Diagnostic yield of routine daily blood culture in patients on veno-arterial extracorporeal membrane oxygenation.
Blood culture
Bloodstream infection
Cardiogenic shock
Contamination
Extracorporeal membrane oxygenation
Journal
Critical care (London, England)
ISSN: 1466-609X
Titre abrégé: Crit Care
Pays: England
ID NLM: 9801902
Informations de publication
Date de publication:
08 07 2021
08 07 2021
Historique:
received:
23
03
2021
accepted:
27
06
2021
entrez:
9
7
2021
pubmed:
10
7
2021
medline:
21
10
2021
Statut:
epublish
Résumé
Bloodstream infections (BSIs) are frequent on veno-arterial extracorporeal membrane oxygenation (V-A ECMO). Performing routine blood cultures (BCs) may identify early paucisymptomatic BSIs. We investigated the contribution of systematic daily BCs to detect BSIs on V-A ECMO. This was a retrospective study including all adult patients requiring V-A ECMO and surviving more than 24 h. Our protocol included routine daily BCs, from V-A ECMO insertion up to 5 days after withdrawal; other BCs were performed on-demand. On the 150 V-A ECMO included, 2146 BCs were performed (1162 routine and 984 on-demand BCs); 190 (9%) were positive, including 68 contaminants. Fifty-one (4%) routine BCs revealed BSIs; meanwhile, 71 (7%) on-demand BCs revealed BSIs (p = 0.005). Performing routine BCs was negatively associated with BSIs diagnosis (OR 0.55, 95% CI [0.38; 0.81], p = 0.002). However, 16 (31%) BSIs diagnosed by routine BCs would have been missed by on-demand BCs. Independent variables for BSIs diagnosis after routine BCs were: V-A ECMO for cardiac graft failure (OR 2.43, 95% CI [1.20; 4.92], p = 0.013) and sampling with on-going antimicrobial therapy (OR 2.15, 95% CI [1.08; 4.27], p = 0.029) or renal replacement therapy (OR 2.05, 95% CI [1.10; 3.81], p = 0.008). Without these three conditions, only two BSIs diagnosed with routine BCs would have been missed by on-demand BCs sampling. Although routine daily BCs are less effective than on-demand BCs and expose to contamination and inappropriate antimicrobial therapy, a policy restricted to on-demand BCs would omit a significant proportion of BSIs. This argues for a tailored approach to routine daily BCs on V-A ECMO, based on risk factors for positivity.
Sections du résumé
BACKGROUND
Bloodstream infections (BSIs) are frequent on veno-arterial extracorporeal membrane oxygenation (V-A ECMO). Performing routine blood cultures (BCs) may identify early paucisymptomatic BSIs. We investigated the contribution of systematic daily BCs to detect BSIs on V-A ECMO.
METHODS
This was a retrospective study including all adult patients requiring V-A ECMO and surviving more than 24 h. Our protocol included routine daily BCs, from V-A ECMO insertion up to 5 days after withdrawal; other BCs were performed on-demand.
RESULTS
On the 150 V-A ECMO included, 2146 BCs were performed (1162 routine and 984 on-demand BCs); 190 (9%) were positive, including 68 contaminants. Fifty-one (4%) routine BCs revealed BSIs; meanwhile, 71 (7%) on-demand BCs revealed BSIs (p = 0.005). Performing routine BCs was negatively associated with BSIs diagnosis (OR 0.55, 95% CI [0.38; 0.81], p = 0.002). However, 16 (31%) BSIs diagnosed by routine BCs would have been missed by on-demand BCs. Independent variables for BSIs diagnosis after routine BCs were: V-A ECMO for cardiac graft failure (OR 2.43, 95% CI [1.20; 4.92], p = 0.013) and sampling with on-going antimicrobial therapy (OR 2.15, 95% CI [1.08; 4.27], p = 0.029) or renal replacement therapy (OR 2.05, 95% CI [1.10; 3.81], p = 0.008). Without these three conditions, only two BSIs diagnosed with routine BCs would have been missed by on-demand BCs sampling.
