"10.1183\/09031936.00095214","article-title":"Ventilator associated respiratory infection following lung transplantation","volume":"45","author":"Riera","year":"2015","journal-title":"Eur. Respir. J."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"291","DOI":"10.1053\/srin.2002.36444","article-title":"Infectious pulmonary complications in lung transplant recipients","volume":"17","author":"Chan","year":"2002","journal-title":"Semin. Respir. Infect."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"647","DOI":"10.1016\/j.ccm.2005.06.003","article-title":"Bacterial and mycobacterial pneumonia in transplant recipients","volume":"26","author":"Gasink","year":"2005","journal-title":"Clin. Chest Med."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"324","DOI":"10.1086\/514649","article-title":"Pneumonia after heart transplantation: A multiinstitutional study","volume":"27","author":"Cisneros","year":"1998","journal-title":"Clin. Infect. Dis."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"2351","DOI":"10.21037\/jtd-20-3586","article-title":"Risk factors for postoperative pneumonia after cardiac surgery: A prediction model","volume":"13","author":"Wang","year":"2021","journal-title":"J. Thorac. Dis."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"17","DOI":"10.1186\/s13613-019-0490-2","article-title":"Infectious complications following heart transplantation in the era of high-priority allocation and extracorporeal membrane oxygenation","volume":"9","author":"Pons","year":"2019","journal-title":"Ann. Intensive Care"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1707","DOI":"10.1016\/j.bbmt.2018.03.007","article-title":"Microbiologic diagnostic workup of acute respiratory failure with pulmonary infiltrates after allogeneic hematopoietic stem cell transplantation: Findings in the era of molecular- and biomarker-based assays","volume":"24","author":"Wohlfarth","year":"2018","journal-title":"Biol. Blood Marrow Transplant."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1356","DOI":"10.1016\/j.chest.2016.12.033","article-title":"Chest CT signs in pulmonary disease: A pictorial review","volume":"151","author":"Raju","year":"2017","journal-title":"Chest"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"e224","DOI":"10.1093\/eurjpc\/zwab175","article-title":"Incidence and prognosis of COVID-19 amongst heart transplant recipients: A systematic review and meta-analysis","volume":"29","author":"Ahmed","year":"2022","journal-title":"Eur. J. Prev. Cardiol."},{"key":"ref_22","first-page":"205","article-title":"Pneumonia after kidney transplant: Incidence, risk factors, and mortality","volume":"12","author":"Dizdar","year":"2014","journal-title":"Exp. Clin. Transplant."},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Vidal, C., Pasqualotto, R., James, A., Dureau, P., Rasata, J., Coutance, G., Varnous, S., Leprince, P., Amour, J., and Bougl\u00e9, A. (2020). Predictive risk factors for postoperative pneumonia after heart transplantation. BMC Anesthesiol., 20.","DOI":"10.1186\/s12871-019-0923-3"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1060","DOI":"10.1002\/lt.23483","article-title":"Etiologies, risk factors, and outcomes of bacterial pneumonia after living donor liver transplantation","volume":"18","author":"Ikegami","year":"2012","journal-title":"Liver Transplant."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"2025","DOI":"10.1097\/TP.0000000000002246","article-title":"Recipient age and mortality after liver transplantation: A Population-based Cohort Study","volume":"102","author":"Gil","year":"2018","journal-title":"Transplantation"},{"key":"ref_26","doi-asserted-by":"crossref","unstructured":"Na Kim, Y., Kim, D.H., Shin, H.S., Lee, S., Lee, N., Park, M.-J., Song, W., and Jeong, S. (2020). The risk factors for treatment-related mortality within first three months after kidney transplantation. PLoS ONE, 15.","DOI":"10.1371\/journal.pone.0243586"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"259","DOI":"10.1161\/CIRCHEARTFAILURE.111.965996","article-title":"Risk prediction for early in-hospital mortality following heart transplantation in the United States","volume":"5","author":"Singh","year":"2012","journal-title":"Circ. Heart Fail."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"421","DOI":"10.1016\/j.arbres.2016.12.019","article-title":"Risk factors for mortality in 272 patients with lung transplant: A multicenter analysis of 7 intensive care units","volume":"53","author":"Rello","year":"2017","journal-title":"Arch. Bronconeumol."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"2135","DOI":"10.1016\/j.jtcvs.2017.07.032","article-title":"Lung transplantation in the elderly: Influence of age, comorbidities, underlying disease, and extended criteria donor lungs","volume":"154","author":"Ehrsam","year":"2017","journal-title":"J. Thorac. Cardiovasc. Surg."