Diagnostic yield of routine daily blood culture in patients on veno-arterial extracorporeal membrane oxygenation

Quentin De Roux,Vincent Fihman,Jean-Winoc Decousser,Raphaël Lepeule,Nicolas Mongardon,Chamsedine Cherait,Marie Renaudier,Olivier Langeron,Antonio Fiore,Wulfran Bougouin,Johanna Boccara,François Hemery

doi:10.1186/s13054-021-03658-7

Abstract

BackgroundBloodstream infections (BSIs) are frequent on veno-arterial extracorporeal membrane oxygenation (V-A ECMO). Performing routine blood cultures (BCs) may identify early paucisymptomatic BSIs. We investigated the contribution of systematic daily BCs to detect BSIs on V-A ECMO.MethodsThis was a retrospective study including all adult patients requiring V-A ECMO and surviving more than 24 h. Our protocol included routine daily BCs, from V-A ECMO insertion up to 5 days after withdrawal; other BCs were performed on-demand.ResultsOn the 150 V-A ECMO included, 2146 BCs were performed (1162 routine and 984 on-demand BCs); 190 (9%) were positive, including 68 contaminants. Fifty-one (4%) routine BCs revealed BSIs; meanwhile, 71 (7%) on-demand BCs revealed BSIs (p = 0.005). Performing routine BCs was negatively associated with BSIs diagnosis (OR 0.55, 95% CI [0.38; 0.81], p = 0.002). However, 16 (31%) BSIs diagnosed by routine BCs would have been missed by on-demand BCs. Independent variables for BSIs diagnosis after routine BCs were: V-A ECMO for cardiac graft failure (OR 2.43, 95% CI [1.20; 4.92], p = 0.013) and sampling with on-going antimicrobial therapy (OR 2.15, 95% CI [1.08; 4.27], p = 0.029) or renal replacement therapy (OR 2.05, 95% CI [1.10; 3.81], p = 0.008). Without these three conditions, only two BSIs diagnosed with routine BCs would have been missed by on-demand BCs sampling.ConclusionsAlthough routine daily BCs are less effective than on-demand BCs and expose to contamination and inappropriate antimicrobial therapy, a policy restricted to on-demand BCs would omit a significant proportion of BSIs. This argues for a tailored approach to routine daily BCs on V-A ECMO, based on risk factors for positivity.

Highlights

Veno-arterial extracorporeal membrane oxygenation (V-A Veno-venous extracorporeal membrane oxygenation (ECMO)) is increasingly used to support various causes of refractory shock [1]
According to the low incidence of poorly symptomatic Bloodstream infection (BSI) and the high rate of contaminants leading to unnecessary antimicrobial therapy, we hypothesized that systematic Blood culture (BC) have a lowest interest than clinically guided BCs
In multivariate analysis considering all BCs (Table 5), independent risk factors associated with BSIs were: Body mass index (BMI), lactate level at admission, bilirubin level at admission, BCs collected on V-A ECMO, BCs collected with ongoing antimicrobial therapy, and BCs collected with ongoing renal replacement therapy

Summary

Introduction

Veno-arterial extracorporeal membrane oxygenation (V-A ECMO) is increasingly used to support various causes of refractory shock [1]. It is life-saving support, it generates new issues and side effects. In a survey of the Extracorporeal Life Support Organization (ELSO), one-third of the American centers performed daily routine BCs [8]. This practice is still debated and has never been evaluated on V-A ECMO [9, 10]. We investigated the contribution of systematic daily BCs to detect BSIs on V-A ECMO

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