Nosocomial Infections During Extracorporeal Membrane Oxygenation: Incidence, Etiology, and Impact on Patients' Outcome
To study incidence, type, etiology, risk factors, and impact on outcome of nosocomial infections during extracorporeal membrane oxygenation. Retrospective analysis of prospectively collected data. Italian tertiary referral center medical-surgical ICU. One hundred five consecutive patients who were t...
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| Vydáno v: | Critical care medicine Ročník 45; číslo 10; s. 1726 |
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| Médium: | Journal Article |
| Jazyk: | angličtina |
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01.10.2017
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| ISSN: | 1530-0293, 1530-0293 |
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| Abstract | To study incidence, type, etiology, risk factors, and impact on outcome of nosocomial infections during extracorporeal membrane oxygenation.
Retrospective analysis of prospectively collected data.
Italian tertiary referral center medical-surgical ICU.
One hundred five consecutive patients who were treated with extracorporeal membrane oxygenation from January 2010 to November 2015.
None.
Ninety-two patients were included in the analysis (48.5 [37-56] years old, simplified acute physiology score II 37 [32-47]) who underwent peripheral extracorporeal membrane oxygenation (87% veno-venous) for medical indications (78% acute respiratory distress syndrome). Fifty-two patients (55%) were infected (50.4 infections/1,000 person-days of extracorporeal membrane oxygenation). We identified 32 ventilator-associated pneumonia, eight urinary tract infections, five blood stream infections, three catheter-related blood stream infections, two colitis, one extracorporeal membrane oxygenation cannula infection, and one pulmonary-catheter infection. G+ infections (35%) occurred earlier compared with G- (48%) (4 [2-10] vs. 13 [7-23] days from extracorporeal membrane oxygenation initiation; p < 0.001). Multidrug-resistant organisms caused 56% of bacterial infections. Younger age (2-35 years old) was independently associated with higher risk for nosocomial infections. Twenty-nine patients (31.5%) died (13.0 deaths/1,000 person-days of extracorporeal membrane oxygenation). Infected patients had higher risk for death (18 vs. 8 deaths/1,000 person-days of extracorporeal membrane oxygenation; p = 0.037) and longer ICU stay (32.5 [19.5-78] vs. 19 [10.5-27.5] days; p = 0.003), mechanical ventilation (36.5 [20-80.5] vs. 16.5 [9-25.5] days; p < 0.001), and extracorporeal membrane oxygenation (25.5 [10.75-54] vs. 10 [5-13] days; p < 0.001). Older age (> 50 years old), reason for connection different from acute respiratory distress syndrome, higher simplified acute physiology score II, diagnosis of ventilator-associated pneumonia, and infection by multidrug-resistant bacteria were independently associated to increased death rate.
Infections (especially ventilator-associated pneumonia) during extracorporeal membrane oxygenation therapy are common and frequently involve multidrug-resistant organisms. In addition, they have a negative impact on patients' outcomes. |
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| AbstractList | To study incidence, type, etiology, risk factors, and impact on outcome of nosocomial infections during extracorporeal membrane oxygenation.OBJECTIVETo study incidence, type, etiology, risk factors, and impact on outcome of nosocomial infections during extracorporeal membrane oxygenation.Retrospective analysis of prospectively collected data.DESIGNRetrospective analysis of prospectively collected data.Italian tertiary referral center medical-surgical ICU.SETTINGItalian tertiary referral center medical-surgical ICU.One hundred five consecutive patients who were treated with extracorporeal membrane oxygenation from January 2010 to November 2015.PATIENTSOne hundred five consecutive patients who were treated with extracorporeal membrane oxygenation from January 2010 to November 2015.None.INTERVENTIONSNone.Ninety-two patients were included in the analysis (48.5 [37-56] years old, simplified acute physiology score II 37 [32-47]) who underwent peripheral extracorporeal membrane oxygenation (87% veno-venous) for medical indications (78% acute respiratory distress syndrome). Fifty-two patients (55%) were infected (50.4 infections/1,000 