Infections complicating extracorporeal membrane oxygenation in patients with traumatic injuries

Schweickhardt, Samantha K.; Sams, Valerie G.; Radowsky, Jason S.; Surgery, Trauma; Sobieszczyk, Michal J.; Medicine, Pulmonary & Critical Care; Marcus, Joseph E; Disease, Infectious

doi:10.1016/j.injury.2022.11.048

Cited by 5 publications

(2 citation statements)

References 32 publications

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“…Previous papers have shown that indication for ECMO, such as burn injury or trauma may inform the predominate pathogens. 17,18 As this study had a preponderance of Gram-positive bacteremia, which may present more sub-acutely than Gramnegative bacteremia due to the absence of lipopolysaccharide and endotoxins, there may be lower sepsis scores than would be found in a population with predominantly Gram-negative organisms. 19 However, it is worth noting that sepsis scores were elevated regardless of the infective organism and there was no difference in any score between Gram-positive and Gram-negative blood stream infections.…”

Section: Discussionmentioning

confidence: 87%

The utility of sepsis scores for predicting blood stream infections in extracorporeal membrane oxygenation

et al. 2023

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Introduction Extracorporeal membrane oxygenation (ECMO) is an increasingly used modality of life support with high risk for nosocomial infections. The accuracy of sepsis prediction tools in identifying blood stream infections (BSI) in this population is unknown as measurement of multiple variables commonly associated with infection are altered by the circuit. Methods This study compares all blood stream infections for patients receiving ECMO between January 2012 and December 2020 to timepoints when blood cultures were negative using the Sequential Organ Failure Assessment (SOFA), Logistic Organ Dysfunction Score (LODS), American Burn Association Sepsis Criteria (ABA), Systemic Inflammatory Response Syndrome (SIRS) scores. Results Of the 220 patients who received ECMO during the study period, 40 (18%) had 51 blood stream infections and were included in this study. Gram-positive infections composed 57% ( n = 29) of infections with E. faecalis ( n = 12, 24%) being the most common organism isolated. There were no significant differences in sepsis prediction scores at the time of infection compared to infection-free time points for SOFA (median (IQR) 7 (5–9) vs. 6 (5–8), p = 0.22), LODS (median (IQR) 12 (10–14) vs. 12 (10–13), p = 0.28), ABA (median (IQR) 2 (1–3) vs. 2 (1–3) p = 0.75), or SIRS (median (IQR) 3 (2–3) vs. 3 (2–3), p = 0.20). Conclusions Our data shows that previously published sepsis scores are elevated throughout a patient’s ECMO course, and do not correlate with bacteremia. Better predictive tools are needed to determine the appropriate timing for blood cultures in this population.

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Section: Discussionmentioning

confidence: 87%

The utility of sepsis scores for predicting blood stream infections in extracorporeal membrane oxygenation

et al. 2023

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“…A study recently observed that infections induced by Gram-negative bacteria were the majority in trauma patients requiring ECMO support, and advocated that empiric antibiotics should have broad spectrum coverage of Gramnegative organisms in this population. 6 The incidence of MDR and extended-spectrum β-lactamase Gram-negative (ESBL GN) bacteria in adult patients undergoing lung transplantation (LT) was 34%, and in-hospital mortality was six times greater. 7 However, more in-depth studies on "ECMO and MDR bacteria" are still urgently needed to guide clinicians, and ECMO patients with MDR bacterial infections in optimal management.…”

Section: Introductionmentioning

confidence: 99%

The Etiological and Drug Resistance Characteristics of Multidrug-Resistant Pathogens in Patients Requiring Extracorporeal Membrane Oxygenation: A Retrospective Cohort Study

Gao¹,

Wang²

2023

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Infections induced by multidrug-resistant (MDR) pathogens are one of the most common and serious complications in extracorporeal membrane oxygenation (ECMO) patients. However, there is currently little research about "ECMO and MDR bacteria". The purpose of our study was to clarify the epidemiological characteristics of MDR bacteria and provide references for empiric antibiotic treatments according to the drug susceptibility tests for ECMO patients. Patients and Methods: There were 104 patients admitted to our department and receiving ECMO treatments between January 2014 and December 2022. Altogether, 61 veno-arterial ECMO (VA-ECMO) and 29 veno-venous ECMO (VV-ECMO) patients enrolled. The data on other intensive care unit (ICU) patients in our department in the same period are summarized. Results: A total of 82 MDR bacteria were detected from ECMO patients, and most of these were MDR Gram-negative bacteria (MDR-GNB). There were also 5559 MDR-GNB collected from other patients in our department in the same period. We found that the distribution of MDR-GNB in ECMO patients was different from other critical patients. The proportion of Klebsiella pneumoniae (MDR-KP) in VV-ECMO patients was higher than other critical patients (35.1% and 21.3%, respectively). Moreover, the proportions of MDR Acinetobacter baumannii (MDR-AB) of VA-ECMO and VV-ECMO were higher than other critical patients (54.6%, 43.2% and 30.5%, respectively). In addition, MDR-AB and MDR-KP in ECMO patients exhibited higher percentages of drug resistance to possibly appropriate antibiotics for other critical patients, but showed better sensitivity to colistin. Conclusion: Infections induced by MDR-GNB in ECMO patients were serious and exhibited higher degrees of drug resistance compared with other ICU patients. Colistin might be an option to consider if there is no medical contraindication. However, widespread use of broad spectrum antibiotics is something that should be discouraged, and alternative options are being explored.

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Nosocomial Infections in Adults Receiving Extracorporeal Membrane Oxygenation: A Review for Infectious Diseases Clinicians

Marcus,

Shah,

Peek

et al. 2024

Clinical Infectious Diseases

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Over the past ten years, there has been a rapid expansion in the use of extracorporeal membrane oxygenation (ECMO) in the care of patients with refractory cardiac or respiratory failure. Infectious diseases clinicians must reconcile conflicting evidence from limited studies as they develop practices at their own institutions, which has resulted in considerably different practices globally. This review describes infection control and prevention as well as antimicrobial prophylaxis strategies in this population. Data on diagnostics and treatment for patients receiving ECMO with a focus on diagnostic and antimicrobial stewardship is then examined. This review summarizes gaps in the current ECMO literature and proposes future needs, including developing clear definitions for infections and encouraging transparent reporting of practices at individual facilities in future clinical trials.

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Infections complicating extracorporeal membrane oxygenation in patients with traumatic injuries

Cited by 5 publications

References 32 publications

The utility of sepsis scores for predicting blood stream infections in extracorporeal membrane oxygenation

The utility of sepsis scores for predicting blood stream infections in extracorporeal membrane oxygenation

The Etiological and Drug Resistance Characteristics of Multidrug-Resistant Pathogens in Patients Requiring Extracorporeal Membrane Oxygenation: A Retrospective Cohort Study

Nosocomial Infections in Adults Receiving Extracorporeal Membrane Oxygenation: A Review for Infectious Diseases Clinicians

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