Megan T Quintana1, Michael Mazzeffi2, Samuel M Galvagno3, Danny Herrera4, Gregory P Boyajian4, Nicole M Hays4, David Kaczorowski5, Ronson J Madathil5, Raymond P Rector6, Ali Tabatabai7, Daniel Herr7, Joseph Rabin8. 1. Center for Trauma and Critical Care, Department of Surgery, George Washington University School of Medicine, Washington DC. 2. Department of Anesthesia, University of Maryland School of Medicine, Baltimore, Maryland. 3. Department of Anesthesia, University of Maryland School of Medicine, Baltimore, Maryland; R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, Maryland. 4. University of Maryland School of Medicine, Baltimore, Maryland. 5. Department of Surgery, Division of Cardiac Surgery, University of Maryland School of Medicine, Baltimore, Maryland. 6. Perfusion Services, University of Maryland Medical Center, Baltimore, Maryland. 7. R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, Maryland. 8. R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, Maryland. Electronic address: jrabin@som.umaryland.edu.
Abstract
BACKGROUND: Healthcare-associated infections (HAIs) in critically ill patients are a serious public health problem. Extracorporeal membrane oxygenation (ECMO) has been used increasingly for patients with severe cardiac or respiratory failure, but it may increase HAI risk. The goal of our study was to characterize HAIs in ECMO patients at an ECMO referral center. METHODS: This institutional review board-approved study identified all consecutive adult ECMO patients admitted to the cardiac surgery intensive care unit (CSICU) between January 1, 2015, and December 31, 2017. Demographic data, diagnosis, ECMO cannulation technique, and survival were collected. Urinary tract infection, pneumonia, and bacteremia incidence during ECMO and within 3 months of decannulation were collected. Outcomes of patients with HAIs were compared with noninfected patients, the CSICU infection incidence, and overall Extracorporeal Life Support Organization survival data. RESULTS: There were 288 ECMO patients and 3396 CSICU admissions during this period. Survival was 72.3% for venoarterial ECMO, 85.3% for venovenous ECMO, and 57.1% for multimodality or veno-arteriovenous ECMO, with discharge survival of 60.2%, 72.0%, and 28.6%, respectively. Bacteremia incidence while cannulated was 6.8% for venoarterial ECMO and 9.3% for venovenous ECMO. Bacteremia occurred in 22 of 288 (7.6%) ECMO patients, compared with 48 of 3109 (1.5%) in non-ECMO CSICU patients, which was statistically significant (P < .002). Bacteremia and pneumonia were associated with decreased VA-ECMO survival, with prolonged overall requirements for ECMO support. CONCLUSIONS: Nosocomial ECMO infections are significantly higher than in other CSICU patients. Infection risk remains significant even after decannulation. Infection is associated with increased mortality and longer duration of ECMO support. Further efforts are needed to determine HAI reduction strategies in this high-risk patient population.
BACKGROUND: Healthcare-associated infections (HAIs) in critically ill patients are a serious public health problem. Extracorporeal membrane oxygenation (ECMO) has been used increasingly for patients with severe cardiac or respiratory failure, but it may increase HAI risk. The goal of our study was to characterize HAIs in ECMO patients at an ECMO referral center. METHODS: This institutional review board-approved study identified all consecutive adult ECMO patients admitted to the cardiac surgery intensive care unit (CSICU) between January 1, 2015, and December 31, 2017. Demographic data, diagnosis, ECMO cannulation technique, and survival were collected. Urinary tract infection, pneumonia, and bacteremia incidence during ECMO and within 3 months of decannulation were collected. Outcomes of patients with HAIs were compared with noninfected patients, the CSICU infection incidence, and overall Extracorporeal Life Support Organization survival data. RESULTS: There were 288 ECMO patients and 3396 CSICU admissions during this period. Survival was 72.3% for venoarterial ECMO, 85.3% for venovenous ECMO, and 57.1% for multimodality or veno-arteriovenous ECMO, with discharge survival of 60.2%, 72.0%, and 28.6%, respectively. Bacteremia incidence while cannulated was 6.8% for venoarterial ECMO and 9.3% for venovenous ECMO. Bacteremia occurred in 22 of 288 (7.6%) ECMO patients, compared with 48 of 3109 (1.5%) in non-ECMO CSICU patients, which was statistically significant (P < .002). Bacteremia and pneumonia were associated with decreased VA-ECMO survival, with prolonged overall requirements for ECMO support. CONCLUSIONS: Nosocomial ECMO infections are significantly higher than in other CSICU patients. Infection risk remains significant even after decannulation. Infection is associated with increased mortality and longer duration of ECMO support. Further efforts are needed to determine HAI reduction strategies in this high-risk patient population.
Authors: Christine Geffers; Frank Schwab; Michael Behnke; Petra Gastmeier Journal: Antimicrob Resist Infect Control Date: 2022-05-07 Impact factor: 6.454
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