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Infections Acquired by Adults Who Receive Extracorporeal Membrane Oxygenation Risk Factors and Outcome

Published online by Cambridge University Press:  02 January 2015

Cecile Aubron ,
Allen C. Cheng ,
David Pilcher ,
Tim Leong ,
Geoff Magrin ,
D. Jamie Cooper ,
Carlos Scheinkestel  and
Vince Pellegrino
Cecile Aubron*
Affiliation:
Intensive Care Unit, Alfred Hospital, Melbourne, Australia The Australian and New Zealand Intensive Care Research Centre, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
Allen C. Cheng
Affiliation:
Infectious Diseases Unit, Alfred Hospital, Melbourne, Australia Monash University, Department of Epidemiology and Preventive Medicine, Melbourne, Australia
David Pilcher
Affiliation:
Intensive Care Unit, Alfred Hospital, Melbourne, Australia The Australian and New Zealand Intensive Care Research Centre, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
Tim Leong
Affiliation:
Intensive Care Unit, Alfred Hospital, Melbourne, Australia Monash University, Department of Epidemiology and Preventive Medicine, Melbourne, Australia
Geoff Magrin
Affiliation:
Transfusion Service, Alfred Hospital, Melbourne, Australia
D. Jamie Cooper
Affiliation:
Intensive Care Unit, Alfred Hospital, Melbourne, Australia The Australian and New Zealand Intensive Care Research Centre, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
Carlos Scheinkestel
Affiliation:
Intensive Care Unit, Alfred Hospital, Melbourne, Australia Monash University, Department of Epidemiology and Preventive Medicine, Melbourne, Australia
Vince Pellegrino
Affiliation:
Intensive Care Unit, Alfred Hospital, Melbourne, Australia Monash University, Department of Epidemiology and Preventive Medicine, Melbourne, Australia
*
ANZIC-RC, Monash University, 99 Commercial Road, Melbourne, VIC 3004, Australia (cecile.aubron@monash.edu)
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Abstract

Objectives.

To analyze infectious complications that occur in patients who receive extracorporeal membrane oxygenation (ECMO), associated risk factors, and consequences on patient outcome.

Design.

Retrospective observational survey from 2005 through 2011.

Participants and Setting.

Patients who required ECMO in an Australian referral center.

Methods.

Cases of bloodstream infection (BSI), catheter-associated urinary tract infection (CAUTI), and ventilator-associated pneumonia (YAP) that occurred in patients who received ECMO were analyzed.

Results.

A total of 146 ECMO procedures were performed for more than 48 hours in 139 patients, and 36 patients had a total of 46 infections (30.1 infectious episodes per 1,000 days of ECMO). They included 24 cases of BSI, 6 of them secondary to VAP; 23 cases of VAP; and 5 cases of CAUTI. The most frequent pathogens were Enterobacteriaceae (found in 16 of 46 cases), and Candida was the most common cause of BSI (in 9 of 24 cases). The Sequential Organ Failure Assessment score before ECMO initiation and the number of days of support were independenuy associated with a risk of BSI, with odds ratios of 1.23 (95% confidence interval [CI], 1.03-1.47; P = .019) and 1.08(95% CI, 1.03-1.19]; P = .006), respectively. Infected patients did not have a significantly higher mortality compared with uninfected patients (41.7% vs 32%; P = .315), but intensive care unit length of stay (16 days [interquartile range, 8-26 days] vs 11 days [IQR, 4-19 days]; P = .012) and hospital length of stay (33.5 days [interquartile range, 15.5-55.5] vs 24 days [interquartile range, 9-42 days]; P = .029) were longer.

Conclusion.

The probability of infection increased with the duration of support and the severity of illness before initiation of ECMO. Infections affected length of stay but did not have an impact on mortality.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 34 , Issue 1 , January 2013 , pp. 24 - 30
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2013

