TOPLINE

Solid organ and haematopoietic stem cell transplant recipients with infective endocarditis (IE) experienced higher 1‑year all‑cause mortality than non-transplant control participants and showed a distinct microbiological profile. Their infections more often involved coagulase‑negative staphylococci (CoNS), Enterococcus species, non‑Haemophilus species, Aggregatibacter, Cardiobacterium, Eikenella, Kingella (HACEK) gram‑negative bacilli, and fungi.

METHODOLOGY

• Researchers reviewed records of a retrospective cohort from 27 hospitals in France to compare IE in solid organ and haematopoietic stem cell transplant recipients with that in non-transplant control participants.
• The study initially included 262 transplant recipients with definite or possible IE (median age at IE diagnosis, 64 years; 70% men) and 1573 non-transplant control participants; after propensity score matching, each group included 253 participants.
• Among the transplant recipients, 55% had kidney transplants, 25% had liver transplants, 8% had thoracic organ transplants, and 5% had haematopoietic stem cell transplants; IE occurred at a median of 56 months after transplant.
• The researchers extracted clinical, microbiological, and outcome data from medical records for analysis.

TAKEAWAY

• Transplant status was associated with 69% higher 1-year all-cause mortality than non-transplant status (adjusted hazard ratio [aHR], 1.69; P = .029), but it did not independently affect 90‑day mortality.
• Microbiological profiles differed significantly between the two groups (P < .001); transplant recipients had more infections due to CoNS, Enterococcus species, non-HACEK gram-negative bacilli, and fungi, whereas streptococcal IE was less frequent.
• Microbiological patterns changed with time since transplant (P = .01): Fungal and CoNS IE were more common within the first posttransplant year, and streptococcal IE was more common later; fungal IE was especially common after thoracic organ and stem cell transplants.
• In the transplant cohort, factors independently associated with 1-year mortality were older age (aHR per 10-year increase, 1.44), septic shock (aHR, 3.07), acute renal failure (aHR, 1.78), and having a surgical indication for which surgery was not performed (aHR, 5.53; P < .05 for all).

IN PRACTICE

"[The study] findings suggest that, in transplant recipients, IE is not only an infectious complication but also a marker of sustained vulnerability," the authors wrote.

SOURCE

The study was led by Laurène Cachera, MD, Hôpitaux Saint-Joseph & Marie-Lannelongue, Paris, France. It was published online on August 21, 2026, in Clinical Infectious Diseases.

LIMITATIONS

Because the study was retrospective, unmeasured factors could have influenced the results and some details may have been recorded inaccurately. Cases of early prosthetic valve endocarditis, device‑related infections, and transplant types other than kidney or liver transplants were underrepresented. Moreover, control participants came from only two referral hospitals, whereas transplant recipients were drawn from 27 centres across the country; local practices and referral patterns may have influenced the observed differences in pathogens.

DISCLOSURES

This study did not receive any specific funding, and the authors reported having no relevant conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.