Incidence of nosocomial infection and causative microorganism during extracorporeal membrane oxygenation in adult patients, a single center study

Abstract

Introduction Extracorporeal membrane oxygenation (ECMO) is an organ support whose use is increasing in acute respiratory distress syndrome (ARDS) cases where adequate gas exchange cannot be achieved despite mechanical ventilation. Patients who were followed up on ECMO are at risk for developing nosocomial infections. In this study, we aimed to investigate the incidence of nosocomial infection and define isolated pathogens from microbiological samples in a single center in Turkey. Methods Patients who were followed up on ECMO due to ARDS between January 1, 2018, and December 31, 2021, were included in the study. Nosocomial infections that were diagnosed after the first 48 h of ECMO cannulation and after 48 h of ECMO decannulation were accepted as ECMO-related infections. Results A total of 50 patients with ARDS were followed up with ECMO. Mean age of patients was 46,8 ± 15,4 and 38 (78%) patients were male. A total of 30 patients (60%) had at least one nosocomial infection, for a rate of 37.6 per 1000 ECMO days. COVID-19, steroid treatment, and ECMO duration were found to be associated with nosocomial infections in patients who underwent ECMO support. In multivariate analysis, antibiotic use was found to be protective against nosocomial infection (OR:0.14, 95% CI: 0.03 – 0.70, p = .017). In addition, prolonged ECMO duration was associated with an increased risk of nosocomial infection in multivariate analysis (OR:1.13, 95% CI: 1.03 – 1.23, p = .010). Gram-negative pathogens were isolated dominantly in blood cultures and tracheal secretion samples, followed by fungi and Gram-positive bacteria. Conclusion Patients are prone to nosocomial infections during ECMO. Microorganisms causing nosocomial infections in ECMO patients seem similar to the flora of each center, and this should be taken into account in the choice of empirical antibiotics.

Antibiotic Prophylaxis in Patients on Extracorporeal Membrane Oxygenation: A Systematic Review

“…At least one nosocomial infection was present in a total of 30 patients (60%)—a rate of 37.6 per 1,000 ECMO days. 4 Patients who were monitored while on ECMO experienced more nosocomial infections (74% vs. 42%, p = 0.023). 4 Patients getting steroid treatment had a higher rate of nosocomial infection detection (84% vs. 58%, p = 0.042), but patients receiving antibiotic treatment had a lower rate (36% vs .…”

“…5,6 Antibiotic use was found to be protective against nosocomial infection in a multivariate study (odds ratio [OR]: 0.14, 95% CI, 0.03–0.70, p = 0.017). 4 In addition, prolonged ECMO (more than 1 week) use was linked in a multivariate analysis to a higher risk of nosocomial infection (OR: 1.13; 95% CI, 1.03–1.23; p = 0.010). 4…”

“…Of the three included studies, two were conducted in Japan, 2,3 and one in Turkey. 4 Kondo et al 2 conducted a cohort study, Uçar et al 4 a cross-sectional study, and Tagami et al 3 a case–control study. Details of inclusion and exclusion criteria are shown in Table 1.…”

“…3 Furthermore, a substantial multicenter observational study found that ECMO recipients had a higher risk of nosocomial infections, with 20.5% of adults contracting culture-positive infections while on ECMO. 4 About 5% patients of 273 patient developed fungal infection in patients with ECMO. 1 These infections have been associated with significant increases in morbidity and mortality among ECMO patients.…”

“…1 These infections have been associated with significant increases in morbidity and mortality among ECMO patients. 4–6…”