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. 2018 Apr 17;22(1):98.
doi: 10.1186/s13054-018-2023-z.

Fungal infections in adult patients on extracorporeal life support

Yiorgos Alexandros Cavayas  1 , Hakeem Yusuff  2 , Richard Porter  2
Affiliations

Fungal infections in adult patients on extracorporeal life support

Yiorgos Alexandros Cavayas et al. Crit Care. .

Abstract

Background: Patients on extracorporeal membrane oxygenation (ECMO) are often among the most severely ill in the intensive care unit. They are often receiving broad-spectrum antibiotics; they have multiple entry points for pathogens; and their immune system is impaired by blood circuit interaction. These factors are thought to predispose them to fungal infections. We thus aimed to evaluate the prevalence, risk factors, and prognosis of fungal infections in adults on ECMO.

Methods: We conducted a retrospective cohort study using the Extracorporeal Life Support Organization registry, which compiles data on ECMO use from hundreds of international centers. We included all adult patients from 2006 to 2016 on any mode of ECMO with either a diagnosis of fungal infection or a positive fungal culture.

Results: Our study comprised 2129 adult patients (10.8%) with fungal colonization or infection. Aspergillus involvement (colonization or infection) was present in 272 patients (1.4%), of whom 35.7% survived to hospital discharge. There were 245 patients (1.2%) with Candida invasive bloodstream infection, with 35.9% survival. Risk factors for Aspergillus involvement included solid organ transplant (OR 1.83; p = 0.008), respiratory support (OR 2.75; p < 0.001), and influenza infection (OR 2.48; p < 0.001). Risk factors for candidemia included sepsis (OR 1.60; p = 0.005) and renal replacement therapy (OR 1.55; p = 0.007). In multivariable analysis, Aspergillus involvement (OR 0.40; p < 0.001) and candidemia (OR 0.47; p < 0.001) were both independently associated with decreased survival.

Conclusions: The prevalence of Aspergillus involvement and Candida invasive bloodstream infection were not higher in patients on ECMO than what has been reported in the general intensive care population. Both were independently associated with a reduced survival. Aspergillus involvement was strongly associated with ECMO for respiratory support and influenza.

Keywords: Aspergillosis [D001228]; Aspergillus [D001230]; Candida [D002175]; Candidemia [D058387]; Extracorporeal membrane oxygenation [D015199]; Invasive fungal infections [D000072742].

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Conflict of interest statement

Ethics approval and consent to participate

After approval by the ELSO Registry Committee, limited de-identified datasets are released to participating centers for research purposes without the need for further approval from individual centers. No patient consent is required. This study was conducted in accordance with the amended Declaration of Helsinki.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Survival of patients with Aspergillus involvement and Candida bloodstream infection compared with the overall survival in the Extracorporeal Life Support Organization (ELSO) registry during study the period. *Statistically significant difference compared with overall survival in the ELSO registry during the study period
See this image and copyright information in PMC

Comment in

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