Impact of bloodstream infections on catheter colonization during extracorporeal membrane oxygenation

Abstract

There are concerns about secondary extracorporeal membrane oxygenation (ECMO) catheter infections in bacteremic patients. We investigated the association between blood stream infection (BSI) and ECMO catheter colonization. From January 2012 to August 2014, 47 adults who received ECMO support were enrolled. The ECMO catheter tip was cultured at the end of the ECMO procedure. The enrolled patients were classified into two groups according to the presence of BSI during ECMO support and analyzed with respect to ECMO catheter colonization. Of 47 cases, BSI during ECMO was identified in 13 patients (27.7 %). ECMO catheter colonization was identified in 6 (46.2 %) patients in the BSI group and 3 (8.8 %) in the non-BSI group. BSI during ECMO support was independently associated with ECMO catheter colonization [odds ratio (OR) 5.55; 95 % confidence interval (CI) 1.00-30.73; p = 0.049]. The organisms colonizing ECMO catheters in the setting of primary BSI were predominantly Gram-positive cocci and Candida species. Acinetobacter baumannii was the most common colonizing pathogen in the setting of secondary BSI. All the organisms colonizing ECMO catheters were multi-drug resistant organisms, including methicillin-resistant S. aureus, Candida glabrata, and carbapenem-resistant A. baumannii. ECMO catheters may become contaminated with multi-drug resistant pathogens in the presence of BSI. Therefore, ECMO should be applied cautiously in septic patients with bacteremia caused by multi-drug resistant pathogens.

Fungal infections in adult patients on extracorporeal life support

“…These factors are thought to predispose them to fungal colonization and infection. Recently reported data suggest that up to 15% of all bloodstream infections while on ECMO are of fungal origin [ 16 ]. A 6.4% prevalence of CBSI in an Australian center has been reported [ 17 ].…”

Biofilm Microbiome in Extracorporeal Membrane Oxygenator Catheters

“…Cannulas are maintained for several days to weeks depending on the patient's condition, and exchanging cannulas is almost impossible. Blood stream infections (BSI) are signi cant complications of ECMO, and they are associated with mortality, morbidity, and increased healthcare costs in ECMO patients [5]. Bacteremia during ECMO has been associated with catheter colonization, and in a previous study we found bio lm related infections in ECMO catheters.…”

Chlorhexidine bathing of the exposed circuits in extracorporeal membrane oxygenation: an uncontrolled before-and-after study

“…Depending on the patient's condition, ECMO treatment may last several days or longer, but its presence is a major risk factor for blood stream infection (BSI). In previous studies, it was found that 19-32% of inserted ECMO catheters were colonized with potentially pathogenic bacteria at the point of removal and that about 10% were associated with ECMO device infection [1,2]. While BSI occurrence during ECMO is a serious complication associated with significant morbidity and mortality, its prevalence has been reported to be as much as 3-18% in adults [3].…”

“…It is likely to only increase the risk of resistant strain development and can potentially lead to yeast overgrowth [4]. Given that the predominant organisms colonizing ECMO catheters were found to be gram-positive cocci and Candida species [1,2], it seems likely that skin bacteria traverse the insertion site onto the catheter, where they colonize the circuit and act as a focus for BSI. Furthermore, manipulation of hub for the use of renal replacement therapy (RRT) during ECMO, or for oxygenator function test, and exchange of oxygenator or catheters potentially pose a risk of BSI.…”