person-days of extracorporeal membrane oxygenation). We identified 32 ventilator-associated pneumonia, eight urinary tract infections, five blood stream infections, three catheter-related blood stream infections, two colitis, one extracorporeal membrane oxygenation cannula infection, and one pulmonary-catheter infection. G+ infections (35%) occurred earlier compared with G- (48%) (4 [2-10] vs. 13 [7-23] days from extracorporeal membrane oxygenation initiation; p < 0.001). Multidrug-resistant organisms caused 56% of bacterial infections. Younger age (2-35 years old) was independently associated with higher risk for nosocomial infections. Twenty-nine patients (31.5%) died (13.0 deaths/1,000 person-days of extracorporeal membrane oxygenation). Infected patients had higher risk for death (18 vs. 8 deaths/1,000 person-days of extracorporeal membrane oxygenation; p = 0.037) and longer ICU stay (32.5 [19.5-78] vs. 19 [10.5-27.5] days; p = 0.003), mechanical ventilation (36.5 [20-80.5] vs. 16.5 [9-25.5] days; p < 0.001), and extracorporeal membrane oxygenation (25.5 [10.75-54] vs. 10 [5-13] days; p < 0.001). Older age (> 50 years old), reason for connection different from acute respiratory distress syndrome, higher simplified acute physiology score II, diagnosis of ventilator-associated pneumonia, and infection by multidrug-resistant bacteria were independently associated to increased death rate.MEASUREMENTS AND MAIN RESULTSNinety-two patients were included in the analysis (48.5 [37-56] years old, simplified acute physiology score II 37 [32-47]) who underwent peripheral extracorporeal membrane oxygenation (87% veno-venous) for medical indications (78% acute respiratory distress syndrome). Fifty-two patients (55%) were infected (50.4 infections/1,000 person-days of extracorporeal membrane oxygenation). We identified 32 ventilator-associated pneumonia, eight urinary tract infections, five blood stream infections, three catheter-related blood stream infections, two colitis, one extracorporeal membrane oxygenation cannula infection, and one pulmonary-catheter infection. G+ infections (35%) occurred earlier compared with G- (48%) (4 [2-10] vs. 13 [7-23] days from extracorporeal membrane oxygenation initiation; p < 0.001). Multidrug-resistant organisms caused 56% of bacterial infections. Younger age (2-35 years old) was independently associated with higher risk for nosocomial infections. Twenty-nine patients (31.5%) died (13.0 deaths/1,000 person-days of extracorporeal membrane oxygenation). Infected patients had higher risk for death (18 vs. 8 deaths/1,000 person-days of extracorporeal membrane oxygenation; p = 0.037) and longer ICU stay (32.5 [19.5-78] vs. 19 [10.5-27.5] days; p = 0.003), mechanical ventilation (36.5 [20-80.5] vs. 16.5 [9-25.5] days; p < 0.001), and extracorporeal membrane oxygenation (25.5 [10.75-54] vs. 10 [5-13] days; p < 0.001). Older age (> 50 years old), reason for connection different from acute respiratory distress syndrome, higher simplified acute physiology score II, diagnosis of ventilator-associated pneumonia, and infection by multidrug-resistant bacteria were independently associated to increased death rate.Infections (especially ventilator-associated pneumonia) during extracorporeal membrane oxygenation therapy are common and frequently involve multidrug-resistant organisms. In addition, they have a negative impact on patients' outcomes.CONCLUSIONSInfections (especially ventilator-associated pneumonia) during extracorporeal membrane oxygenation therapy are common and frequently involve multidrug-resistant organisms. In addition, they have a negative impact on patients' outcomes. To study incidence, type, etiology, risk factors, and impact on outcome of nosocomial infections during extracorporeal membrane oxygenation. Retrospective analysis of prospectively collected data. Italian tertiary referral center medical-surgical ICU. One hundred five consecutive patients who were treated with extracorporeal membrane oxygenation from January 2010 to November 2015. None. Ninety-two patients were included in the analysis (48.5 [37-56] years old, simplified acute physiology score II 37 [32-47]) who underwent peripheral extracorporeal membrane oxygenation (87% veno-venous) for medical indications (78% acute respiratory distress syndrome). Fifty-two patients (55%) were infected (50.4 infections/1,000 person-days of extracorporeal membrane oxygenation). We identified 