Jay Menaker1, Samuel Galvagno2, Ronald Rabinowitz3, Vesselin Penchev4, Allison Hollis5, Zachary Kon6, Kristopher Deatrick7, Anthony Amoroso8, Daniel Herr3, Michael Mazzeffi9. 1. University of Maryland School of Medicine, Department of Surgery, Program in Trauma, 22 South Greene Street, Baltimore, MD 21201, USA. 2. University of Maryland School of Medicine, Department of Anesthesiology, Program in Trauma, 22 South Greene Street, Baltimore, MD 21201, USA. 3. University of Maryland School of Medicine, Department of Medicine, Program in Trauma, 22 South Greene Street, Baltimore, MD 21201, USA. 4. University of Maryland School of Medicine, 655 West Baltimore Street, Baltimore, MD 21201, USA. 5. University of Maryland Medical Center, 22 South Greene Street, Baltimore, MD 21201, USA. 6. New York University Langone Health, Depart of Surgery, Division of Adult Cardiac Surgery, 530 1st Ave, Suite 9V, New York, NY 10016, USA. 7. University of Maryland School of Medicine, Department of Surgery, Division of Cardiothoracic Surgery, 22 South Greene Street, Baltimore, MD 21201, USA. 8. University of Maryland School of Medicine, Department of Medicine, Division of Infectious Diseases, 22 South Greene Street, Baltimore, MD 21201. 9. University of Maryland School of Medicine, Department of Anesthesiology, 22 South Greene Street, Baltimore, MD 21201, USA. Electronic address: mmazzeffi@som.umaryland.edu.
Abstract
PURPOSE: The purpose of our study was to characterize the epidemiology of blood stream infection (BSI) in adult extracorporeal membrane oxygenation (ECMO) patients at a single tertiary care academic medical center with standardized post-cannulation antibiotic prophylaxis practices. METHODS: A single-center retrospective cohort study was performed over a five-year period. BSI incidence was characterized and patients who developed BSI during ECMO were compared with those who did not. RESULTS: Nineteen of 145 VV ECMO patients (13.1%) developed BSI while 7 of 123 VA ECMO patients (5.7%) developed BSI. When accounting for total ECMO days, the incidence rate was 8 BSIs per 1,000 ECMO days for both VV and VA ECMO patients. VV ECMO patients with BSI had longer ECMO runs and more red blood cell transfusion (both p<0.05). VA ECMO patients who developed BSI had longer ECMO runs and more platelet transfusion (both p<0.05). In VV ECMO patients there was an association between renal failure and BSI and in VA ECMO patients there was an association between hepatic failure and BSI. CONCLUSIONS: BSIs are common in ECMO patients even with post-cannulation antimicrobial prophylaxis and are associated with ECMO duration, blood transfusion, and organ failure. Further work is needed to clarify the optimal duration and type of antimicrobial prophylaxis, as well as surveillance strategies for BSIs during adult ECMO.
PURPOSE: The purpose of our study was to characterize the epidemiology of blood stream infection (BSI) in adult extracorporeal membrane oxygenation (ECMO) patients at a single tertiary care academic medical center with standardized post-cannulation antibiotic prophylaxis practices. METHODS: A single-center retrospective cohort study was performed over a five-year period. BSI incidence was characterized and patients who developed BSI during ECMO were compared with those who did not. RESULTS: Nineteen of 145 VV ECMO patients (13.1%) developed BSI while 7 of 123 VA ECMO patients (5.7%) developed BSI. When accounting for total ECMO days, the incidence rate was 8 BSIs per 1,000 ECMO days for both VV and VA ECMO patients. VV ECMO patients with BSI had longer ECMO runs and more red blood cell transfusion (both p<0.05). VA ECMO patients who developed BSI had longer ECMO runs and more platelet transfusion (both p<0.05). In VV ECMO patients there was an association between renal failure and BSI and in VA ECMO patients there was an association between hepatic failure and BSI. CONCLUSIONS: BSIs are common in ECMO patients even with post-cannulation antimicrobial prophylaxis and are associated with ECMO duration, blood transfusion, and organ failure. Further work is needed to clarify the optimal duration and type of antimicrobial prophylaxis, as well as surveillance strategies for BSIs during adult ECMO.
Authors: Eun Hwa Lee; Ki Hyun Lee; Se Ju Lee; Jinnam Kim; Yae Jee Baek; Jin Young Ahn; Su Jin Jeong; Nam Su Ku; Jun Yong Choi; Joon-Sup Yeom; Young Goo Song; Jung Ho Kim Journal: Sci Rep Date: 2022-09-05 Impact factor: 4.996