Blood Stream Infection in Patients on Venovenous Extracorporeal Membrane Oxygenation for Respiratory Failure

Na, Soo Jin; Chung, Chi Ryang; Choi, Hee Jung; Cho, Yang Hyun; Yang, Jeong Hoon; Suh, Gee Young; Jeon, Kyeongman

doi:10.1017/ice.2018.90

Cited by 17 publications

(31 citation statements)

References 18 publications

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“…Previous studies have shown that age, autoimmune comorbidities, higher Sequential Organ Failure Assessment score, and ECMO duration are predictors of NI during ECMO [5,9,21,27]. Contrast to previous studies, we found that decreased BMI and longer CPR to pump on time were associated with NIs in IHCA patients undergoing ECPR.…”

Section: Plos Onecontrasting

confidence: 99%

“…ECMO in ECPR (75 [IQR 48-140] hours) is shorter than that of veno-venous ECMO in our previous study (14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26) days) [9,24].…”

Section: Plos Onementioning

confidence: 76%

“…The risk of developing NIs might be inevitably increased in ECPR patients with immunocompromised conditions and who have additional indwelling medical devices such as central lines, arterial lines, renal replacement therapy, and invasive mechanical ventilation [4][5][6]. However, to date, only a few studies have evaluated the incidence, risk factors, microbial etiology, and antibiotic resistance patterns of NIs in patients with acute respiratory distress syndrome require prolonged support of veno-venous ECMO [7][8][9]. There are no data regarding the clinical features and outcomes of NIs in ECPR patients.…”

Section: Introductionmentioning

confidence: 99%

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Nosocomial infections in in-hospital cardiac arrest patients who undergo extracorporeal cardiopulmonary resuscitation

Huh

Kim

et al. 2020

PLoS ONE

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Background Little is known of nosocomial infections (NI) in patients who suffer from in-hospital cardiac arrest who undergoing extracorporeal cardiopulmonary resuscitation. This study aimed to investigate clinical pictures of NI, and the association of NIs with clinical outcomes in in-hospital cardiac arrest patients who undergoing extracorporeal cardiopulmonary resuscitation. Methods To evaluate the incidence and clinical characteristics of NI in patients who undergoing extracorporeal cardiopulmonary resuscitation, a retrospective cohort study was conducted in a single tertiary referral center between January 2010 and December 2018. We included adult patients who undergoing extracorporeal cardiopulmonary resuscitation for in-hospital cardiac arrest and excluded patients who were out-of-hospital cardiac arrest or failed ECMO implantation. Clinical characteristics and outcomes were compared between NI and Non-NI patients, or multidrug-resistant (MDR) and non-MDR. The independent risk factors associated with NIs were also analyzed using multivariable logistic regression model. Results Thirty-five (23.3%) patients developed a NI. These cases included 21 patients with a gram negative (G-) infection, 12 patients with a gram positive (G+) bacterial infection, and two patients with fungal infection. Pneumonia was the most common type of NIs, followed by catheter-related infection. The in-hospital mortality and neurologic outcomes at discharge were not different between the NI and non-NI groups. Multidrug-resistant (MDR) pathogens were detected in 10 cases (28.6%). The MDR NI patients had a higher ICU mortality than did those with non-MDR NI (80% vs. 32%, p = 0.028). Following multivariable adjustment, body mass index (adjusted OR 0.87, 95% CI, 0.77–0.97, p = 0.016) and cardiopulmonary resuscitation to pump on time (adjusted OR 1.04, 95% CI, 1.01–1.06, p = 0.001) were independent predictors of NI development. Conclusions In patients who received extracorporeal cardiopulmonary resuscitation, NIs were not associated with an increase in in-hospital mortality. However, NIs with MDR organisms do increase the risk of in-hospital mortality. Lower body mass index and longer low flow time were significant predictors of NI development.

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Section: Plos Onecontrasting

confidence: 99%

“…ECMO in ECPR (75 [IQR 48-140] hours) is shorter than that of veno-venous ECMO in our previous study (14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26) days) [9,24].…”

Section: Plos Onementioning

confidence: 76%

Section: Introductionmentioning

confidence: 99%

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Nosocomial infections in in-hospital cardiac arrest patients who undergo extracorporeal cardiopulmonary resuscitation

Huh

Kim

et al. 2020

PLoS ONE

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“…Although limited by small sample sizes, the incidence of BSI ranged between 13% and 27%. [16][17][18][19][20][21] BSIs are known to be associated with increased mortality in critically ill patients. UTIs and CAUTIs are also frequently encountered HAIs; however, these infections were uncommonly encountered in the ECMO population compared to BSI and VAP.…”

