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Published on: October 24, 2018
Pediatric ECMO and infection risk: A retrospective study on surgical site and bloodstream infections
Samiyah Althagafi1, Mashael Alenzi2, Mohammed Alsuhaibani3
1Department of Pediatric Infectious Diseases, King Abdullah Specialized Children's Hospital (KASCH), Ministry of National Guard Health Affairs, Jeddah, Saudi Arabia.
Insights
Pediatric patients on extracorporeal membrane oxygenation (ECMO) experienced high rates of surgical site infections (SSI) and bloodstream infections (BSI), linked to longer intensive care unit (ICU) stays. Infection prevention strategies are crucial for managing these critical cases.
Area of Science:
- Pediatric critical care medicine
- Infectious disease epidemiology
- Extracorporeal membrane oxygenation (ECMO) support
Background:
- Extracorporeal membrane oxygenation (ECMO) is a life-saving therapy but carries significant risks of severe complications, including surgical site infections (SSI) and bloodstream infections (BSI).
- Understanding the incidence, risk factors, and outcomes of these infections in pediatric ECMO patients is crucial for improving patient management and outcomes.
Purpose of the Study:
- To investigate the incidence, risk factors, common pathogens, and mortality rates of SSI and BSI in pediatric patients undergoing ECMO.
- To identify factors associated with infection development and assess the impact of prophylactic antimicrobials.
Main Methods:
- A retrospective cohort study was conducted on pediatric patients (≤14 years) who received ECMO between January 2012 and December 2022.
- Data collected included patient demographics, ECMO details, infection types (SSI, BSI), causative pathogens, ICU length of stay, and in-hospital mortality.
Main Results:
- The study analyzed 163 ECMO episodes, with 22.1% experiencing composite infections (SSI and/or BSI).
- Key pathogens identified were Coagulase-negative staphylococcus and Klebsiella pneumoniae for SSI, and Coagulase-negative staphylococcus, Escherichia coli, and Candida species for BSI.
- Composite infections were significantly associated with longer ICU stays (median 35 days vs. 25 days, P=0.032), while prophylactic antimicrobials did not show a significant reduction in infection risk (P=0.265). In-hospital mortality was 49.1%.
Conclusions:
- Prolonged ICU stay was a significant factor influencing the incidence of SSI and BSI in pediatric ECMO patients.
- Clinicians must prioritize robust infection prevention strategies and maintain vigilance for early detection and management of infections in this vulnerable population.
- Further research with larger cohorts is recommended to validate these findings and inform clinical practice.
Introduction:
Extracorporeal membrane oxygenation (ECMO) is associated with severe complications, such as surgical site infections (SSI) and bloodstream infections (BSI). This study investigated the incidence, risk factors, common pathogens, and mortality rates of SSI and BSI in pediatric ECMO patients.
Methods:
This retrospective cohort study included patients aged ≤14 years who received ECMO from (January 2012-December 2022) at King Faisal Specialist Hospital and Research Centre, Riyadh.
Results:
The analysis of 163 ECMO episodes revealed that 51.5 % were males with a median age of 4 months [IQR: 0.8-24]. BSI occurred in 8 (4.9 %) cases (incidence: 6.8 cases per 1000 ECMO days), with pathogens including Coagulase-negative staphylococcus (25.0 %), Escherichia coli (25.0 %), and Candida species (25.0 %). SSI occurred in 31 (19.0 %) cases (incidence: 26.5 cases per 1000 ECMO days), with primary pathogens including Coagulase-negative staphylococcus (40.0 %) and Klebsiella pneumoniae (25.0 %). Composite infections (SSI and/or BSI) occurred in 36 (22.1 %) cases with a median of 5 ECMO days [IQR: 4-10]. In univariable analysis, composite infections were significantly associated with longer ICU stays, with a median of 35 days in infected patients compared to 25 days in those without infection (P = 0.032). Yet, prophylactic antimicrobials did not significantly reduce infection risk (P = 0.265). The in-hospital mortality was 49.1 % (80/163).
Conclusions:
The incidence of SSI and BSI in this cohort was influenced by prolonged ICU stay. However, a larger cohort is recommended to support our findings. Clinicians managing ECMO patients should prioritize infection prevention strategies and remain vigilant for early-onset infections to ensure effective clinical management.
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