1887
Volume 2017, Issue 1
  • ISSN: 0253-8253
  • E-ISSN: 2227-0426

Abstract

Mortality of patients on extracorporeal membrane oxygenation (ECMO) remains high. Diagnosis of infection during extracorporeal life support (ECLS) is still challenging, and prevention strategies vary widely from center to center.1–3 These facts led us to analyze the occurrence rate, site, and organism in our ECLS patients in order to implement infection control measures to reduce the incidence of infections during ECLS.4

Our objective was to analyze our Extracorporeal Life Support Organization (ELSO) registry center data specifically focused on incidence of infection, typical microorganisms, time of manifestation, and site of cultures in the settings of tertiary pediatric cardiac intensive care unit mainly utilizing transthoracic cannulation and VA-ECMO, and compare with the ELSO database.1 We conducted a retrospective study analyzing 25 neonatal and pediatric ECMO cases in relation to infection from January 2014 to December 2015, in comparison to the ELSO database age and modality specific data. We obtained ethical approval from our institution. We examined the prevalence of infection, the time of the first positive cultures, the site of the positive cultures, and the underlying microorganisms and compared with ELSO data whenever feasible. There is no specific data on the incidence of infection in the ELSO database with open chest/transthoracic cannulation; our incidence was 0.44. The species was the highest offending organism (24% vs. ELSO 12% concerning the entire ECMO population), followed by 20%, 16%, and 12%. The first positive culture was taken on the 8th day of ECMO (median). By site, the highest prevalence of infection is as follows: ventilator-associated pneumonia (VAP), 41%, followed by bloodstream infection (BSI), 22%, and then catheter-associated urinary tract infection (CAUTI), 12%. The highest prevalence of infections is most probably due to the combined antibiotic and steroid therapy for patients with capillary leak syndrome. This may prompt that routine antifungal prophylaxis can be added after 1 week of ECMO for this patient group. Alternatively, the early detection with fungal polymerase chain reaction (PCR) assay should be evaluated.5 The high occurrence of VAP may indicate the need of reinforcing enteral feeding, oral decontamination protocol along with VAP bundle, and investigation of alternative source of contamination. As Gram-negative Enterobacteriaceae and were in second line as typical multidrug-resistant (MDR) organisms, those should be covered whenever a need for empiric antibiotic therapy arises.

Loading

Article metrics loading...

/content/journals/10.5339/qmj.2017.swacelso.25
2017-02-14
2019-10-15
Loading full text...

Full text loading...

References

  1. [1]. Bizzarro   MJ., , Conrad   SA., , Kaufman   DA., , Rycus   P. . Infections acquired during extracorporeal membrane oxygenation in neonates, children and adults. . Pediatr Crit Care Med . 2011; ;12: 3 : 277– 281 .
    [Google Scholar]
  2. [2]. O'Neill   JM., , Schutze   GE., , Heulitt   MJ., , Simpson   PM., , Taylor   BJ. . Nosocomial infections during extracorporeal membrane oxygenation. . Intensive Care Med . 2001; ;27: 8 : 1247– 1253 .
    [Google Scholar]
  3. [3]. Steiner   CK., , Stewart   DL., , Bond   SJ., , Hornung   CA., , McKay   VJ. . Predictors of acquiring a nosocomial bloodstream infection on extracorporeal membrane oxygenation. . J Pediatr Surg . 2001; ;36: 3 : 487– 492 .
    [Google Scholar]
  4. [4]. Brown   KL., , Ridout   DA., , Shaw   M., , Dodkins   I., , Smith   LC., , O'Callaghan   MA., , Goldman   AP., , Macqueen   S., , Hartley   JC. . Healthcare-associated infection in pediatric patients on extracorporeal life support: The role of multidisciplinary surveillance. . Pediatr Crit Care Med . 2006; ;7: 6 : 546– 550 .
    [Google Scholar]
  5. [5]. Gardner   AH., , Prodhan   P., , Stovall   SH., , Gosset   JM., , Stern   JR., , Wilson   CD., , Fiser   RT. . Fungal infections and antifungal prophylaxis in pediatric cardiac extracorporeal life support. . J Thorac Cardiovasc Surg . 2012; ;143: 3 : 689– 695 .
    [Google Scholar]
http://instance.metastore.ingenta.com/content/journals/10.5339/qmj.2017.swacelso.25
Loading
  • Article Type: Research Article
Keyword(s): ECLS , ECMO , fungal infection , infection , infection control , microorganism and pediatrics
This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error