Risk factors for nosocomial infection during extracorporeal membrane oxygenation

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Summary

An increasing number of patients receive extracorporeal membrane oxygenation (ECMO) for life support. This study aimed to investigate the incidence and risk factors for nosocomial infection in adult patients receiving ECMO. We reviewed the medical records of adult patients who received ECMO support for more than 72 h at Far Eastern Memorial Hospital from 2001 to 2007. ECMO-related nosocomial infections were defined as infections occurring from 24 h after ECMO initiation until 48 h after ECMO discontinuation. There were 12 episodes of nosocomial infection identified in 10 of the 114 (8.77%) patients on ECMO, including four cases of pneumonia, three cases of bacteraemia, three surgical site infections and two urinary tract infections. The incidence of ECMO-related nosocomial infection was 11.92 per 1000 ECMO-days. The length of ECMO use and intensive care unit (ICU) stay were significantly different between patients with, and without, nosocomial infection (P < 0.001). More than 10 days of ECMO use was associated with a significantly higher nosocomial infection rate (P = 0.003). Gram-negative bacilli were responsible for 78% of the nosocomial infections. In the univariate analysis, the duration of ICU stay and duration of ECMO use were associated with nosocomial infection. In the multivariate analysis, only the duration of ECMO was independently associated with nosocomial infection (P = 0.007). Overall, the only independent risk factor for ECMO-related nosocomial infection identified in this study was prolonged ECMO use.

Introduction

Extracorporeal membrane oxygenation (ECMO) is a life support device for patients with reversible cardiac or pulmonary failure. However, cannulation of the major vessels disrupts the barrier protection of patients and provides a portal of entry for pathogens. These patients usually have many other invasive devices in addition to ECMO, such as endotracheal tubes, urinary catheters, and central venous catheters, which further increase the likelihood of nosocomial infection.1, 2, 3 Thus, patients requiring ECMO support receive early administration of prophylactic antibiotics.1, 4, 5, 6

In our hospital, ECMO support was first used for a patient with right heart failure in 2000. Since then, an increasing number of patients have used ECMO in our hospital. However, limited data are available on nosocomial infections in adult patients with ECMO cannulation. We retrospectively collected the records of patients receiving ECMO and investigated the incidence, clinical features and types of nosocomial infections. We also analysed whether prophylactic antibiotics can prevent nosocomial infection in these patients.

Section snippets

Patients and data collection

Patients over the age of 18 years who received ECMO support for more than 72 h at Far Eastern Memorial Hospital from 1 July 2001 to 30 June 2007 were included in this retrospective study. Far Eastern Memorial Hospital is a 1000-bed medical centre with a 23-bed cardiovascular intensive care unit (ICU). Clinical information on patients, including age, sex, underlying medical conditions, Acute Physiological Assessment and Chronic Health Evaluation (APACHE) II score or Therapeutic Intervention

Epidemiology

During the six-year study period, 189 patients received ECMO support and 114 adult patients (aged >18 years) received ECMO support for more than 72 h. Review of complete medical records for these 114 patients revealed a total of 1007 days of ECMO support during the study period. There were 12 episodes of nosocomial infection which occurred in 10 of the 114 (8.77%) patients. The incidence of ECMO-related nosocomial infection was 11.92 per 1000 ECMO-days. In the same period, the average incidence

Discussion

The reported rate of ECMO-related nosocomial infection ranged from 20% to 45% and the incidence of infection ranged from 10 to 20 per 1000 ECMO-days for paediatric and adult patients.2, 3, 4, 9, 10 Bloodstream infection is the most common type of nosocomial infection in patients undergoing ECMO.1, 2, 8, 9, 11, 12 This single centre six-year study of nosocomial infections in patients with ECMO may be the largest reported study analysing the characteristics of adult patients with ECMO-related

References (14)

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