*Purpose: This study aimed to identify probable cases of nosocomial Coronavirus Disease 2019 (COVID-19) among hospitalized solid organ transplant (SOT) recipients.

*Methods: All hospitalized SOT recipients diagnosed with COVID-19 by polymerase chain reaction (PCR) from March 11, 2020 to August 24, 2020 were evaluated. Potential nosocomial cases included admissions where the first positive PCR occurred on hospital day 3 or later (intra-admission) or within 14 days of a previous hospital discharge (inter-admission). Two infectious disease specialists independently adjudicated all potential cases into four categories (definitely community-acquired, likely community-acquired, likely hospital-acquired, and definitely hospital-acquired) using systematic chart review of symptom onset, radiographic findings, and community risk factors. Discrepancies were resolved by a third investigator.

*Results: Of 132 hospitalized SOT recipients diagnosed with COVID-19, nosocomial infections were apparent in 19 (14%; Figure 1). Intra-admission cases (n=11, 4 likely hospital-acquired and 7 definitely hospital-acquired) were diagnosed a median (IQR) of 43 (8 to 53) days after admission. Inter-admission cases (n=8, all likely hospital-acquired) had 5 (3 to 10) days of hospital care in the 14 days preceding diagnosis. The proportion of COVID-19 infections classified as nosocomial varied by time from most recent transplant until diagnosis (P<0.001) and transplant type (P<0.001; Table 1). Probable nosocomial infections peaked in June and gradually declined.

*Conclusions: Despite infection control measures to sequester SOT recipients and their nurses on dedicated transplant floors and provide patients and healthcare workers with screening, COVID-19 may have been acquired during healthcare interactions in 14% of hospitalized SOT recipients diagnosed with COVID-19. Vaccination against COVID-19 for front-line healthcare workers is important for protection of SOT recipients.

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