Analysis of Nosocomial Infections in Post–Cardiac Surgery Extracorporeal Membrane Oxygenation Support Therapy
DOI:
https://doi.org/10.1532/hsf.1789Abstract
Objectives: This study aims to analyze the nosocomial infection factors in post–cardiac surgery extracorporeal membrane oxygenation (ECMO) supportive treatment (pCS-ECMO).
Methods: The clinical data of the pCS-ECMO patients who obtained nosocomial infections (NI) were collected and analyzed retrospectively. Among the 74 pCS-ECMO patients, 30 occurred with NI, accounting for 40.5%; a total of 38 pathogens were isolated, including 22 strains of Gram-negative bacteria (57.9%), 15 strains of Gram-positive bacteria (39.5%), and 1 fungus (2.6%).
Results: Multidrug-resistant strains were highly concentrated, among which Acinetobacter baumannii and various coagulase-negative staphylococci were the main types; NI was related to mechanical ventilation time, intensive care unit (ICU) residence, ECMO duration, and total hospital stay, and the differences were statistically significant (P < .05). The binary logistic regression analysis indicated that ECMO duration was a potential independent risk factor (OR = 0.992, P = .045, 95.0% CI = 0.984-1.000).
Conclusions: There existed significant correlations between the secondary infections of pCS-ECMO and mechanical ventilation time, ICU residence, ECMO duration, and total hospital stay; therefore, hospitals should prepare appropriate preventive measures to reduce the incidence of ECMO secondary infections.
References
Allen S, Holena D, McCunn M, Kohl B, Sarani B. 2011. 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 26(1):13-26.
Annich GM, Lynch WR, MacLare GR, Wilson JM, Bartlett RH, editors. 2012. ECMO: extracorporeal cardiopulmonary support in critical care. 4th ed. Ann Arbor (MI): Extracorporeal Life Support Organization.
Aubron C, Cheng AC, Pilcher D, et al. 2013. Factors associated with outcomes of patients on extracorporeal membrane oxygenation support: a 5-year cohort study. Crit Care 17:R73.
Aubron C, Cheng AC, Pilcher D, et al. 2013. Infections acquired by adults who receive extracorporeal membrane oxygenation: risk factors and outcome. Infect Control Hosp Epidemiol 34(1):24-30.
Bizzarro MJ, Conrad SA, Kaufman DA, Rycus P. 2011. Infections acquired during extracorporeal membrane oxygenation in neonates, children, and adults. Pediatr Crit Care Med 12(3):277-81.
Bowman ME, Rebeyka IM, Ross DB, Quinonez LG, Forgie SE. 2013. Risk factors for surgical site infection after delayed sternal closure. Am J Infect Control 41(5):464-5.
Castagnola E, Gargiullo L, Loy A, et al. 2018. Epidemiology of infectious complications during extracorporeal membrane oxygenation in children: a single center experience in 46 runs. Pediatr Infect Dis J 37(7):624-6.
Cheng A, Sun HY, Lee CW, et al. 2013. Survival of septic adults compared with nonseptic adults receiving extracorporeal membrane oxygenation for cardiopulmonary failure: a propensity-matched analysis. J Crit Care 28(4):532.e1-532.e10.
Cheng R, Hachamovitch R, Kittleson M, et al. 2014. Complications of extracorporeal membrane oxygenation for treatment of cardiogenic shock and cardiac arrest: a meta-analysis of 1,866 adult patients. Ann Thorac Surg 97(2):610-6.
Combes A, Leprince P, Luyt CE, et al. 2008. Outcomes and long-term quality-of-life of patients supported by extracorporeal membrane oxygenation for refractory cardiogenic shock. Crit Care Med 36(5):1404-11.
Fu JW, Wang R, Mou YQ. 2012. Patients with lower respiratory tract infection pathogenic bacteria distribution and drug resistance change. J Clin Lung 6:1017-9.
Haneke F, Schildhauer TA, Schlebes AD, Strauch JT, Swol J. 2016. Infections and extracorporeal membrane oxygenation: incidence, therapy, and outcome. ASAIO J 62(1):80-6.
Harder EE, Gaies MG, Yu S, et al. 2013. Risk factors for surgical site infection in pediatric cardiac surgery patients undergoing delayed sternal closure. J Thorac Cardiovasc Surg 146(2):326-33.
Hsu MS, Chiu KM, Huang YT, Kao KL, Chu SH, Liao CH. 2009. Risk factors for nosocomial infection during extracorporeal membrane oxygenation. J Hosp Infect 73(3):210-6.
Kumar TK, Zurakowski D, Dalton H, et al. 2010. Extracorporeal membrane oxygenation in postcardiotomy patients: factors influencing outcome. J Thorac Cardiovasc Surg 140(2):330-336.e2.
Liu X, Xu Y, Zhang R, et al. 2016. Survival predictors for severe ARDS patients treated with extracorporeal membrane oxygenation: a retrospective study in China. PLoS One 11(6):e0158061.
Lunz D, Philipp A, Dolch M, Born F, Zausig YA. 2014. [Veno-arterial extracorporeal membrane oxygenation. Indications, limitations and practical implementation]. Anaesthesist 63(8-9):625-35. German.
Mateen FJ, Muralidharan R, Shinohara RT, Parisi JE, Schears GJ, Wijdicks EF. 2011. Neurological injury in adults treated with extracorporeal membrane oxygenation. Arch Neurol 68(12):1543-9.
Mirabel M, Luyt CE, Leprince P, et al. 2011. Outcomes, long-term quality of life, and psychologic assessment of fulminant myocarditis patients rescued by mechanical circulatory support. Crit Care Med 39(5):1029-35.
Müller T, Lubnow M, Philipp A, et al. 2011. Risk of circuit infection in septic patients on extracorporeal membrane oxygenation: a preliminary study. Artif Organs 35(4):E84-90.
Paden ML, Conrad SA, Rycus PT, Thiagarajan RR. 2013. Extracorporeal Life Support Organization Registry Report 2012. ASAIO J 59(3):202-10.
Pieri M, Agracheva N, Fumagalli L, et al. 2013. Infections occurring in adult patients receiving mechanical circulatory support: the two-year experience of an Italian National Referral Tertiary Care Center. Med Intensiva 37(7):468-75.
Sherwin J, Heath T, Watt K. 2016. Pharmacokinetics and dosing of anti-infective drugs in patients on extracorporeal membrane oxygenation: a review of the current literature. Clin Ther 38(9):1976-94.
Smith C, Bellomo R, Raman JS, et al. 2001. An extracorporeal membrane oxygenation-based approach to cardiogenic shock in an older population. Ann Thorac Surg 71(5):1421-7.
Sun HY, Ko WJ, Tsai PR, et al. 2010. Infections occurring during extracorporeal membrane oxygenation use in adult patients. J Thorac Cardiovasc Surg 140(5):1125-1132.e2.
Zangrillo A, Landoni G, Biondi-Zoccai G, et al. 2013. A meta-analysis of complications and mortality of extracorporeal membrane oxygenation. Crit Care Resusc 15(3):172-8
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