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. 2023 Apr 20;11(4):1079.
doi: 10.3390/microorganisms11041079.

Nosocomial Infections in Adult Patients Supported by Extracorporeal Membrane Oxygenation in a Cardiac Intensive Care Unit

Simone Mornese Pinna  1 , Iago Sousa Casasnovas  2 , María Olmedo  1   3 , Marina Machado  1   3 , Miriam Juàrez Fernández  2 , Carolina Devesa-Cordero  2 , Alicia Galar  1   3 , Ana Alvarez-Uria  1   3 , Francisco Fernández-Avilés  2   3 , Jorge García Carreño  2 , Manuel Martínez-Sellés  2   3   4   5 , Francesco Giuseppe De Rosa  6 , Silvia Corcione  6 , Emilio Bouza  1   3   4 , Patricia Muñoz  1   3   4 , Maricela Valerio  1   3   4
Affiliations

Nosocomial Infections in Adult Patients Supported by Extracorporeal Membrane Oxygenation in a Cardiac Intensive Care Unit

Simone Mornese Pinna et al. Microorganisms. .

Abstract

The use of venoarterial (VA) extracorporeal membrane oxygenation therapy (ECMO) in patients admitted to cardiac intensive care units (CICU) has increased. Data regarding infections in this population are scarce. In this retrospective study, we analyzed the risk factors, outcome, and predictors of in-hospital mortality due to nosocomial infections in patients with ECMO admitted to a single coronary intensive care unit between July 2013 and March 2019 treated with VA-ECMO for >48 h. From 69 patients treated with VA-ECMO >48 h, (median age 58 years), 29 (42.0%) patients developed 34 episodes of infections with an infection rate of 0.92/1000 ECMO days. The most frequent were ventilator-associated pneumonia (57.6%), tracheobronchitis (9.1%), bloodstream infections (9.1%), skin and soft tissue infections (9.1%), and cytomegalovirus reactivation (9.1%). In-hospital mortality was 47.8%, but no association with nosocomial infections was found (p = 0.75). The number of days on ECMO (OR 1.14, 95% CI 1.01-1.30, p = 0.029) and noninfectious complications were higher in the infected patients (OR: 3.8 95% CI = 1.05-14.1). A higher baseline creatinine value (OR: 8.2 95% CI = 1.12-60.2) and higher blood lactate level at 4 h after ECMO initiation (OR: 2.0 95% CI = 1.23-3.29) were significant and independent risk factors for mortality. Conclusions: Nosocomial infections in medical patients treated with VA-ECMO are very frequent, mostly Gram-negative respiratory infections. Preventive measures could play an important role for these patients.

Keywords: ECMO; cardiac intensive care unit; cardiovascular infections; nosocomial infections; venoarterial extracorporeal membrane oxygenation.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Noninfectious complications occurring during extracorporeal membrane oxygenation.
Figure 2
Figure 2
Kaplan–Meier mortality rates for patients with and without nosocomial infection.
See this image and copyright information in PMC

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