No CrossRef data available.
Article contents
Infection profile of patients with extracorporeal membrane oxygenation in paediatric cardiac surgery ICU
Published online by Cambridge University Press: 28 April 2022
Abstract
Aim:
We investigated the risk of increased nosocomial infections and the associated pathogens in patients who underwent paediatric cardiovascular surgery and were put on extracorporeal membrane oxygenation support. We studied the duration of extracorporeal membrane oxygenation use and other variables that may be associated with increased nosocomial infection risk.
Methods:
Patients who were treated with an extracorporeal membrane oxygenation in paediatric cardiovascular surgery ICU between 2010 and 2020 were included in this retrospective study. We analysed the site of infection and microbiological profile of infections occurring in these patients according to CDC and National Healthcare Safety Network criteria.
Results:
The onset of infection development in patients after extracorporeal membrane oxygenation was found to be median 8 (3–15, 25–75 IQR) days in the whole group, and median 11 (3–16, 25–75 IQR) days in those who developed infection without being put on extracorporeal membrane oxygenation. When patients were divided into those with and without infection, duration of ICU was found to be 19 (16–28, IQR 25–75) days in patients with infection vs. 8 (2–16, IQR 25–75; p: <0.001) days in patients without infection. Duration of extracorporeal membrane oxygenation support was found to be 14 (10–25, IQR 25–75) days in patients with infection versus 5 (2–10, IQR 25–75; p: <0.001) days in patients without infection and total hospital stay was 26 (18–33, IQR 25–75) days in patients with infection versus 8 (2–23, IQR 25–75) days in those without infection. A total of 24 patients out of the 70 patients experienced 32 infectious episodes during extracorporeal membrane oxygenation support. Culture-positive infections were detected at a single site in 19 patients, and multiple sites in 5 patients.
Conclusion:
We propose that prolonged extracorporeal membrane oxygenation support is associated with an increased risk of infection. Although extracorporeal membrane oxygenation is a life-saving treatment method, prolonged extracorporeal membrane oxygenation may increase the development of infectious complications and the associated mortality and morbidity of the patient.
- Type
- Original Article
- Information
- Copyright
- © The Author(s), 2022. Published by Cambridge University Press
References
Roeleveld, PP, Mendonca, M. Neonatal cardiac ECMO in 2019 and beyond. Front Pediatr 2019; 7: 1–13.CrossRefGoogle ScholarPubMed
ECLS RegistryReport. International Report October_page1.pdf [Internet]. ELSO. Retrieved from https://www.elso.org/Registry/Statistics/InternationalSummary.aspx
Google Scholar
Vogel, AM, Lew, DF, Kao, LS, Lally, KP. Defining risk for infectious complications on extracorporeal life support. J Pediatr Surg 2011; 46: 2260–2264.CrossRefGoogle ScholarPubMed
Chauhan, S, Malik, M, Malik, V, Chauhan, Y, Kiran, U, Bisoi, AK. Extra corporeal membrane oxygenation after pediatric cardiac surgery: a 10 year experience. Ann Card Anaesth 2011; 14: 19–24.Google ScholarPubMed
Biffi, S, Di Bella, S, Scaravilli, V, et al. Infections during extracorporeal membrane oxygenation: epidemiology, risk factors, pathogenesis and prevention. Int J Antimicrob Agents [Internet] 2017; 50: 9–16.CrossRefGoogle ScholarPubMed
CDC - Center for Disease Control and Prevention. Identifying Healthcare-associated Infections (HAI) for NHSN Surveillance, 2015: 1–14. http://www.cdc.gov/nhsn/PDFs/pscManual/2PSC_IdentifyingHAIs_NHSNcurrent.pdf
Google Scholar
Ayyıldız, P, Kasar, T, Ozturk, E, et al. The evaluation of nosocomial infections in pediatric patients with extracorporeal membrane oxygenation support. Brazilian J Cardiovasc Surg 2017; 32: 468–474.Google ScholarPubMed
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: 277–281.CrossRefGoogle ScholarPubMed
Rodríguez, RX, Villarroel, LA, Meza, RA, et al. Infection profile in neonatal patients during extracorporeal membrane oxygenation. Int J Artif Organs 2020; 43: 719–725.CrossRefGoogle Scholar
Santiago-Lozano, MJ, Barquín-Conde, ML, Fuentes-Moreno, L, et al. Infectious complications in paediatric patients treated with extracorporeal membrane oxygenation. Enferm Infecc Microbiol Clin 2018; 36: 563–567.CrossRefGoogle ScholarPubMed
Cashen, K, Reeder, R, Dalton, HJ, et al. Acquired infection during neonatal and pediatric extracorporeal membrane oxygenation. Perfus (United Kingdom) 2018; 33: 472–482.Google ScholarPubMed
MacLaren, G, Schlapbach, LJ, Aiken, AM. Nosocomial infections during extracorporeal membrane oxygenation in neonatal, pediatric, and adult patients: a comprehensive narrative review. Pediatr Crit Care Med 2020; 21: 283–290.CrossRefGoogle ScholarPubMed
Castagnola, E, Gargiullo, L, Loy, A, et al. Epidemiology of infectious complications during extracorporeal membrane oxygenation in children: a single-center experience in 46 runs. Pediatr Infect Dis J 2018; 37: 624–626.CrossRefGoogle ScholarPubMed
Selçuk, Ü.N, Sargın, M, Baştopçu, M, et al. Microbiological spectrum of nosocomial ECMO infections in a tertiary care center. Brazilian J Cardiovasc Surg 2021; 36: 338–345.CrossRefGoogle ScholarPubMed
Pieri, M, Greco, T, De Bonis, M, et al. Diagnosis of infection in patients undergoing extracorporeal membrane oxygenation: a case-control study. J Thorac Cardiovasc Surg 2012; 143: 1411–1416.e1.CrossRefGoogle ScholarPubMed
Jin, Y, Feng, Z, Zhao, J, et al. Outcomes and factors associated with early mortality in pediatric postcardiotomy veno-arterial extracorporeal membrane oxygenation. Artif Organs 2021; 45: 6–14.CrossRefGoogle ScholarPubMed