Cashen Katherine, Reeder Ron, Dalton Heidi J, Berg Robert A, Shanley Thomas P, Newth Christopher J L, Pollack Murray M, Wessel David, Carcillo Joseph, Harrison Rick, Dean J Michael, Tamburro Robert, Meert Kathleen L
1 Division of Critical Care, Department of Pediatrics, Children's Hospital of Michigan/Wayne State University, Detroit, MI, USA.
2 Department of Pediatrics, University of Utah, Salt Lake City, UT, USA.
Perfusion. 2018 Sep;33(6):472-482. doi: 10.1177/0267659118766436. Epub 2018 Apr 11.
Our objectives are to (1) describe the pathogens, site, timing and risk factors for acquired infection during neonatal and pediatric ECMO and (2) explore the association between acquired infection and mortality.
Secondary analysis of prospective data collected by the Collaborative Pediatric Critical Care Research Network between December 2012 and September 2014. Clinical factors associated with acquired infection were assessed with multivariable Cox regression. Factors associated with mortality were assessed with logistic regression.
Of 481 patients, 247 (51.3%) were neonates and 400 (83.2%) received venoarterial ECMO. Eighty (16.6%) patients acquired one or more infections during ECMO; 60 (12.5%) patients had bacterial, 21 (4.4%) had fungal and 11 (2.3%) had viral infections. The site of infection included respiratory for 53 (11.0%) patients, bloodstream for 21 (4.4%), urine for 20 (4.2%) and other for 7 (1.5%). Candida species were most common. Median time to infection was 5.2 days (IQR 2.3, 9.6). On multivariable analysis, a greater number of procedures for ECMO cannula placement was independently associated with increased risk of acquired infection during ECMO (Hazard Ratio 2.13 (95% CI 1.22, 3.72), p<0.01) and receiving ECMO in a neonatal ICU compared to a pediatric or cardiac ICU was associated with decreased risk (Hazard Ratio pediatric ICU 4.25 (95% CI 2.20, 8.20), cardiac ICU 2.91 (95% CI 1.48, 5.71), neonatal ICU as reference, p<0.001). Acquired infection was not independently associated with mortality.
ECMO procedures and location may contribute to acquired infection risk; however, acquired infection did not predict mortality in this study.
我们的目标是：（1）描述新生儿和儿科体外膜肺氧合（ECMO）期间获得性感染的病原体、部位、时间及危险因素；（2）探讨获得性感染与死亡率之间的关联。
对协作儿科危重症研究网络在2012年12月至2014年9月期间收集的前瞻性数据进行二次分析。采用多变量Cox回归评估与获得性感染相关的临床因素。采用逻辑回归评估与死亡率相关的因素。
481例患者中，247例（51.3%）为新生儿，400例（83.2%）接受了静脉-动脉ECMO治疗。80例（16.6%）患者在ECMO期间发生了一种或多种感染；60例（12.5%）患者发生细菌感染，21例（4.4%）发生真菌感染，11例（2.3%）发生病毒感染。感染部位包括呼吸道感染53例（11.0%）、血流感染21例（4.4%）、泌尿系统感染20例（4.2%）及其他部位感染7例（1.5%）。念珠菌属最为常见。感染的中位时间为5.2天（四分位间距2.3，９.6）。多变量分析显示，ECMO插管放置的操作次数越多，ECMO期间获得性感染的风险独立增加（风险比2.13（95%置信区间1.22，3.72），p<0.01），与儿科或心脏重症监护病房相比，在新生儿重症监护病房接受ECMO治疗的感染风险降低（风险比：儿科重症监护病房4.25（95%置信区间2.20，8.20），心脏重症监护病房2.91（95%置信区间1.48，5.71），以新生儿重症监护病房为参照，p<0.001）。获得性感染与死亡率无独立关联。
ECMO操作及治疗地点可能影响获得性感染风险；然而，在本研究中获得性感染并不能预测死亡率。