Section: Discussionmentioning

confidence: 99%

Incidence of healthcare-associated infections in patients with fever during the first 48 hours after decannulation from veno-venous extracorporeal membrane oxygenation

et al. 2020

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Introduction: Fevers following decannulation from veno-venous extracorporeal membrane oxygenation often trigger an infectious workup; however, the yield of this workup is unknown. We investigated the incidence of post-veno-venous extracorporeal membrane oxygenation decannulation fever as well as the incidence and nature of healthcare-associated infections in this population within 48 hours of decannulation. Methods: All patients treated with veno-venous extracorporeal membrane oxygenation for acute respiratory failure who survived to decannulation between August 2014 and November 2018 were retrospectively reviewed. Trauma patients and bridge to lung transplant patients were excluded. The highest temperature and maximum white blood cell count in the 24 hours preceding and the 48 hours following decannulation were obtained. All culture data obtained in the 48 hours following decannulation were reviewed. Healthcare-associated infections included blood stream infections, ventilator-associated pneumonia, and urinary tract infections. Results: A total of 143 patients survived to decannulation from veno-venous extracorporeal membrane oxygenation and were included in the study. In total, 73 patients (51%) were febrile in the 48 hours following decannulation. Among this cohort, seven healthcare-associated infections were found, including five urinary tract infections, one blood stream infection, and one ventilator-associated pneumonia. In the afebrile cohort (70 patients), four healthcare-associated infections were found, including one catheter-associated urinary tract infection, two blood stream infections, and one ventilator-associated pneumonia. In all decannulated patients, the majority of healthcare-associated infections were urinary tract infections (55%). No central line–associated blood stream infections were identified in either cohort. When comparing febrile to non-febrile cohorts, there was a significant difference between pre- and post-decannulation highest temperature (p < 0.001) but not maximum white blood cell count (p = 0.66 and p = 0.714) between the two groups. Among all positive culture data, the most commonly isolated organism was Klebsiella pneumoniae (41.7%) followed by Escherichia coli (33%). Median hospital length of stay and time on extracorporeal membrane oxygenation were shorter in the afebrile group compared to the febrile group; however, this did not reach a statistical difference. Conclusion: Fever is common in the 48 hours following decannulation from veno-venous extracorporeal membrane oxygenation. Differentiating infection from non-infectious fever in the post-decannulation veno-venous extracorporeal membrane oxygenation population remains challenging. In our febrile post-decannulation cohort, the incidence of healthcare-associated infections was low. The majority were diagnosed with a urinary tract infection. We believe obtaining cultures in febrile patients in the immediate decannulation period from veno-venous extracorporeal membrane oxygenation has utility, and even in the absence of other clinical suspicion, should be considered. However, based on our data, a urinalysis and urine culture may be sufficient as an initial work up to identify the source of infection.

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“…Importantly it is likely the magnitude of the problem is not fully appreciated: CRIs may be under-reported in the absence of a consensus definition[15] and thus this complication may be under-recognised in clinical practice and less reliably reported in the evidence base. Patients on ECMO generally have multiple invasive lines in addition to the large-bore ECMO lines which increases the number of entry portals for intraluminal contaminants and constitutes an increased risk for BSI among other factors[6, 33]. Routine changeout of ECMO lines is unfeasible due to the high risk of life-threatening complications and patient cardiorespiratory instability precludes this as an option when potential or proven infections occur.…”

Section: Discussionmentioning

confidence: 99%

Cannula and circuit management in peripheral extracorporeal membrane oxygenation: An international survey of 45 countries

et al. 2019

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Effective and safe practices during extracorporeal membrane oxygenation (ECMO) including infection precautions and securement of lines (cannulas and circuits) are critical to prevent life-threatening patient complications, yet little is known about the practices of bedside clinicians and data to support best practice is lacking. Therefore, the aim of this study was to identify and describe common line-related practices for patients supported by peripheral ECMO worldwide and to highlight any gaps for further investigation. An electronic survey was conducted to examine common line practices for patients managed on peripheral ECMO. Responses were obtained from 45 countries with the majority from the United States (n = 181) and United Kingdom (n = 32). Standardised infection precautions including hand hygiene, maximal barrier precautions and skin antisepsis were commonplace for cannulation. The most common antisepsis strategies included alcohol-based chlorhexidine gluconate (CHG) for cannula insertion (53%) and maintenance (54%), isopropyl alcohol on circuit access ports (39%), and CHG-impregnated dressings to cover insertion sites (36%). Adverse patient events due to line malposition or dislodgement were reported by 34% of respondents with most attributable to ineffective securement. Centres ‘always’ suturing peripheral cannula sites were more likely to experience a cannula adverse event than centres that ‘never’ sutured (35% [95% CI 30, 41] vs 0% [95% CI 0, 28]; Chi-square 4.40; p = 0.04) but this did not meet the a priori significance level of <0.01. An evidence-based guideline would be beneficial to improve ECMO line management according to 78% of respondents. Evidence gaps were identified for antiseptic agents, dressing products and regimens, securement methods, and needleless valves. Future research addressing these areas may provide opportunities for consensus guideline development and practice improvement.

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Blood Stream Infection in Patients on Venovenous Extracorporeal Membrane Oxygenation for Respiratory Failure

Cited by 17 publications

References 18 publications

Nosocomial infections in in-hospital cardiac arrest patients who undergo extracorporeal cardiopulmonary resuscitation

Nosocomial infections in in-hospital cardiac arrest patients who undergo extracorporeal cardiopulmonary resuscitation

Incidence of healthcare-associated infections in patients with fever during the first 48 hours after decannulation from veno-venous extracorporeal membrane oxygenation

Cannula and circuit management in peripheral extracorporeal membrane oxygenation: An international survey of 45 countries

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