32 ventilator-associated pneumonia, eight urinary tract infections, five blood stream infections, three catheter-related blood stream infections, two colitis, one extracorporeal membrane oxygenation cannula infection, and one pulmonary-catheter infection. G+ infections (35%) occurred earlier compared with G- (48%) (4 [2-10] vs. 13 [7-23] days from extracorporeal membrane oxygenation initiation; p < 0.001). Multidrug-resistant organisms caused 56% of bacterial infections. Younger age (2-35 years old) was independently associated with higher risk for nosocomial infections. Twenty-nine patients (31.5%) died (13.0 deaths/1,000 person-days of extracorporeal membrane oxygenation). Infected patients had higher risk for death (18 vs. 8 deaths/1,000 person-days of extracorporeal membrane oxygenation; p = 0.037) and longer ICU stay (32.5 [19.5-78] vs. 19 [10.5-27.5] days; p = 0.003), mechanical ventilation (36.5 [20-80.5] vs. 16.5 [9-25.5] days; p < 0.001), and extracorporeal membrane oxygenation (25.5 [10.75-54] vs. 10 [5-13] days; p < 0.001). Older age (> 50 years old), reason for connection different from acute respiratory distress syndrome, higher simplified acute physiology score II, diagnosis of ventilator-associated pneumonia, and infection by multidrug-resistant bacteria were independently associated to increased death rate. Infections (especially ventilator-associated pneumonia) during extracorporeal membrane oxygenation therapy are common and frequently involve multidrug-resistant organisms. In addition, they have a negative impact on patients' outcomes. |
| Author | Scaravilli, Vittorio Patroniti, Nicolò Peri, Anna Maria Pesenti, Antonio Bombino, Michela Di Bella, Stefano Alagna, Laura Grasselli, Giacomo Bisi, Luca Biffi, Stefano Gori, Andrea |
| Author_xml | – sequence: 1 givenname: Giacomo surname: Grasselli fullname: Grasselli, Giacomo organization: 1Department of Anesthesia, Critical Care and Emergency, Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico, Milan (MI), Italy. 2Infectious Disease Unit, University Hospital of Trieste, Trieste (TS), Italy. 3School of Medicine and Surgery, University of Milan-Bicocca, Milan (MI), Italy. 4Department of Anesthesia, Critical Care and Emergency, ASST Monza San Gerardo Hospital, Monza (MB), Italy. 5Infectious Disease Clinics, ASST Monza San Gerardo Hospital, Monza (MB), Italy. 6Department of Pathophysiology and Transplantation, University of Milan, Milan (MI), Italy – sequence: 2 givenname: Vittorio surname: Scaravilli fullname: Scaravilli, Vittorio – sequence: 3 givenname: Stefano surname: Di Bella fullname: Di Bella, Stefano – sequence: 4 givenname: Stefano surname: Biffi fullname: Biffi, Stefano – sequence: 5 givenname: Michela surname: Bombino fullname: Bombino, Michela – sequence: 6 givenname: Nicolò surname: Patroniti fullname: Patroniti, Nicolò – sequence: 7 givenname: Luca surname: Bisi fullname: Bisi, Luca – sequence: 8 givenname: Anna Maria surname: Peri fullname: Peri, Anna Maria – sequence: 9 givenname: Antonio surname: Pesenti fullname: Pesenti, Antonio – sequence: 10 givenname: Andrea surname: Gori fullname: Gori, Andrea – sequence: 11 givenname: Laura surname: Alagna fullname: Alagna, Laura |
| BackLink | https://www.ncbi.nlm.nih.gov/pubmed/28777198$$D View this record in MEDLINE/PubMed |
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Retrospective... To study incidence, type, etiology, risk factors, and impact on outcome of nosocomial infections during extracorporeal membrane oxygenation.OBJECTIVETo study... |
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| SubjectTerms | Adolescent Adult Age Factors Bacteremia - epidemiology Bacteremia - microbiology Catheter-Related Infections - epidemiology Child Child, Preschool Cross Infection - epidemiology Cross Infection - microbiology Drug Resistance, Multiple, Bacterial Extracorporeal Membrane Oxygenation - adverse effects Female Humans Incidence Intensive Care Units Italy - epidemiology Length of Stay - statistics & numerical data Male Middle Aged Pneumonia, Ventilator-Associated - epidemiology Pneumonia, Ventilator-Associated - microbiology Retrospective Studies Risk Factors Urinary Tract Infections - epidemiology Urinary Tract Infections - microbiology Young Adult |
| Title | Nosocomial Infections During Extracorporeal Membrane Oxygenation: Incidence, Etiology, and Impact on Patients' Outcome |
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