Abstract

BackgroundIn ICU patients, digestive tract colonization by multidrug-resistant (MDR) Gram-negative (G−) bacteria is a significant risk factor for the development of infections. In patients undergoing extracorporeal membrane oxygenation (ECMO), colonization by MDR bacteria and risk of subsequent nosocomial infections (NIs) have not been studied yet. The aim of this study is to evaluate the incidence, etiology, risk factors, impact on outcome of gastrointestinal colonization by MDR G− bacteria, and risk of subsequent infections in patients undergoing ECMO.MethodsThis is a retrospective analysis of prospectively collected data: 105 consecutive patients, treated with ECMO, were admitted to the ICU of an Italian tertiary referral center (San Gerardo Hospital, Monza, Italy) from January 2010 to November 2015. Rectal swabs for MDR G− bacteria were cultured at admission and twice a week. Only colonization and NIs by MDR G− bacteria were analyzed.ResultsNinety-one included patients [48.5 (37–56) years old, 63% male, simplified acute physiology score II 37 (32–47)] underwent peripheral ECMO (87% veno-venous) for medical indications (79% ARDS). Nineteen (21%) patients were colonized by MDR G− bacteria. Male gender (OR 4.03, p = 0.029) and duration of mechanical ventilation (MV) before ECMO > 3 days (OR 3.57, p = 0.014) were associated with increased risk of colonization. Colonized patients had increased odds of infections by the colonizing germs (84% vs. 29%, p < 0.001, OR 12.9), longer ICU length of stay (LOS) (43 vs. 24 days, p = 0.002), MV (50 vs. 22 days, p < 0.001) and ECMO (28 vs. 12 days, p < 0.001), but did not have higher risk of death (survival rate 58% vs. 67%, p = 0.480, OR 0.68). Infected patients had almost halved ICU survival (46% vs. 78%, p < 0.001, OR 4.11).ConclusionsIn patients undergoing ECMO for respiratory and/or circulatory failure, colonization by MDR G− bacteria is frequent and associated with more the tenfold odds for subsequent infection. Those infections are associated with an increased risk of death.

Highlights

  • In intensive care unit (ICU) patients, digestive tract colonization by multidrug-resistant (MDR) Gram-negative (G−) bacteria is a significant risk factor for the development of infections

  • We present a retrospective analysis of prospectively collected data of all consecutive extracorporeal membrane oxygenation (ECMO) patients admitted to the General Intensive Care Unit (ICU) of San Gerardo Hospital (Monza, Italy) from January 2010 to November 2015

  • From January 2010 to November 2015, 105 patients were treated with ECMO at the General Intensive Care Unit (ICU) of San Gerardo Hospital (Monza, Italy)

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Summary

Introduction

In ICU patients, digestive tract colonization by multidrug-resistant (MDR) Gram-negative (G−) bacteria is a significant risk factor for the development of infections. ICU patients have higher rates of digestive tract colonization by MDR G− bacteria (i.e., producing extended-spectrum β-lactamase (ESBL+) and carbapenem-resistant bacteria) compared to patients admitted to general wards [5, 6]. Such colonizations could represent a significant risk factor for the development of subsequent infections [7,8,9]. In such a fragile population, prevention, early diagnosis and prompt treatment of MDR HAIs may significantly affect morbidity and mortality

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