Blood stream infections common in ECMO patients
Blood stream infections (BSIs) commonly occur in patients on extracorporeal membrane oxygenation (ECMO), a recent study has found.
The study included 145 patients on veno-venous (VV) ECMO and 123 on veno-arterial (VA) ECMO. A total of 26 patients developed BSIs, resulting in an overall prevalence rate of 9.7 percent. This was higher in those on VV vs VA ECMO (13.1 percent vs 5.7 percent).
Because patients spent 2,336 and 888 days on VV and VA ECMO respectively, the corresponding BSI incidence rates were 8 and 8 BSIs per 1,000 VV and VA ECMO days.
Patients who developed BSIs while on VV (median, 18 vs 9 days; p=0.0007) and VA (17 vs 6 days; p=0.02) ECMO spent significantly longer time attached to the machine than counterparts who did not have the infection. Moreover, VV ECMO patients with BSIs required more red blood cell transfusions (20 vs 13 units; p=0.04).
The most common infectious agents in VV ECMO patients were species belonging to the Candida taxon and gram-negative bacilli, such as Pseudomonas aeruginosa, Acinetobacter baumannii, Burkholderia cepacia and Enterobacter aerogenes.
In comparison, Aeromonas hydrophila, Aeromonas caviae, Klebsiella pneumoniae, A. baumannii and P. aeruginosa were the most frequently occurring infectants in VA ECMO patients.
Acute renal failure significantly increased the likelihood of BSI in VV ECMO patients (odds ratio [OR], 3.31; 95 percent CI, 1.21–9.01), while acute hepatic failure was a significant risk factor in VA ECMO patients (OR, 11.56; 2.31–57.91).