CONCLUSIONS
Although routine daily BCs are less effective than on-demand BCs and expose to contamination and inappropriate antimicrobial therapy, a policy restricted to on-demand BCs would omit a significant proportion of BSIs. This argues for a tailored approach to routine daily BCs on V-A ECMO, based on risk factors for positivity.
Identifiants
pubmed: 34238367
doi: 10.1186/s13054-021-03658-7
pii: 10.1186/s13054-021-03658-7
pmc: PMC8264470
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
241Références
J Korean Med Sci. 2017 Apr;32(4):593-598
pubmed: 28244284
Infect Control Hosp Epidemiol. 2018 Jul;39(7):871-874
pubmed: 29733005
J Intensive Care Med. 2016 Dec;31(10):654-669
pubmed: 25670726
Int J Antimicrob Agents. 2017 Jul;50(1):9-16
pubmed: 28528989
Comput Biol Med. 2013 Feb;43(2):84-90
pubmed: 23228481
Anaesth Crit Care Pain Med. 2018 Jun;37(3):193-194
pubmed: 29154945
Crit Care Med. 2011 Jun;39(6):1359-64
pubmed: 21336107
Anaesth Crit Care Pain Med. 2020 Dec;39(6):883-885
pubmed: 33130015
Infect Control Hosp Epidemiol. 2005 Jun;26(6):559-66
pubmed: 16018432
Clin Infect Dis. 2008 Feb 15;46(4):642-4
pubmed: 18205540
Minerva Anestesiol. 2017 May;83(5):493-501
pubmed: 28124861
Pediatr Infect Dis J. 2017 Mar;36(3):346-347
pubmed: 27902647
Int J Artif Organs. 2019 Jun;42(6):299-306
pubmed: 30537880
ASAIO J. 2001 May-Jun;47(3):220-3
pubmed: 11374761
N Engl J Med. 2013 Feb 7;368(6):533-42
pubmed: 23388005
J Hosp Infect. 2011 Mar;77(3):233-6
pubmed: 21216032
Pediatr Surg Int. 2009 Feb;25(2):169-73
pubmed: 19148654
Nat Med. 2021 Jan;27(1):115-124
pubmed: 33169017
Transpl Infect Dis. 2005 Mar;7(1):11-7
pubmed: 15984943
ASAIO J. 2011 May-Jun;57(3):231-8
pubmed: 21317768
Chonnam Med J. 2018 Jan;54(1):48-54
pubmed: 29399566
Intensive Care Med. 2010 Feb;36(2):241-7
pubmed: 19924398
Int J Antimicrob Agents. 2020 Dec;56(6):106184
pubmed: 33045353
Anaesth Crit Care Pain Med. 2019 Oct;38(5):549-562
pubmed: 30836191
JAMA. 1991 Jan 16;265(3):365-9
pubmed: 1984535
Anaesth Crit Care Pain Med. 2019 Dec;38(6):647-656
pubmed: 31606548
Anaesth Crit Care Pain Med. 2018 Jun;37(3):259-268
pubmed: 29033360
Crit Care Med. 2008 Nov;36(11):2993-9
pubmed: 18824907
Int J Cardiol. 2021 Jan 1;322:191-196
pubmed: 32841617
Intensive Care Med. 2020 Feb;46(2):182-191
pubmed: 31768569
Clin Microbiol Rev. 2006 Oct;19(4):788-802
pubmed: 17041144
Eur J Clin Microbiol Infect Dis. 2015 Jul;34(7):1395-401
pubmed: 25828065
Crit Care Med. 2021 Jan 1;49(1):60-69
pubmed: 33165029
Front Microbiol. 2016 May 12;7:697
pubmed: 27242721
Anaesth Crit Care Pain Med. 2018 Feb;37(1):83-98
pubmed: 29155054
Am J Infect Control. 2008 Jun;36(5):309-32
pubmed: 18538699
Crit Care Med. 2017 Oct;45(10):1726-1733
pubmed: 28777198
J Pediatr Surg. 2001 Mar;36(3):487-92
pubmed: 11227003
Intensive Care Med. 2015 May;41(5):902-5
pubmed: 25619488
Clin Infect Dis. 2012 Dec;55(12):1633-41
pubmed: 22990851
Crit Care Med. 2018 Feb;46(2):e171-e172
pubmed: 29337807