Healthcare-associated infections in patients with severe COVID-19 supported with extracorporeal membrane oxygenation: a nationwide cohort study.
Bloodstream infections
ECLS
Nosocomial infections
SARS-CoV 2
Ventilator-associated pneumonia
Journal
Critical care (London, England)
ISSN: 1466-609X
Titre abrégé: Crit Care
Pays: England
ID NLM: 9801902
Informations de publication
Date de publication:
20 Feb 2024
20 Feb 2024
Historique:
received:
20
12
2023
accepted:
10
02
2024
medline:
20
2
2024
pubmed:
20
2
2024
entrez:
19
2
2024
Statut:
epublish
Résumé
Both critically ill patients with coronavirus disease 2019 (COVID-19) and patients receiving extracorporeal membrane oxygenation (ECMO) support exhibit a high incidence of healthcare-associated infections (HAI). However, data on incidence, microbiology, resistance patterns, and the impact of HAI on outcomes in patients receiving ECMO for severe COVID-19 remain limited. We aimed to report HAI incidence and microbiology in patients receiving ECMO for severe COVID-19 and to evaluate the impact of ECMO-associated infections (ECMO-AI) on in-hospital mortality. For this study, we analyzed data from 701 patients included in the ECMOSARS registry which included COVID-19 patients supported by ECMO in France. Among 602 analyzed patients for whom HAI and hospital mortality data were available, 214 (36%) had ECMO-AI, resulting in an incidence rate of 27 ECMO-AI per 1000 ECMO days at risk. Of these, 154 patients had bloodstream infection (BSI) and 117 patients had ventilator-associated pneumonia (VAP). The responsible microorganisms were Enterobacteriaceae (34% for BSI and 48% for VAP), Enterococcus species (25% and 6%, respectively) and non-fermenting Gram-negative bacilli (13% and 20%, respectively). Fungal infections were also observed (10% for BSI and 3% for VAP), as were multidrug-resistant organisms (21% and 15%, respectively). Using a Cox multistate model, ECMO-AI were not found associated with hospital death (HR = 1.00 95% CI [0.79-1.26], p = 0.986). In a nationwide cohort of COVID-19 patients receiving ECMO support, we observed a high incidence of ECMO-AI. ECMO-AI were not found associated with hospital death. Trial registration number NCT04397588 (May 21, 2020).
Sections du résumé
BACKGROUND
BACKGROUND
Both critically ill patients with coronavirus disease 2019 (COVID-19) and patients receiving extracorporeal membrane oxygenation (ECMO) support exhibit a high incidence of healthcare-associated infections (HAI). However, data on incidence, microbiology, resistance patterns, and the impact of HAI on outcomes in patients receiving ECMO for severe COVID-19 remain limited. We aimed to report HAI incidence and microbiology in patients receiving ECMO for severe COVID-19 and to evaluate the impact of ECMO-associated infections (ECMO-AI) on in-hospital mortality.
METHODS
METHODS
For this study, we analyzed data from 701 patients included in the ECMOSARS registry which included COVID-19 patients supported by ECMO in France.
RESULTS
RESULTS
Among 602 analyzed patients for whom HAI and hospital mortality data were available, 214 (36%) had ECMO-AI, resulting in an incidence rate of 27 ECMO-AI per 1000 ECMO days at risk. Of these, 154 patients had bloodstream infection (BSI) and 117 patients had ventilator-associated pneumonia (VAP). The responsible microorganisms were Enterobacteriaceae (34% for BSI and 48% for VAP), Enterococcus species (25% and 6%, respectively) and non-fermenting Gram-negative bacilli (13% and 20%, respectively). Fungal infections were also observed (10% for BSI and 3% for VAP), as were multidrug-resistant organisms (21% and 15%, respectively). Using a Cox multistate model, ECMO-AI were not found associated with hospital death (HR = 1.00 95% CI [0.79-1.26], p = 0.986).
CONCLUSIONS
CONCLUSIONS
In a nationwide cohort of COVID-19 patients receiving ECMO support, we observed a high incidence of ECMO-AI. ECMO-AI were not found associated with hospital death. Trial registration number NCT04397588 (May 21, 2020).
