Department of Internal Medicine, Section of Infectious Disease, Far Eastern Memorial Hospital, Taipei, Taiwan.
J Hosp Infect. 2009 Nov;73(3):210-6. doi: 10.1016/j.jhin.2009.07.016. Epub 2009 Sep 25.
An increasing number of patients receive extracorporeal membrane oxygenation (ECMO) for life support. This study aimed to investigate the incidence and risk factors for nosocomial infection in adult patients receiving ECMO. We reviewed the medical records of adult patients who received ECMO support for more than 72h at Far Eastern Memorial Hospital from 2001 to 2007. ECMO-related nosocomial infections were defined as infections occurring from 24h after ECMO initiation until 48h after ECMO discontinuation. There were 12 episodes of nosocomial infection identified in 10 of the 114 (8.77%) patients on ECMO, including four cases of pneumonia, three cases of bacteraemia, three surgical site infections and two urinary tract infections. The incidence of ECMO-related nosocomial infection was 11.92 per 1000 ECMO-days. The length of ECMO use and intensive care unit (ICU) stay were significantly different between patients with, and without, nosocomial infection (P<0.001). More than 10 days of ECMO use was associated with a significantly higher nosocomial infection rate (P=0.003). Gram-negative bacilli were responsible for 78% of the nosocomial infections. In the univariate analysis, the duration of ICU stay and duration of ECMO use were associated with nosocomial infection. In the multivariate analysis, only the duration of ECMO was independently associated with nosocomial infection (P=0.007). Overall, the only independent risk factor for ECMO-related nosocomial infection identified in this study was prolonged ECMO use.
越来越多的患者接受体外膜肺氧合（ECMO）进行生命支持。本研究旨在探讨成人 ECMO 支持患者发生医院感染的发生率和危险因素。我们回顾了 2001 年至 2007 年期间在远东纪念医院接受 ECMO 支持超过 72 小时的成人患者的病历。ECMO 相关医院感染的定义为 ECMO 开始后 24 小时至 ECMO 停止后 48 小时发生的感染。在 114 名接受 ECMO 的患者中，有 10 名患者发生了 12 次医院感染，包括 4 例肺炎、3 例菌血症、3 例手术部位感染和 2 例尿路感染。ECMO 相关医院感染的发生率为每 1000 个 ECMO 日 11.92 例。有和没有医院感染的患者的 ECMO 使用时间和重症监护病房（ICU）停留时间差异有统计学意义（P<0.001）。ECMO 使用超过 10 天与医院感染率显著升高相关（P=0.003）。革兰氏阴性杆菌占医院感染的 78%。在单因素分析中，ICU 停留时间和 ECMO 使用时间与医院感染有关。在多因素分析中，只有 ECMO 使用时间与医院感染独立相关（P=0.007）。总体而言，本研究确定 ECMO 相关医院感染的唯一独立危险因素是 ECMO 使用时间延长。
