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Veno-Venous Extracorporeal Membrane Oxygenation in a Mouse
Published on: October 24, 2018
Nosocomial bloodstream infection in critically ill patients: is extracorporeal membrane oxygenation a relevant
Almudena Martínez1, María Marín-Cerezuela2, Carmen Carrasco1
1Critical Care Department, Hospital Universitario y Politécnico la Fe, Valencia, Spain.
Background:
Nosocomial bloodstream infection (BSI) in critically ill patients can cause clinical deterioration, prolong intensive care unit (ICU) stays, and increase mortality risk. Extracorporeal membrane oxygenation support (ECMO) is a known risk factor for BSI, and infections in these patients are assumed to have a worse prognosis.
Aim:
To compare risk factors for BSI between ECMO and non-ECMO patients.
Methods:
A three-year prospective observational study was conducted in a 24-bed medical ICU. Consecutive nosocomial BSI episodes were recorded, and BSIs in mechanically ventilated patients were analysed based on ECMO treatment status.
Findings:
A total of 98 BSI episodes were included: 30 (30.6%) in ECMO and 68 (69.3%) in non-ECMO patients. The total number of ECMO patients during the study period was 110, with a bacteraemia rate of 27.7% (20.26 episodes per 1000 treatment-days). In non-ECMO patients, the BSI rate was 7.9% (P < 0.001). ECMO patients were younger and had fewer comorbidities. BSI type and aetiology were similar between groups, but severity was higher in ECMO patients. Although multidrug-resistant micro-organisms were more frequent in ECMO patients, the appropriate treatment rate was similar. ICU mortality was 66.6% in ECMO patients and 30.8% in non-ECMO patients (P < 0.001). However, continuous renal replacement therapy (odds ratio (OR): 3.67), Sepsis Organ Failure Assessment score (OR: 1.54), and COVID-19 diagnosis (OR: 1.54) were the only independent risk factors associated with mortality in BSI patients.
Conclusion:
Although BSI was more frequent and severe in ECMO patients, ECMO support was not independently related to mortality in patients with healthcare-associated BSI.
Insights
Bloodstream infections (BSI) are more frequent and severe in patients on extracorporeal membrane oxygenation (ECMO). However, ECMO itself was not an independent risk factor for mortality in healthcare-associated BSIs.
Area of Science:
- Critical Care Medicine
- Infectious Diseases
- Cardiopulmonary Support
Background:
- Nosocomial bloodstream infections (BSI) increase mortality and ICU stays in critically ill patients.
- Extracorporeal membrane oxygenation (ECMO) is a risk factor for BSI, with presumed worse prognoses.
Purpose of the Study:
- To compare risk factors for BSI between patients receiving ECMO and those not on ECMO.
- To investigate the impact of ECMO on BSI characteristics and patient outcomes.
Main Methods:
- A three-year prospective observational study in a medical ICU.
- Analysis of consecutive nosocomial BSI episodes in mechanically ventilated patients, stratified by ECMO status.
Main Results:
- BSIs were more frequent (27.7% vs. 7.9%) and severe in ECMO patients, despite younger age and fewer comorbidities.
- Multidrug-resistant organisms were more common in ECMO patients, but appropriate treatment rates were similar.
- ICU mortality was higher in ECMO patients (66.6% vs. 30.8%), but independent risk factors for mortality included renal replacement therapy, SOFA score, and COVID-19.
Conclusions:
- Healthcare-associated BSIs are more frequent and severe in ECMO patients.
- ECMO support was not independently associated with mortality in patients with healthcare-associated BSI.
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