Nosocomial infections during extracorporeal membrane oxygenation
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Objective: To examine trends in nosocomial infection associated with Extracorporeal Membrane Oxygenation (ECMO). Design: Retrospective review of all patients who underwent ECMO over a 4-year period at our institution; specifically, examining reasons for placement and duration of time on ECMO, as well as nosocomial infections incurred while on or shortly after discontinuation of support. Infections were considered ECMO-related if the organism was recovered on support or within 7 days from decannulation. Analyses were performed utilizing Pearson's chi-square for dichotomous factors and t-tests for continuous factors. Results: Of 141 patients requiring ECMO support, 90 (64%) survived to hospital discharge. Indication for support included circulatory failure (53%) and non-cardiac (47%). Twenty-six percent of patients developed infections on ECMO. Organisms isolated included: bacterial 20 (54%), fungal 10 (27%), mixed five (14%) and viral two (5%). Infection sites included: blood 13 (35%), urine nine (24%), mixed eight (22%), wound five (14%) and lung two (5%). Seventy-eight percent of infections noted occurred in cardiac patients. Patients with nosocomial infections were supported for a median of 169 h (range, 84–936 h), versus those without nosocomial infection [146 h (range, 50–886 h); P<0.001]. Procedures on ECMO were associated with an increased risk of infection (P<0.001) as was the presence of an open chest (P<0.025). Conclusions: The incidence of infection in ECMO patients at our institution has not increased significantly since our previous study. Cardiac patients have increased risk for nosocomial infection while on ECMO, which may be in part due to longer cannulation times, as well as increased likelihood of undergoing major procedures or having an open chest.
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