Reducing Broad-Spectrum Antimicrobial Use in Extracorporeal Membrane Oxygenation: Reduce AMMO Study

Area of Science:

• Critical Care Medicine
• Infectious Diseases
• Pharmacology

Background:

• Extracorporeal membrane oxygenation (ECMO) use is rising in critically ill adults.
• No established guidelines exist for antimicrobial prophylaxis in ECMO patients.
• Antimicrobial stewardship is crucial for optimizing treatment in this population.

Purpose of the Study:

• To develop and refine an ECMO antimicrobial prophylaxis protocol.
• To analyze the impact of protocol implementation on antimicrobial use and infection rates.
• To propose a standardized antimicrobial prophylaxis regimen for ECMO patients.

Main Methods:

• Quasi-experimental interrupted time series analysis of 7 years of data.
• Evaluation of an initial protocol (2014) and a revised protocol (2018).
• Analysis of antimicrobial use and National Healthcare Safety Network-reportable infection rates in 338 ECMO patients.

Main Results:

• The initial protocol showed no significant changes in antimicrobial use or infection rates.
• The revised and streamlined protocol significantly reduced broad-spectrum antimicrobial use for prophylaxis.
• No compensatory increase in infection rates was observed after protocol revision.

Conclusions:

• A revised ECMO antimicrobial prophylaxis protocol effectively reduces broad-spectrum antibiotic use.
• The developed protocol supports antimicrobial stewardship principles without compromising patient safety.
• Standardizing prophylaxis regimens for ECMO patients is feasible and beneficial.