Experience with infections in the use of extracorporeal membrane oxygenation

Checa, Rosa María Calderón; Conejo, Pablo Rojo; Flores, Aranzazu Flavia González-Posada; Fuente, Ana María Llorente de la; Cuesta, Alba Palacios; Aguilar, José Manuel Ruano; Hofheinz, Sylvia Belda

doi:10.1016/j.anpede.2017.07.011

Cited by 5 publications

(5 citation statements)

References 16 publications

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“…Univariable analysis in this study confirms the presence of factors associated with increased acquired infection risk; the longer duration of ECMO, almost unanimously described in previous studies, 5–7,10,12,13,20,21 longer duration of pre-ECMO ventilation, and other factors that have previously been described without significant differences: 5,7 lower birth weight, vaginal delivery, and primary diagnosis of CDH.…”

Section: Discussionsupporting

confidence: 89%

Infection profile in neonatal patients during extracorporeal membrane oxygenation

et al. 2020

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Objectives: To describe risk factors for acquired infection during neonatal extracorporeal membrane oxygenation and to examine the predictive value of inflammatory markers in the diagnosis of infection. Methods: A retrospective study was conducted with data for patients under 30 days supported with extracorporeal membrane oxygenation from 2003 to April 2016, in a neonatal intensive care unit. Results: Our study included 160 neonatal patients, the average age of connection was 8.5 days and the duration of extracorporeal membrane oxygenation support was 9.7 days. The incidence of confirmed infection was 23%. Patients with confirmed infection present more frequently: vaginal delivery, lower birth weight, female sex, diagnosis of congenital diaphragmatic hernia, and longer duration of extracorporeal membrane oxygenation. When comparing the group of patients with confirmed infection and suspicion of infection, there were no significant differences in the inflammatory markers. When calculating the slope for each one, the difference in white blood cell count slope 72 h before the infection is significant; in patients with confirmed infection, the count of white blood cell increases (slope: 0.25), versus the group of patients with suspected infection in whom the count decreases (slope: −0.39). No differences were found in other variables. Conclusion: Our study describes that the factors that increase the risk of infection are lower birth weight, vaginal birth, duration of extracorporeal membrane oxygenation, and a positive trend of white blood cell 72 h prior to infection/suspicion. Further studies are necessary to include or definitively rule out the use of these factors and the biomarkers as predictors of infection in neonatal patients supported with extracorporeal membrane oxygenation.

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Section: Discussionsupporting

confidence: 89%

Infection profile in neonatal patients during extracorporeal membrane oxygenation

et al. 2020

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“…The reported rate of ECMO-related NIs varies widely depending on age, nature, and case selection with a trend towards greater incidence in adults than in pediatric patients [15][16][17]. Both in pediatric and adult populations, the incidence of NIs increase proportionally to the rate of patients with underlying cardiac disease; however, data focusing on adults supported by VA-ECMO are scarce [18][19][20][21][22]. Our results are consistent with previous studies of adult patients who underwent VA-ECMO, which reported an incidence of NIs of 23% to 64% and an infection rate that varied from 43 to 75.5 episodes/1000 ECMO days [9,16,[22][23][24].…”

Section: Discussionmentioning

confidence: 99%

Nosocomial Infections in Adult Patients Supported by Extracorporeal Membrane Oxygenation in a Cardiac Intensive Care Unit

et al. 2023

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The use of venoarterial (VA) extracorporeal membrane oxygenation therapy (ECMO) in patients admitted to cardiac intensive care units (CICU) has increased. Data regarding infections in this population are scarce. In this retrospective study, we analyzed the risk factors, outcome, and predictors of in-hospital mortality due to nosocomial infections in patients with ECMO admitted to a single coronary intensive care unit between July 2013 and March 2019 treated with VA-ECMO for >48 h. From 69 patients treated with VA-ECMO >48 h, (median age 58 years), 29 (42.0%) patients developed 34 episodes of infections with an infection rate of 0.92/1000 ECMO days. The most frequent were ventilator-associated pneumonia (57.6%), tracheobronchitis (9.1%), bloodstream infections (9.1%), skin and soft tissue infections (9.1%), and cytomegalovirus reactivation (9.1%). In-hospital mortality was 47.8%, but no association with nosocomial infections was found (p = 0.75). The number of days on ECMO (OR 1.14, 95% CI 1.01–1.30, p = 0.029) and noninfectious complications were higher in the infected patients (OR: 3.8 95% CI = 1.05–14.1). A higher baseline creatinine value (OR: 8.2 95% CI = 1.12–60.2) and higher blood lactate level at 4 h after ECMO initiation (OR: 2.0 95% CI = 1.23–3.29) were significant and independent risk factors for mortality. Conclusions: Nosocomial infections in medical patients treated with VA-ECMO are very frequent, mostly Gram-negative respiratory infections. Preventive measures could play an important role for these patients.

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“…This in turn may confer an increased risk of infection. Infections are among the most common complications associated with ECMO (10), which may significantly impact the outcomes (11). The infectious risk has been shown to increase with the increase in duration of the ECMO run (10), which represents the most important risk factor for developing infections.…”

Section: Discussionmentioning

confidence: 99%

“…Infections are among the most common complications associated with ECMO (10), which may significantly impact the outcomes (11). The infectious risk has been shown to increase with the increase in duration of the ECMO run (10), which represents the most important risk factor for developing infections. Other ECMO-specific factors that can predispose the patient to infections include the severity of the underlying illness, the high risk of bacterial translocation from the gut and ECMO-related immune system impairment (12).…”

Section: Discussionmentioning

confidence: 99%

Hospital‑acquired pneumonia caused by Kodamaea ohmeri during extracorporeal membrane oxygenation treatment: A case report and literature review

Ding,

Zhu,

Zhang

et al. 2023

Exp Ther Med

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Kodamaea ohmeri (K. ohmeri) is an ascosporogenic species of yeast that belongs to the genus Ascosporogenous and the family of Saccharomycetaceae. It has recently been found to cause various types of infections, particularly in critically ill immunocompromised patients. The present study describes a case of hospital-acquired pneumonia caused by K. ohmeri during veno-arterial extracorporeal membrane oxygenation. The fungal culture turned negative after the administration of caspofungin and amphotericin B. Extracorporeal membrane oxygenation (ECMO) is an adjunctive medical technique that provides temporary cardiopulmonary support for patients. Previous observations have suggested that the immune function of patients will typically decline during the use of ECMO, rendering infection to be one of the main complications of ECMO. K. ohmeri is a rare pathogenic fungus, particularly in immunocompromised individuals with vascular catheters, while amphotericin B is the most common antifungal therapy administered to treat K. ohmeri infections. It is important to raise awareness of rare fungal infections and actively treat them.

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Experience with infections in the use of extracorporeal membrane oxygenation

Cited by 5 publications

References 16 publications

Infection profile in neonatal patients during extracorporeal membrane oxygenation

Infection profile in neonatal patients during extracorporeal membrane oxygenation

Nosocomial Infections in Adult Patients Supported by Extracorporeal Membrane Oxygenation in a Cardiac Intensive Care Unit

Hospital‑acquired pneumonia caused by Kodamaea ohmeri during extracorporeal membrane oxygenation treatment: A case report and literature review

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