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References

1. Chen, YS, Lin, JW, Yu, HY, et al. Cardiopulmonary resuscitation with assisted extracorporeal life-support versus conventional cardiopulmonary resuscitation in adults with in-hospital cardiac arrest: an observational study and propensity analysis. Lancet 2008;372:554–561.10.1016/S0140-6736(08)60958-7Google Scholar
2. Brogan, TV, Thiagarajan, RR, Rycus, PT, Bartlett, RH, Bratton, SL. Extracorporeal membrane oxygenation in adults with severe respiratory failure: a multi-center database. Intensive Care Med 2009;35:2105–2114.10.1007/s00134-009-1661-7Google Scholar
3. Davies, A, Jones, D, Bailey, M, et al. Extracorporeal membrane oxygenation for 2009 influenza A(H1N1) acute respiratory distress syndrome. JAMA 2009;302:1888–1895.Google Scholar
4. Allen, S, Holena, D, McCunn, M, Kohl, B, Sarani, B. A review of the fundamental principles and evidence base in the use of extracorporeal membrane oxygenation (ECMO) in critically ill adult patients. J Intensive Care Med 2011;26:13–26.10.1177/0885066610384061Google Scholar
5. Mirabel, M, Luyt, CE, Leprince, P, et al. Outcomes, long-term quality of life, and psychologic assessment of fulminant myocarditis patients rescued by mechanical circulatory support. Crit Care Med 2011;39:1029–1035.10.1097/CCM.0b013e31820ead45Google Scholar
6. Marasco, SF, Vale, M, Pellegrino, V, et al. Extracorporeal membrane oxygenation in primary graft failure after heart transplantation. Ann Thorac Surg 2010;90:1541–1546.10.1016/j.athoracsur.2010.05.066Google Scholar
7. Camboni, D, Philipp, A, Lubnow, M, et al. Support time-dependent outcome analysis for veno-venous extracorporeal membrane oxygenation. Eur J Cardiothorac Surg 2011;40: 1341–1347.Google Scholar
8. Combes, A, Leprince, P, Luyt, CE, et al. Outcomes and long-term quality-of-life of patients supported by extracorporeal membrane oxygenation for refractory cardiogenic shock. Crit Care Med 2008;36:1404–1411.10.1097/CCM.0b013e31816f7cf7Google Scholar
9. Burket, JS, Bartlett, RH, Vander Hyde, K, Chenoweth, CE. Nosocomial infections in adult patients undergoing extracorporeal membrane oxygenation. Clin Infect Dis 1999;28:828–833.10.1086/515200Google Scholar
10. O'Neill, JM, Schutze, GE, Heulitt, MJ, Simpson, PM, Taylor, BJ. Nosocomial infections during extracorporeal membrane oxygenation. Intensive Care Med 2001;27:1247–1253.10.1007/s001340101029Google Scholar
11. Brown, KL, Ridout, DA, Shaw, M, et al. Healthcare-associated infection in pediatric patients on extracorporeal life support: the role of multidisciplinary surveillance. Pediatr Crit Care Med 2006;7:546–550.10.1097/01.PCC.0000243748.74264.CEGoogle Scholar
12. Schutze, GE, Heulitt, MJ. Infections during extracorporeal life support. J Pediatr Surg 1995;30:809–812.10.1016/0022-3468(95)90753-XGoogle Scholar
13. Steiner, CK, Stewart, DL, Bond, SJ, Hornung, CA, McKay, VJ. Predictors of acquiring a nosocomial bloodstream infection on extracorporeal membrane oxygenation. J Pediatr Surg 2001;36: 487–492.10.1053/jpsu.2001.21609Google Scholar
14. Sun, HY, Ko, WJ, Tsai, PR, et al. Infections occurring during extracorporeal membrane oxygenation use in adult patients. J Thorac Cardiovasc Surg 2010;140:1125–1132.10.1016/j.jtcvs.2010.07.017Google Scholar
15. Hsu, MS, Chiu, KM, Huang, YT, Kao, KL, Chu, SH, Liao, CH. Risk factors for nosocomial infection during extracorporeal membrane oxygenation. J Hosp Infect 2009;73:210–216.10.1016/j.jhin.2009.07.016Google Scholar
16. Montgomery, VL, Strotman, JM, Ross, MP. Impact of multiple organ system dysfunction and nosocomial infections on survival of children treated with extracorporeal membrane oxygenation after heart surgery. Crit Care Med 2000;28:526–531.10.1097/00003246-200002000-00040Google Scholar
17. Vincent, JL, Moreno, R, Takala, J, et al; Working Group on Sepsis-related Problems of the European Society of Intensive Care Medicine. The SOFA (Sepsis-related Organ Failure Assessment) score to describe organ dysfunction/failure. Intensive Care Med 1996; 22:707–710.10.1007/BF01709751Google Scholar
18. Horan, TC, Andrus, M, Dudeck, MA. Centers for Disease Control and Prevention/National Healthcare Safety Network surveillance definition of health care-associated infection and criteria for specific types of infections in the acute care setting. Am J Infect Control 2008;36:309–332.10.1016/j.ajic.2008.03.002Google Scholar
19. Bizzarro, MJ, Conrad, SA, Kaufman, DA, Rycus, P. Infections acquired during extracorporeal membrane oxygenation in neonates, children, and adults. Ped Crit Care Med 2011;12:277–281.10.1097/PCC.0b013e3181e28894Google Scholar
20. Das, I, Nightingale, P, Patel, M, Jumaa, P. Epidemiology, clinical characteristics, and outcome of candidemia: experience in a tertiary referral center in the UK. Int J Infect Dis 2011; 15:e759–e763.10.1016/j.ijid.2011.06.006Google Scholar
21. Douglass, BH, Keenan, AL, Purohit, DM. Bacterial and fungal infection in neonates undergoing venoarterial extracorporeal membrane oxygenation: an analysis of the registry data of the extracorporeal life support organization. Artif Organs 1996;20: 202–208.10.1111/j.1525-1594.1996.tb04428.xGoogle Scholar
22. Coffin, SE, Bell, LM, Manning, M, Polin, R. Nosocomial infections in neonates receiving extracorporeal membrane oxygenation. Infect Control Hosp Epidemiol 1997;18:93–96.10.2307/30142396Google Scholar
23. Marik, PE, Corwin, HL. Efficacy of red blood cell transfusion in the critically ill: a systematic review of the literature. Crit Care Med 2008;36:2667–2674.10.1097/CCM.0b013e3181844677Google Scholar
24. Taylor, RW, O'Brien, J, Trottier, SJ, et al. Red blood cell transfusions and nosocomial infections in critically ill patients. Crit Care Med 2006;34:2302–2308, quiz 9.10.1097/01.CCM.0000234034.51040.7FGoogle Scholar
25. Kumar, TK, Zurakowski, D, Dalton, H, et al. Extracorporeal membrane oxygenation in postcardiotomy patients: factors influencing outcome. J Thorac Cardiovasc Surg 2010;140:330–336.10.1016/j.jtcvs.2010.02.034Google Scholar