Nosocomial infections in adult patients supported by extracorporeal membrane oxygenation in a cardiac intensive care unit

The use of venoarterial (VA) extracorporeal membrane oxygenation therapy (ECMO) in patients admitted to cardiac intensive care units (CICU) has increased. Data regarding infections in this population are scarce. In this retrospective study, we analyzed the risk factors, outcome, and predictors of in...

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Detalles Bibliográficos
Autores: Mornese Pinna, Simone, Sousa Casasnovas, Iago, Olmedo, María, Machado, Marina, Juàrez Fernández, Miriam, Devesa Cordero, Carolina, Galar, Alicia, Álvarez Uría, Ana, Fernández Avilés, Francisco, García Carreño, Jorge, Martínez-Sellés D Oliveira Soares, Manuel, De Rosa, Francesco Giuseppe, Corcione, Silvia, Bouza Santiago, Emilio, Muñoz García, Patricia Carmen, Valerio Minero, Maricela
Tipo de recurso: artículo
Fecha de publicación:2023
País:España
Institución:Universidad Complutense de Madrid (UCM)
Repositorio:Docta Complutense
Idioma:inglés
OAI Identifier:oai:docta.ucm.es:20.500.14352/104864
Acceso en línea:https://hdl.handle.net/20.500.14352/104864
Access Level:acceso abierto
Palabra clave:616.9
616-036.22
ECMO
Venoarterial extracorporeal membrane oxygenation
Nosocomial infections
Cardiac intensive care unit
Cardiovascular infections
Enfermedades infecciosas
Microbiología médica
3201.03 Microbiología Clínica
3202 Epidemiología
Descripción
Sumario:The use of venoarterial (VA) extracorporeal membrane oxygenation therapy (ECMO) in patients admitted to cardiac intensive care units (CICU) has increased. Data regarding infections in this population are scarce. In this retrospective study, we analyzed the risk factors, outcome, and predictors of in-hospital mortality due to nosocomial infections in patients with ECMO admitted to a single coronary intensive care unit between July 2013 and March 2019 treated with VA-ECMO for >48 h. From 69 patients treated with VA-ECMO >48 h, (median age 58 years), 29 (42.0%) patients developed 34 episodes of infections with an infection rate of 0.92/1000 ECMO days. The most frequent were ventilator-associated pneumonia (57.6%), tracheobronchitis (9.1%), bloodstream infections (9.1%), skin and soft tissue infections (9.1%), and cytomegalovirus reactivation (9.1%). In-hospital mortality was 47.8%, but no association with nosocomial infections was found (p = 0.75). The number of days on ECMO (OR 1.14, 95% CI 1.01–1.30, p = 0.029) and noninfectious complications were higher in the infected patients (OR: 3.8 95% CI = 1.05–14.1). A higher baseline creatinine value (OR: 8.2 95% CI = 1.12–60.2) and higher blood lactate level at 4 h after ECMO initiation (OR: 2.0 95% CI = 1.23–3.29) were significant and independent risk factors for mortality. Conclusions: Nosocomial infections in medical patients treated with VA-ECMO are very frequent, mostly Gram-negative respiratory infections. Preventive measures could play an important role for these patients.

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