Outcome and Clinical Characteristics of Nosocomial Infection in Adult Patients Undergoing Extracorporeal Membrane Oxygenation: A Systematic Review and Meta-Analysis

Li, Xiyuan; Wang, Liangshan; Wang, Hong; Hou, Xiaotong

doi:10.3389/fpubh.2022.857873

Cited by 15 publications

(10 citation statements)

References 35 publications

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“…A recent study showed that relapses and superinfections occurred in 79% of COVID-19 patients assisted with ECMO [ 15 ]. The challenge of a VAP diagnosis in this population may have induced misdiagnoses and delayed appropriate therapy [ 5 , 35 ]. Thus, it may have increased the burden of VAP, while favoring the risk for treatment failure.…”

Section: Discussionmentioning

confidence: 99%

Ventilator-Associated Pneumonia in COVID-19 Patients Admitted in Intensive Care Units: Relapse, Therapeutic Failure and Attributable Mortality—A Multicentric Observational Study from the OutcomeRea Network

Wicky

Dupuis

Cerf

et al. 2023

JCM

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Introduction: Ventilator-associated pneumonia (VAP) incidence is high among critically ill COVID-19 patients. Its attributable mortality remains underestimated, especially for unresolved episodes. Indeed, the impact of therapeutic failures and the determinants that potentially affect mortality are poorly evaluated. We assessed the prognosis of VAP in severe COVID-19 cases and the impact of relapse, superinfection, and treatment failure on 60-day mortality. Methods: We evaluated the incidence of VAP in a multicenter prospective cohort that included adult patients with severe COVID-19, who required mechanical ventilation for ≥48 h between March 2020 and June 2021. We investigated the risk factors for 30-day and 60-day mortality, and the factors associated with relapse, superinfection, and treatment failure. Results: Among 1424 patients admitted to eleven centers, 540 were invasively ventilated for 48 h or more, and 231 had VAP episodes, which were caused by Enterobacterales (49.8%), P. aeruginosa (24.8%), and S. aureus (22%). The VAP incidence rate was 45.6/1000 ventilator days, and the cumulative incidence at Day 30 was 60%. VAP increased the duration of mechanical ventilation without modifying the crude 60-day death rate (47.6% vs. 44.7% without VAP) and resulted in a 36% increase in death hazard. Late-onset pneumonia represented 179 episodes (78.2%) and was responsible for a 56% increase in death hazard. The cumulative incidence rates of relapse and superinfection were 45% and 39.5%, respectively, but did not impact death hazard. Superinfection was more frequently related to ECMO and first episode of VAP caused by non-fermenting bacteria. The risk factors for treatment failure were an absence of highly susceptible microorganisms and vasopressor need at VAP onset. Conclusions: The incidence of VAP, mainly late-onset episodes, is high in COVID-19 patients and associated with an increased risk of death, similar to that observed in other mechanically ventilated patients. The high rate of VAP due to difficult-to-treat microorganisms, pharmacokinetic alterations induced by renal replacement therapy, shock, and ECMO likely explains the high cumulative risk of relapse, superinfection, and treatment failure.

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Section: Discussionmentioning

confidence: 99%

Ventilator-Associated Pneumonia in COVID-19 Patients Admitted in Intensive Care Units: Relapse, Therapeutic Failure and Attributable Mortality—A Multicentric Observational Study from the OutcomeRea Network

Wicky

Dupuis

Cerf

et al. 2023

JCM

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“…We assumed that patients receiving ECMO treatment may require more analgosedation, a more intense anticoagulation, and may be sicker overall. For instance, studies reported higher infection rates among patients who were ECMO-treated compared to patients who were non-ECMO-treated [ 32 , 33 , 34 ]. Moreover, we observed a longer treatment duration in the ECMO subgroup.…”

