Microbial Colonization of Oxygenator and Clinical Outcomes in Extracorporeal Membrane Oxygenation.
Journal
ASAIO journal (American Society for Artificial Internal Organs : 1992)
ISSN: 1538-943X
Titre abrégé: ASAIO J
Pays: United States
ID NLM: 9204109
Informations de publication
Date de publication:
01 08 2021
01 08 2021
Historique:
pubmed:
3
2
2021
medline:
16
10
2021
entrez:
2
2
2021
Statut:
ppublish
Résumé
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.
Identifiants
pubmed: 33528159
doi: 10.1097/MAT.0000000000001337
pii: 00002480-202108000-00016
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
930-934Informations de copyright
Copyright © ASAIO 2021.
Déclaration de conflit d'intérêts
Disclosure: The authors have no conflicts of interest to report.
Références
Lafç G, Budak AB, Yener AÜ, Cicek OF: Use of extracorporeal membrane oxygenation in adults. Heart Lung Circ. 23: 10–23, 2014.
Khalid N, Javed H, Ahmad SA, et al.: Analysis of the Food and Drug Administration Manufacturer and User Facility Device Experience Database for patient- and circuit-related adverse events involving extracorporeal membrane oxygenation. Cardiovasc Revasc Med. 21: 230–234, 2020.
Kim DW, Yeo HJ, Yoon SH, et al.: Impact of bloodstream infections on catheter colonization during extracorporeal membrane oxygenation. J Artif Organs. 19: 128–133, 2016.
O’Horo JC, Cawcutt KA, De Moraes AG, Sampathkumar P, Schears GJ: The evidence base for prophylactic antibiotics in patients receiving extracorporeal membrane oxygenation. ASAIO J. 62: 6–10, 2016.
Millar JE, Fanning JP, McDonald CI, McAuley DF, Fraser JF: The inflammatory response to extracorporeal membrane oxygenation (ECMO): A review of the pathophysiology. Crit Care. 20: 387, 2016.
Ruisanchez C, Sarralde JA, Gonzalez-Fernandez C, Dominguez MJ: Sudden dysfunction of veno-venous extracorporeal membrane oxygenation caused by intermittent cannula obstruction: The key role of echocardiography. Intensive Care Med. 43: 1055–1056, 2017.
Sun HY, Ko WJ, Tsai PR, et al.: Infections occurring during extracorporeal membrane oxygenation use in adult patients. J Thorac Cardiovasc Surg. 140: 1125–32.e2, 2010.
Biffi S, Di Bella S, Scaravilli V, et al.: Infections during extracorporeal membrane oxygenation: Epidemiology, risk factors, pathogenesis and prevention. Int J Antimicrob Agents. 50: 9–16, 2017.
Müller T, Lubnow M, Philipp A, et al.: Risk of circuit infection in septic patients on extracorporeal membrane oxygenation: A preliminary study. Artif Organs. 35: E84–E90, 2011.
Robak O, Lakatos PK, Bojic A, et al.: Influence of different oxygenator types on changing frequency, infection incidence, and mortality in ARDS patients on veno-venous ECMO. Int J Artif Organs. 37: 839–846, 2014.
Schilcher G, Eisner F, Hackl G, et al.: Candida infection of membrane oxygenator during ECMO therapy. J Infect. 78: 75–86, 2019.
Garvey MI, Phillips N, Bradley CW, Holden E: Decontamination of an extracorporeal membrane oxygenator contaminated with mycobacterium chimaera. Infect Control Hosp Epidemiol. 38: 1244–1246, 2017.
Kuehn C, Orszag P, Burgwitz K, et al.: Microbial adhesion on membrane oxygenators in patients requiring extracorporeal life support detected by a universal rDNA PCR test. ASAIO J. 59: 368–73, 2013.
Dani A: Colonization and infection. Cent European J Urol. 67: 86–87, 2014.
Raad I, Darouiche R, Dupuis J, et al.: Central venous catheters coated with minocycline and rifampin for the prevention of catheter-related colonization and bloodstream infections. A randomized, double-blind trial. The Texas Medical Center Catheter Study Group. Ann Intern Med. 127: 267–274, 1997.
de Beer J, Petruccelli D, Rotstein C, Weening B, Royston K, Winemaker M: Antibiotic prophylaxis for total joint replacement surgery: Results of a survey of Canadian orthopedic surgeons. Can J Surg. 52: E229–E234, 2009.
Verderosa AD, Totsika M, Fairfull-Smith KE: Bacterial biofilm eradication agents: A current review. Front Chem. 7: 824, 2019.
Lehle Karla, Philipp Alois, Gleich Otto, et al.: Efficiency in extracorporeal membrane oxygenation—cellular deposits on polymethypentene membranes increase resistance to blood flow and reduce gas exchange capacity. ASAIO J. 54: 612–617, 2008.
Riga EK, Vohringer M, Widyaya VT, Lienkamp K: Polymer-based surfaces designed to reduce biofilm formation: From antimicrobial polymers to strategies for long-term applications. Macromol Rapid Commun. 38, 2017. doi:10.1002/marc.201700216.
doi: 10.1002/marc.201700216