Bloodstream infections in patients undergoing extracorporeal membrane oxygenation.

Jian-Rong Wang,Wei Hu,Wei-Hang Hu,Ying Zhu,Xue-Ying Cai,Jin-Yu Huang

doi:10.12669/pjms.36.6.2882

Abstract

Objective:We aimed to evaluate the incidence, risk factors, and prognosis of bloodstream infections (BSIs) during extracorporeal membrane oxygenation (ECMO) treatment in a Chinese population.Methods:Patients receiving ECMO treatment from January 2013 to August 2019 were retrospectively studied. The incidence of BSIs was calculated. The clinical characteristics between patients with a BSI (BSI group) and without a BSI (non-BSI group)Results:Among 69 included patients, 19 (27.5%) developed at least one BSI. Gram-negative bacteria (73.7%) were mainly responsible for the BSIs, with Klebsiella pneumoniae (6/19, 31.5%) ranking as the top related pathogen. The BSI group had a greater proportion of methicillin-resistant Staphylococcus aureus (MRSA) prophylactic regimens (52.6% vs. 26.0%, P = 0.036), a higher pre-ECMO Sequential Organ Failure Assessment (SOFA) score (11 vs. 8, P = 0.008), more applications of continuous renal replacement therapy (CRRT) during ECMO (63.1% vs. 36.1%, P = 0.042). Longer ECMO support duration, period of ventilator use before ECMO weaning and hospital stay were observed in the BSI group. The SOFA score (OR: 1.174; 95% CI: 1.039–1.326; P = 0.010) was an independent risk factor for BSIs.Conclusion:BSIs during ECMO therapy frequently involve Gram-negative bacteria. Stringent care and monitoring should be provided for patients with high SOFA scores.

Highlights

Extracorporeal membrane oxygenation (ECMO) is one of the most important strategies to treat severe acute respiratory failure or cardiac failure
The incidence of bloodstream infections (BSIs) remains substantial, impacting the prognosis of patients treated with ECMO.[4,5]
BSIs were observed in 19 patients (27.5%) with an incidence of 33.6 infections per 1000 days of ECMO

Summary

INTRODUCTION

Extracorporeal membrane oxygenation (ECMO) is one of the most important strategies to treat severe acute respiratory failure or cardiac failure. Despite the growing implementation of adult ECMO, mortality due to severe acute respiratory failure or cardiac failure remains relatively high. Multiple factors increase the risk of nosocomial infection in patients receiving ECMO.[3] the incidence of bloodstream infections (BSIs) remains substantial, impacting the prognosis of patients treated with ECMO.[4,5] the management of patients with a BSI during ECMO remains a challenge. A thorough understanding of the clinical features of BSIs may improve the prognosis of patients receiving ECMO.[6] in this study, we aimed to explore the incidence, risk factors, and prognosis of Chinese patients undergoing ECMO with BSIs

METHODS

RESULTS

DISCUSSION