Analysis of Nosocomial Infections in Post–Cardiac Surgery Extracorporeal Membrane Oxygenation Support Therapy
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.
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
How to Cite
Author Disclosure & Copyright Transfer Agreement
In order to publish the original work of another person(s), The Heart Surgery Forum® must receive an acknowledgment of the Author Agreement and Copyright Transfer Statement transferring to Forum Multimedia Publishing, L.L.C., a subsidiary of Carden Jennings Publishing Co., Ltd. the exclusive rights to print and distribute the author(s) work in all media forms. Failure to check Copyright Transfer agreement box below will delay publication of the manuscript.
A current form follows:
The author(s) hereby transfer(s), assign(s), or otherwise convey(s) all copyright ownership of the manuscript submitted to Forum Multimedia Publishing, LLC (Publisher). The copyright transfer covers the exclusive rights to reproduce and distribute the article and the material contained therein throughout the world in all languages and in all media of expression now known or later developed, including but not limited to reprints, photographic reproduction, microfilm, electronic data processing (including programming, storage, and transmission to other electronic data record(s), or any other reproductions of similar nature), and translations.
However, Publisher grants back to the author(s) the following:
- The right to make and distribute copies of all or part of this work for use of the author(s) in teaching;
- The right to use, after publication in The Heart Surgery Forum, all or part of the material from this work in a book by the author(s), or in a collection of work by the author(s);
- The royalty-free right to make copies of this work for internal distribution within the institution/company that employs the author(s) subject to the provisions below for a work-made-for-hire;
- The right to use figures and tables from this work, and up to 250 words of text, for any purpose;
- The right to make oral presentations of material from this work.
Publisher reserves the right to grant or refuse permission to third parties to republish all or part of the article or translations thereof. To republish, such third parties must obtain written permission from the Publisher. (This is in accordance with the Copyright Statute, United States Code, Title 17. Exception: If all authors were bona fide officers or employees of the U.S. Government at the time the paper was prepared, the work is a “work of the US Government” (prepared by an officer or employee of the US Government as part of official duties), and therefore is not subject to US copyright; such exception should be indicated on signature lines. If this work was prepared under US Government contract or grant, the US Government may reproduce, royalty-free, all or portions of this work and may authorize others to do so, for official US Government purposes only, if the US Government contract or grant so requires.
I have participated in the conception and design of this work and in the writing of the manuscript and take public responsibility for it. Neither this manuscript nor one with substantially similar content under my authorship has been published, has been submitted for publication elsewhere, or will be submitted for publication elsewhere while under consideration by The Heart Surgery Forum, except as described in an attachment. I have reviewed this manuscript (original version) and approve its submission. If I am listed above as corresponding author, I will provide all authors with information regarding this manuscript and will obtain their approval before submitting any revision. I attest to the validity, accuracy, and legitimacy of the content of the manuscript and understand that Publisher assumes no responsibility for the validity, accuracy, and legitimacy of its content. I warrant that this manuscript is original with me and that I have full power to make this Agreement. I warrant that it contains no matter that is libelous or otherwise unlawful or that invades individual privacy or infringes any copyright or other proprietary right. I agree to indemnify and hold Publisher harmless of and from any claim made against Publisher that relates to or arises out of the publication of the manuscript and agree that this indemnification shall include payment of all costs and expenses relating to the defense of any such claim, including all reasonable attorney’s fees.
I warrant that I have no financial interest in the drugs, devices, or procedures described in the manuscript (except as disclosed in the attached statement).
I state that the institutional Human Subjects Committee and/or the Ethics Committee approved the clinical protocol reported in this manuscript for the use of experimental techniques, drugs, or devices in human subjects and appropriate informed consent documents were utilized.
Furthermore, I state that any and all animals used for experimental purposes received humane care in USDA registered facilities in compliance with the “Principles of Laboratory Animal Care” formulated by the National Society for Medical Research and the “Guide for the Care and Use of Laboratory Animals” prepared by the Institute of Laboratory Animal Resources and published by the National Institutes of Health (NIH Publication No. 85-23, revised 1985).