Identifiants
pubmed: 38374103
doi: 10.1186/s13054-024-04832-3
pii: 10.1186/s13054-024-04832-3
doi:
Banques de données
ClinicalTrials.gov
['NCT04397588']
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
54Subventions
Organisme : University hospital of Rennes
ID : Appel à projets CFTR2
Organisme : French society of thoracic and cardio-vascular surgery (Société française de chirurgie thoracique et cardio-vasculaire)
ID : Bourse Marc Laskar
Investigateurs
Olivier Fouquet
(O)
Marc Pierrot
(M)
Sidney Chocron
(S)
Guillaume Flicoteaux
(G)
Philippe Mauriat
(P)
Alexandre Ouattara
(A)
Hadrien Roze
(H)
Olivier Huet
(O)
Marc-Olivier Fischer
(MO)
Raphel Bellaïche
(R)
Ophélie Constant
(O)
Quentin De Roux
(Q)
L Y André
(LY)
Arnaud Meffert
(A)
Jean-Claude Merle
(JC)
Lucile Picard
(L)
Elena Skripkina
(E)
Thierry Folliguet
(T)
Antonio Fiore
(A)
Nicolas D'ostrevy
(N)
Marie-Catherine Morgan
(MC)
Maxime Nguyen
(M)
Nicolas Terzi
(N)
Gwenhaël Colin
(G)
Olivier Fabre
(O)
Arash Astaneh
(A)
Justin Issard
(J)
Elie Fadel
(E)
Dominique Fabre
(D)
Julien Guihaire
(J)
Iolande Ion
(I)
Jean Baptiste Menager
(JB)
Delphine Mitilian
(D)
Olaf Mercier
(O)
François Stephan
(F)
Jacques Thes
(J)
Jerôme Jouan
(J)
Thibault Duburcq
(T)
Valentin Loobuyck
(V)
Mouhammed Moussa
(M)
Sabrina Manganiello
(S)
Agnes Mugnier
(A)
Natacha Rousse
(N)
Olivier Desebbe
(O)
Jean-Luc Fellahi
(JL)
Roland Henaine
(R)
Matteo Pozzi
(M)
Zakaria Riad
(Z)
Christophe Guervilly
(C)
Sami Hraiech
(S)
Laurent Papazian
(L)
Matthias Castanier
(M)
Charles Chanavaz
(C)
Cyril Cadoz
(C)
Sebastien Gette
(S)
Guillaume Louis
(G)
Erick Portocarrero
(E)
Philippe Gaudard
(P)
Kais Brini
(K)
Nicolas Bischoff
(N)
Antoine Kimmoun
(A)
Bruno Levy
(B)
Pierre Perez
(P)
Alexandre Bourdiol
(A)
Yannick Hourmant
(Y)
Pierre-Joachim Mahé
(PJ)
Bertrand Rozec
(B)
Mickaël Vourc'h
(M)
Stéphane Aubert
(S)
Florian Bazalgette
(F)
Claire Roger
(C)
Pierre Jaquet
(P)
Brice Lortat-Jacob
(B)
Pierre Mordant
(P)
Patrick Nataf
(P)
Juliette Patrier
(J)
Sophie Provenchere
(S)
Morgan Roué
(M)
Romain Sonneville
(R)
Alexy Tran-Dinh
(A)
Paul-Henri Wicky
(PH)
Charles Al Zreibi
(C)
Bernard Cholley
(B)
Yannis Guyonvarch
(Y)
Sophie Hamada
(S)
Claudio Barbanti
(C)
Astrid Bertier
(A)
Anatole Harrois
(A)
Jordi Matiello
(J)
Thomas Kerforne
(T)
Corentin Lacroix
(C)
Nicolas Brechot
(N)
Alain Combes
(A)
Juliette Chommeloux
(J)
Cosimo D'alessandro
(C)
Pierre Demondion
(P)
Alexandre Demoule
(A)
Martin Dres
(M)
Guillaume Fadel
(G)
Muriel Fartoukh
(M)
Guillaume Hekimian
(G)
Charles Juvin
(C)
Pascal Leprince
(P)
David Levy
(D)
Charles Edouard Luyt
(CE)
Thibaut Schoell
(T)
Pierre Fillâtre
(P)
Nicolas Massart
(N)
Maud Jonas
(M)
Nicolas Allou
(N)
Salvatore Muccio
(S)
Dario Di Perna
(D)
Vito-Giovanni Ruggieri
(VG)
Bruno Mourvillier
(B)
Amedeo Anselmi
(A)
Karl Bounader
(K)
Yoann Launey
(Y)
Thomas Lebouvier
(T)
Alessandro Parasido
(A)
Florian Reizine
(F)
Maxime Esvan
(M)
Philippe Seguin
(P)
Emmanuel Besnier
(E)
Dorothée Carpentier
(D)
Thomas Clavier
(T)
Anne Olland
(A)
Marion Villard
(M)
Fanny Bounes
(F)
François Labaste
(F)
Vincent Minville
(V)
Antoine Guillon
(A)
Yannick Fedun
(Y)
Informations de copyright
© 2024. The Author(s).
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