Microbial Colonization of Oxygenator and Clinical Outcomes in Extracorporeal Membrane Oxygenation

Abstract

The importance of microbial colonization during extracorporeal membrane oxygenation (ECMO) is unclear. We prospectively cultured ECMO oxygenators and retrospectively reviewed the culture results, clinical outcomes, and associated factors in 112 ECMO patients (122 oxygenators, 1,196 ECMO days). Of the oxygenators, 11.6% (n = 13) had positive cultures. The most common pathogen was Klebsiella pneumoniae, followed by Acinetobacter baumannii and Staphylococcus epidermidis. Nine (69%) cases showed catheter colonization, and five (38%) bloodstream infection (BSI) with the same microorganism. Most of the microorganisms were multidrug resistant. BSI tended to be associated with oxygenator colonization (r = 0.172, p = 0.070). The patients were divided into oxygenator colonization (n = 13) and no colonization groups (n = 99). Successful weaning from ECMO and survival to discharge were significantly lower in the oxygenator colonization group (weaning 30.8% vs. 90.9%, p < 0.001, survival 23.1% vs. 76.8%; p < 0.001). In multivariate analyses, age (per decade) (odds ratio [OR] = 1.95, 95% CI = 1.28–2.95; p = 0.002), oxygenator colonization (OR = 15.49, 95% CI = 3.31–72.46; p < 0.001), and renal replacement therapy (OR = 4.61, 95% CI = 1.69–12.58; p = 0.003) were significantly associated with mortality. Oxygenator colonization was associated with poor outcomes in ECMO patients. These results support the early exchange and culture of oxygenators in patients with persisting bacteremia.

Development of a risk prediction model for subsequent infection after colonization with carbapenem-resistant Enterobacterales: a retrospective cohort study

“…In the process of establishing our prediction model, we had already recon rmed that catheterization had an observably strong impact on the progress from CRE colonization to infection. However, we found that application of other invasive procedures and devices was insigni cant in predicting the incidence of CRE-colonized infection, while a few papers demonstrated that using CRRT and ECMO could augment the risk of microbial colonization and infection [21][22][23]. This could be another worthy discussion issue to validate if CRE-colonized patients receiving CRRT or ECMO were in a high-risk status of subsequent infection.…”

The Influence of Extracorporeal Membrane Oxygenation on Antibiotic Pharmacokinetics

“…Mediastinitis can be an issue in patients receiving VA-ECMO and cannula-related infections have also been noted in this population [ 15 , 17 , 18 ]. Lastly, the ECMO circuit itself, including the cannulas or oxygenator, can become colonized with microorganisms from alternative infectious sources leading to a difficult-to-treat infection [ 17 , 18 , 19 ].…”

Nosocomial infections during extracorporeal membrane oxygenation

“…A study analysing the rates of cannula colonisation and infection using cannula, blood and skin swab cultures after ECMO removal showed a 33% rate of colonisation and a 9% rate of infection [21]. Interestingly, none of the patients presented with infection signs at decannulation or during the following 48 h, and the culture positivity in patients who develop fever after removal of ECMO support remains low [22…”

“…Interestingly, none of the patients presented with infection signs at decannulation or during the following 48 h, and the culture positivity in patients who develop fever after removal of ECMO support remains low [22 ▪ ]. Regarding colonisation of other parts of the circuit, a recent retrospective study in 112 patients revealed a 11.6% rate of oxygenator colonisation, which was significantly associated lower survival (23.1% vs. 76.8% in the noncolonised group) [23 ▪ ].…”