Prophylactic antibiotics for extracorporeal membrane oxygenation in critically-Ill adults

Abstract

Context and Aims: Primary objective of this study was to estimate time to infection after extracorporeal membrane oxygenation (ECMO) initiation among patients who received prophylactic antibiotics compared to those who did not. Subjects and Methods: This retrospective cohort study included adult patients initiated on ECMO between February 1, 2009, and June 30, 2012, in Intensive Care Units at an 816-bed tertiary care hospital. Results: Prophylaxis defined as an antibiotic initiated at start of ECMO without other bacterial infectious indications was categorized into three levels: (1) No prophylaxis, (2) single antibiotic, and (3) combination two or more antibiotics with activity against methicillin-resistant Staphylococcus aureus and Gram-negative bacteria. Of the 96 patients included, 37 (39%) patients acquired a sterile site infection; 17 of which were caused by of multidrug-resistant organisms. There was no significant difference in the proportion of new infections by antibiotic exposure group. By 500 h on ECMO, all patients had a 60% probability of developing infection. There was a trend that patients on combination antibiotics were less likely to develop a sterile site infection than patients who were not exposed to antibiotics after adjusting for age and comorbid illnesses (adjusted hazard ratio 0.44, 95% confidence interval 0.17–1.13) (P = 0.09). Conclusions: Patients on ECMO on single and combination antibiotic regimens demonstrated no significant difference in the hazard for the development of a new sterile site infection compared to no antibiotic group. The following core competencies are addressed in this article: Medical knowledge, Patient care, Practice-based learning and improvement, Systems-based practice.