Infection and antibiotic patterns in critically ill patients on extracorporeal membrane oxygenation

This study aims to investigate the infection patterns and antibiotic utilization in critically ill patients receiving extracorporeal membrane oxygenation treatment.

Between January 2019 and January 2024, a total of 165 patients (109 males, 56 females; median age: 58 years; range, 48 to 67 years) who were hospitalized for at least 24 h and underwent extracorporeal membrane oxygenation, and received ≥1 antibiotic treatment in the cardiovascular intensive care unit were retrospectively analyzed. Microbiological culture results, pathogen resistance patterns, antibiotics used, and their doses during extracorporeal membrane oxygenation were evaluated based on the literature and the Sanford Antimicrobial Guide database.

The median number of days spent on extracorporeal membrane oxygenation was 4 (range, 2 to 7) days. Klebsiella pneumoniae (28.8%) and Acinetobacter baumannii (21.1%) were frequently detected in culture results. The median number and duration of antibiotics were 2 (range, 1 to 3) and 2 (range, 1 to 4) days, respectively. Cephalosporins (39%) and penicillins (30%) were the most commonly used antibiotics. At least one antibiotic dose inappropriateness was detected in 56 (33.9%) patients. A total of 366 antibiotic administrations included 73 (19.9%) dose inappropriateness. Continuous renal replacement therapy, sepsis/septic shock, and extracorporeal membrane oxygenation duration >4 days were identified as risk factors increasing antibiotic inappropriateness (p<0.05).

Our study results indicate that patients receiving extracorporeal membrane oxygenation frequently experience antibiotic resistance and the proliferation of Gram-negative bacteria. In our study, antibiotic dosing was inappropriate in approximately one-third of patients receiving extracorporeal membrane oxygenation. Based on these findings, adherence to the literature should be increased while selecting antibiotics and doses for patients.