Sars-Cov 2 versus Flu: ECMO-associated bloodstream infections

Area of Science:

• Critical Care Medicine
• Infectious Diseases
• Respiratory Medicine

Background:

• Severe acute respiratory distress syndrome (ARDS) from SARS-CoV-2 and influenza necessitates extracorporeal membrane oxygenation (ECMO).
• Understanding bloodstream infections (BSIs) and outcomes in ECMO patients is crucial for managing critical respiratory illnesses.

Purpose of the Study:

• To compare the incidence of bloodstream infections (BSIs) and patient outcomes in intensive care unit (ICU) patients with SARS-CoV-2 versus influenza undergoing ECMO.
• To analyze demographic and microbiological data for patients on ECMO due to these respiratory infections.

Main Methods:

• Retrospective analysis of the San Matteo COVID-19 Registry (SMACORE) cohort from January 2018 to April 2020.
• Inclusion of 18 patients on ECMO: 22 with SARS-CoV-2 and 7 with influenza.
• Analysis of demographic data, microbiological data, and bloodstream infections occurring during ECMO support.

Main Results:

• Median age was 61 years for SARS-CoV-2 and 50 years for flu patients (not significant).
• Median ECMO duration and time to bloodstream infection from ECMO initiation were similar between groups.
• Bloodstream infection incidence rates were 2.2/100 patient-days for SARS-CoV-2 and 2.65/100 patient-days for flu.
• Overall infection rates were 5/100 patient-days for SARS-CoV-2 and 5.3/100 patient-days for flu.
• Mortality during ECMO was 40.9% for SARS-CoV-2 patients versus 0% for flu patients.

Conclusions:

• While bloodstream infection rates are comparable, SARS-CoV-2 infection is associated with significantly higher mortality in patients requiring ECMO compared to influenza.
• These findings highlight the critical impact of SARS-CoV-2 on ECMO outcomes.