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Outcomes of Fungemia in Patients Receiving Extracorporeal Membrane Oxygenation

Melissa M Rosas1, Michal J Sobieszczyk1, Whittney Warren1

  • 1Pulmonary and Critical Care Division, Department of Medicine, Brooke Army Medical Center, Joint Base San Antonio, Texas, USA.

Open Forum Infectious Diseases
|August 11, 2022
PubMed

Insights

Fungal infections during extracorporeal membrane oxygenation (ECMO) have limited treatment data. Survival to discharge was 57% in 14 patients, but 40% of those treated before ECMO removal experienced recurrence.

Area of Science:

  • Critical Care Medicine
  • Infectious Diseases
  • Cardiopulmonary Support

Background:

  • Fungal bloodstream infections (FBSI) are a rare but serious complication in patients requiring extracorporeal membrane oxygenation (ECMO).
  • Limited evidence exists regarding optimal antifungal treatment strategies and outcomes for FBSI in this vulnerable population.
  • ECMO support itself may influence the host immune response and antifungal drug distribution.

Purpose of the Study:

  • To investigate the clinical outcomes of patients who developed fungal infections while on ECMO.
  • To assess the survival rates and recurrence patterns of fungal infections in ECMO patients.
  • To provide preliminary data on the management of fungal infections in the context of mechanical circulatory support.

Main Methods:

  • Retrospective analysis of 14 patients who developed fungal bloodstream infections during ECMO therapy.
  • Review of patient demographics, fungal species, antifungal treatments, and clinical outcomes.
  • Assessment of survival to discharge and rates of fungal infection recurrence.

Main Results:

  • A total of 14 patients with fungal bloodstream infections on ECMO were identified.
  • The overall survival rate to discharge for these patients was 57% (8 out of 14).
  • Among the 5 patients who completed antifungal treatment prior to ECMO decannulation, 2 (40%) experienced recurrent fungal infections.

Conclusions:

  • Fungal infections pose a significant challenge in ECMO patients, with a moderate survival rate.
  • The risk of recurrent fungal infections after treatment completion before decannulation warrants further investigation.
  • These findings highlight the need for optimized antifungal treatment protocols and close monitoring in ECMO patients with fungal infections.
Keywords:
COVID-19extracorporeal membrane oxygenationfungemia

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