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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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