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Daily Surveillance Blood Cultures in Children Supported With Extracorporeal Membrane Oxygenation: Single-Center,

Nicholas Schmoke1, Eunice Clark2, Christopher Nemeh1

  • 1Division of Pediatric Surgery, Department of Surgery, Columbia University Vagelos College of Physicians and Surgeons/NewYork-Presbyterian Morgan Stanley Children's Hospital, New York, NY.

Pediatric Critical Care Medicine : a Journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies
|February 7, 2025
PubMed

Insights

Daily blood cultures for bloodstream infections (BSIs) in pediatric and neonatal extracorporeal membrane oxygenation (ECMO) patients are low-yield. Clinical signs and symptoms, not routine cultures, effectively diagnose BSIs in these critical patients.

Area of Science:

  • Pediatric critical care medicine
  • Infectious disease diagnostics
  • Extracorporeal membrane oxygenation (ECMO) support

Background:

  • Diagnosing bloodstream infections (BSIs) in patients on extracorporeal membrane oxygenation (ECMO) is challenging due to altered physiology and unreliable inflammatory markers.
  • Practice variability exists regarding routine blood cultures for BSI surveillance in ECMO centers.

Purpose of the Study:

  • To evaluate the utility of daily surveillance blood cultures for diagnosing BSIs in pediatric and neonatal ECMO patients.
  • To determine if clinical signs and laboratory findings can effectively guide BSI diagnosis in this population.

Main Methods:

  • Retrospective review of daily surveillance blood cultures from January 2021 to July 2023.
  • Analysis of clinical signs, symptoms, and laboratory results in patients with positive blood cultures.
  • Inclusion of all pediatric and neonatal patients supported on ECMO.

Main Results:

  • A cohort of 111 patients (39 neonates, 72 children) on ECMO was analyzed.
  • 3% of daily blood cultures were positive, affecting 6% of patients.
  • All positive cultures correlated with new clinical signs of infection or elevated inflammatory markers on the day of collection.

Conclusions:

  • Daily surveillance blood cultures demonstrate low yield in pediatric and neonatal ECMO patients.
  • Changes in clinical status (e.g., hypotension, hypothermia, respiratory decline) and laboratory findings are key indicators for BSI.
  • As-needed blood cultures prompted by clinical criteria are recommended to reduce unnecessary draws and costs.
Abstract

Keywords:
bacteremiablood cultureextracorporeal membrane oxygenationinfantnewbornpediatrics

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