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"891","DOI":"10.1016\/j.jtcvs.2016.03.096","article-title":"The use of extended criteria donors decreases one-year survival in high-risk lung recipients: A review of the United Network of Organ Sharing Database","volume":"152","author":"Mulligan","year":"2016","journal-title":"J. Thorac. Cardiovasc. Surg."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"1530","DOI":"10.1016\/j.transproceed.2006.02.098","article-title":"Pulmonary complications in heart transplant recipients","volume":"38","author":"Atasever","year":"2006","journal-title":"Transplant. Proc."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"2001720","DOI":"10.1183\/13993003.01720-2020","article-title":"Successful Pseudomonas aeruginosa eradication improves outcomes after lung transplantation: A retrospective cohort analysis","volume":"56","author":"Sacreas","year":"2020","journal-title":"Eur. Respir. J."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"1028","DOI":"10.1111\/ajt.15687","article-title":"Pseudomonas aeruginosa and acute rejection independently increase the risk of donor-specific antibodies after lung transplantation","volume":"20","author":"Kulkarni","year":"2020","journal-title":"Am. J. Transplant."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"2131","DOI":"10.1016\/j.jtcvs.2020.08.094","article-title":"Mortality due to hospital-acquired infection after cardiac surgery","volume":"163","author":"Massart","year":"2022","journal-title":"J. Thorac. Cardiovasc. Surg."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"e13545","DOI":"10.1111\/ctr.13545","article-title":"Pneumonia in solid organ transplantation: Guidelines from the American Society of Transplantation Infectious Diseases Community of Practice","volume":"33","author":"Dulek","year":"2019","journal-title":"Clin. Transplant."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"232","DOI":"10.1111\/tid.12193","article-title":"Pneumonia in solid organ transplant recipients: A prospective multicenter study","volume":"16","author":"Giannella","year":"2014","journal-title":"Transpl. Infect. Dis."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"472","DOI":"10.1159\/000495081","article-title":"Trends in the causes of death among kidney transplant recipients in the United States (1996\u20132014)","volume":"48","author":"Awan","year":"2018","journal-title":"Am. J. Nephrol."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"2887","DOI":"10.1681\/ASN.2020050566","article-title":"Death after kidney transplantation: An analysis by era and time post-transplant","volume":"31","author":"Ying","year":"2020","journal-title":"J. Am. Soc. Nephrol."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"896","DOI":"10.1002\/bjs.11451","article-title":"Short- and long-term mortality after liver transplantation in patients with and without hepatocellular carcinoma in the UK","volume":"107","author":"Wallace","year":"2020","journal-title":"Br. J. Surg."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"e006971","DOI":"10.1136\/bmjopen-2014-006971","article-title":"Time-varying impact of comorbidities on mortality after liver transplantation: A national cohort study using linked clinical and administrative data","volume":"5","author":"Tovikkai","year":"2015","journal-title":"BMJ Open"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"266","DOI":"10.1016\/j.healun.2011.10.004","article-title":"Development of a quantitative donor risk index to predict short-term mortality in orthotopic heart transplantation","volume":"31","author":"Weiss","year":"2012","journal-title":"J. Heart Lung Transplant."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"1580","DOI":"10.1016\/j.jtcvs.2017.10.079","article-title":"Predicting 1-year cardiac transplantation survival using a donor-recipient risk-assessment tool","volume":"155","author":"Joyce","year":"2018","journal-title":"J. Thorac. Cardiovasc. Surg."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"268","DOI":"10.1097\/MOT.0000000000000753","article-title":"Survival in adult lung transplantation: Where are we in 2020?","volume":"25","author":"Bos","year":"2020","journal-title":"Curr. Opin. Organ Transplant."},{"key":"ref_44","unstructured":"Ministerio de Sanidad (2023, April 01). Anuncio de Cambio y Nueva Normativa para la Codificaci\u00f3n de la Infecci\u00f3n por SARS-CoV-2 (COVID-19), Available online: https:\/\/www.sanidad.gob.es\/estadEstudios\/estadisticas\/normalizacion\/CIE10\/Norm_COVID19_01072020.pdf."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/12\/17\/5532\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T20:39:04Z","timestamp":1760128744000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/12\/17\/5532"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,8,25]]},"references-count":44,"journal-issue":{"issue":"17","published-online":{"date-parts":[[2023,9]]}},"alternative-id":["jcm12175532"],"URL":"https:\/\/doi.org\/10.3390\/jcm12175532","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,8,25]]}}}