Extracorporeal Membrane Oxygenation-Related Nosocomial Infection after Cardiac Surgery in Adult Patients

Abstract

Introduction The evaluation of extracorporeal membrane oxygenation-related nosocomial infection (ECMO-related NI) in a homogeneous cohort remains scarce. This study analyzed ECMO-related NI in adult patients who have undergone cardiac surgery. Methods From January 2012 to December 2017, 322 adult patients who have received ECMO support after cardiac surgery were divided into the infection group (n=131) and the non-infection group (n=191). ECMO-related NI was evaluated according to demographic data, surgical procedures, and ECMO parameters. Results The incidence of ECMO-related NI was 85.4 cases per 1000 ECMO days. Acinetobacter baumannii was the most common pathogen causing blood stream infection and respiratory tract infection. Prolonged duration of surgery ( P =0.042) and cardiopulmonary bypass assist ( P =0.044) increased the risk of ECMO-related NI. Body mass index (odds ratio [OR]: 1.077; 95% confidence interval [CI]: 1.004-1.156; P =0.039) and duration of ECMO support (OR: 1.006; 95% CI: 1.003-1.009; P =0.0001) were the independent risk factors for ECMO-related NI. Duration of ECMO support > 144 hours (OR: 2.460; 95% CI: 1.155-7.238; P <0.0001) and ECMO-related NI (OR: 3.726; 95% CI: 1.274-10.895; P =0.016) increased significantly the risk of in-hospital death. Conclusion Prolonged duration of ECMO support was an independent risk factor for NI. Surgical correcting latent causes of cardiopulmonary failure and shortening duration of ECMO whenever possible would reduce susceptibility to NI.

Comparison of the Efficacy of ECMO With or Without IABP in Patients With Cardiogenic Shock: A Meta-Analysis

“…Yun et al found that patients with gram-negative rods died more frequently and earlier than those with gram-positive cocci ( 26 ). However, there was also evidence that proved that an acquired infection was not independently associated with mortality ( 27 ) and that a prolonged duration of ECMO was an independent risk factor for nosocomial infection ( 28 ). In our meta-analysis, we found that there was no significant difference in infection or sepsis when patients were treated with ECMO and IABP or ECMO alone.…”

Rates and Determinants of Hospital-Acquired Infection among ICU Patients Undergoing Cardiac Surgery in Developing Countries: Results from EMERGENCY’NGO’s Hospital in Sudan

“…The higher frequency of infectious events recorded in the group undergoing urgent surgery compared to the elective group can be explained not only by the more critical condition of these patients (as indicated by the SOFA score) but also by the higher number of devices used and longer exposure time to these medical aids (CVC, Foley) [ 13 , 14 , 15 , 16 ]. Moreover, surgical patients treated urgently spent more time in extracorporeal circulation (ECC) and continuous veno-venous haemofiltration (CVVH) than patients treated with elective surgery: These are two well-known risk factors for hospital-acquired infection [ 8 , 17 , 18 , 19 ].…”

Outcome and Clinical Characteristics of Nosocomial Infection in Adult Patients Undergoing Extracorporeal Membrane Oxygenation: A Systematic Review and Meta-Analysis

“…A total of 12 studies reported the prevalence of both lower respiratory tract infection and bloodstream infection. Among them, six studies considered lower respiratory tract infection to be the most common (8,10,16,18,23,24); the prevalence ranged from 12.7-55.9%. Four studies considered bloodstream infection to account for the largest proportion of complications (11,13,14,22); the prevalence was 11.38-27.59%.…”

“…Other risk factors included VV ECMO mode (9, 13), ventilator use time before ECMO removal (9,14), age of patient (20), and autoimmune disease diagnoses (13). One study concluded that the greater the body mass index, the higher the risk of nosocomial infection (10). However, two other studies reached the opposite conclusion (15,23).…”

“…The prevalence, incidence, mortality, and risk factors of nosocomial infection in patients treated by ECMO in every single center were reported with considerable discrepancy, especially in in-hospital mortality. Eight studies (3)(4)(5)(6)(7)(8)(9)(10) concluded that nosocomial infection significantly increased in-hospital mortality; but the other studies (11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24) argued that there was no significant difference in in-hospital mortality between infected groups and uninfected groups. This study's purpose is to conduct a meta-analysis to clarify whether nosocomial infection increased in-hospital mortality in adult patients receiving ECMO treatment and to summarize clinical epidemiological characteristics via a narrative systematic review.…”