Nosocomial Infections During Extracorporeal Membrane Oxygenation: Incidence, Etiology, and Impact on Patients’ Outcome

• Published in: Critical care medicine Vol. 45; no. 10; pp. 1726 - 1733
• Main Authors: Grasselli, Giacomo, Scaravilli, Vittorio, Di Bella, Stefano, Biffi, Stefano, Bombino, Michela, Patroniti, Nicolò, Bisi, Luca, Peri, Anna Maria, Pesenti, Antonio, Gori, Andrea, Alagna, Laura
• Format: Journal Article
• Language: English
• Published: United States Copyright by by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc 01-10-2017
• Subjects: Adolescent; Adult; Age Factors; Bacteremia - epidemiology; Bacteremia - microbiology; Catheter-Related Infections - epidemiology; Child; Child, Preschool; Cross Infection - epidemiology; Cross Infection - microbiology; Drug Resistance, Multiple, Bacterial; Extracorporeal Membrane Oxygenation - adverse effects; Female; Humans; Incidence; Intensive Care Units; Italy - epidemiology; Length of Stay - statistics & numerical data; Male; Middle Aged; Pneumonia, Ventilator-Associated - epidemiology; Pneumonia, Ventilator-Associated - microbiology; Retrospective Studies; Risk Factors; Urinary Tract Infections - epidemiology; Urinary Tract Infections - microbiology; Young Adult
• ISSN: 0090-3493; 1530-0293
• DOI: 10.1097/CCM.0000000000002652

OBJECTIVE:To study incidence, type, etiology, risk factors, and impact on outcome of nosocomial infections during extracorporeal membrane oxygenation.
DESIGN:Retrospective analysis of prospectively collected data.
SETTING:Italian tertiary referral center medical-surgical ICU.
PATIENTS:One hundred five consecutive patients who were treated with extracorporeal membrane oxygenation from January 2010 to November 2015.
INTERVENTIONS:None.
MEASUREMENTS AND MAIN RESULTS:Ninety-two patients were included in the analysis (48.5 [37–56] years old, simplified acute physiology score II 37 [32–47]) who underwent peripheral extracorporeal membrane oxygenation (87% veno-venous) for medical indications (78% acute respiratory distress syndrome). Fifty-two patients (55%) were infected (50.4 infections/1,000 person-days of extracorporeal membrane oxygenation). We identified 32 ventilator-associated pneumonia, eight urinary tract infections, five blood stream infections, three catheter-related blood stream infections, two colitis, one extracorporeal membrane oxygenation cannula infection, and one pulmonary-catheter infection. G+ infections (35%) occurred earlier compared with G– (48%) (4 [2–10] vs. 13 [7–23] days from extracorporeal membrane oxygenation initiation; p < 0.001). Multidrug-resistant organisms caused 56% of bacterial infections. Younger age (2–35 years old) was independently associated with higher risk for nosocomial infections. Twenty-nine patients (31.5%) died (13.0 deaths/1,000 person-days of extracorporeal membrane oxygenation). Infected patients had higher risk for death (18 vs. 8 deaths/1,000 person-days of extracorporeal membrane oxygenation; p = 0.037) and longer ICU stay (32.5 [19.5–78] vs. 19 [10.5–27.5] days; p = 0.003), mechanical ventilation (36.5 [20–80.5] vs. 16.5 [9–25.5] days; p < 0.001), and extracorporeal membrane oxygenation (25.5 [10.75–54] vs. 10 [5–13] days; p < 0.001). Older age (> 50 years old), reason for connection different from acute respiratory distress syndrome, higher simplified acute physiology score II, diagnosis of ventilator-associated pneumonia, and infection by multidrug-resistant bacteria were independently associated to increased death rate.
CONCLUSIONS:Infections (especially ventilator-associated pneumonia) during extracorporeal membrane oxygenation therapy are common and frequently involve multidrug-resistant organisms. In addition, they have a negative impact on patients’ outcomes.