Section: Discussionmentioning

confidence: 99%

Drug–Drug Interactions in Patients with Acute Respiratory Distress Syndrome

Bischof,

Schaller,

Buchtele

et al. 2024

Pharmaceutics

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Acute respiratory distress syndrome (ARDS) is a potential life-threatening, heterogenous, inflammatory lung disease. There are no data available on potential drug–drug interactions (pDDIs) in critically ill patients with ARDS. This study analyzed pDDIs in this specific cohort and aimed to investigate possible associations of coronavirus disease 2019 (COVID-19) as an underlying cause of ARDS and treatment with extracorporeal membrane oxygenation (ECMO) with the occurrence of pDDIs. This retrospective study included patients ≥18 years of age diagnosed with ARDS between January 2010 and September 2021. The Janusmed database was used for the identification of pDDIs. A total of 2694 pDDIs were identified in 189 patients with a median treatment duration of 22 days. These included 323 (12%) clinically relevant drug combinations that are best avoided, corresponding to a median rate of 0.05 per day. There was no difference in the number of pDDIs between COVID-19- and non-COVID-19-associated ARDS. In patients treated with ECMO, the rate of the most severely graded pDDIs per day was significantly higher compared with those who did not require ECMO. PDDIs occur frequently in patients with ARDS. On average, each patient may encounter at least one clinically relevant drug combination that should be avoided during their intensive care unit stay.

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“…Our results show that MDR infections were related to poor prognosis of ECMO patients as aspect excepting mortality. A meta-analysis suggested that the infections in ECMO patients increased mortality by 32percentt [3]. But compared with Group N, Group R of patients did not exhibit higher mortality, which may be explained by the range of patient selection [8].…”

Section: Discussionmentioning

confidence: 99%

“…Patients receiving ECMO treatments are high risk for MDR infections due to the immunode ciency caused by severe illness and the applications of invasive life support measures [5]. It is con rmed that MDR infections in ECMO patients and delayed treatment associated with increased mortality [2,3]. Timely and targeted empiric antibiotic therapies against MDR pathogens are associated with reduced mortality [2].…”

Section: Introductionmentioning

confidence: 99%

Etiological characteristics and appropriate empiric antibiotic strategies of multidrug-resistant pathogens in patients requiring extracorporeal membrane oxygenation: a retrospective cohort study

Gao

Wang

2023

Preprint

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Background: Delayed treatments of MDR infections in patients receiving extracorporeal membrane oxygenation (ECMO) supports associated with increased mortality. But, there was currently no relevant references available to guide early anti-infective treatments for them. The purpose of our study was to clarify etiological characteristics and empiric antibiotic strategies of MDR pathogens in ECMO patients. Methods: The clinical data of 104 ECMO patients in Tianjin third central hospital were retrospectively collected from January 2014 to December 2022. There were 61 and 29 adult patients supported by veno-arterial (VA)-ECMO or veno-venous (VV)-ECMO for > 24 hours enrolled. Patients were divided into “group R” and “group N” by with or without MDR infections. Clinical characteristics of enrolled patients were collected. The data of MDR pathogens and anti-infection treatments against them were summarized. Results: The rates of MDRinfections were 50.8% and 79.3% in VA-ECMO and VV-ECMO patients respectively. ECMO patients in group R presented poor prognostic indicators as expected. MDR pathogens detected were mainly MDR Gram-negative bacteria (MDR-GNB) (91.6% in VA-ECMO patients and 92.5% in VV-ECMO patients, respectively). Sputum was the main source of MDR. There were 72.9% and 80% of MDR pathogens deprived from sputum in VA-ECMO and VV-ECMO patients respectively. MDR pathogens generally showed high drug-resistant prevalence to routine antibiotics, and anti-infection treatments against them were not optimistic. Cephalosporins, meropenem, linezolid and tigecycline were most selected antibiotics according to antimicrobial susceptibility tests in our study. Conclusion: ECMO patients had high incidence of MDR infection, which mostly induced by MDR-GNB from sputum. Cephalosporins, meropenem, linezolid and tigecycline were appropriate empiric antibiotics against MDR pathogens in ECMO patients according to our study.

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Outcome and Clinical Characteristics of Nosocomial Infection in Adult Patients Undergoing Extracorporeal Membrane Oxygenation: A Systematic Review and Meta-Analysis

Cited by 15 publications

References 35 publications

Ventilator-Associated Pneumonia in COVID-19 Patients Admitted in Intensive Care Units: Relapse, Therapeutic Failure and Attributable Mortality—A Multicentric Observational Study from the OutcomeRea Network

Ventilator-Associated Pneumonia in COVID-19 Patients Admitted in Intensive Care Units: Relapse, Therapeutic Failure and Attributable Mortality—A Multicentric Observational Study from the OutcomeRea Network

Drug–Drug Interactions in Patients with Acute Respiratory Distress Syndrome

Etiological characteristics and appropriate empiric antibiotic strategies of multidrug-resistant pathogens in patients requiring extracorporeal membrane oxygenation: a retrospective cohort study

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