Juthani Biren K, Macfarlan Jennifer, Wu James, Misselbeck Timothy S
Lehigh Valley Health Network, LVPG Cardiac and Thoracic Surgery, Center for Advanced Health Care, 1250 S. Cedar Crest Blvd., Allentown, PA 18103, United States; Danbury Hospital, 24 Hospital Avenue, 4 South, Danbury Hospital, Department of Surgery, Danbury, CT 06811, United States.
Lehigh Valley Health Network, Network Office of Research and Innovation, 1255 S. Cedar Crest Blvd., Allentown, PA 18103, United States.
Heart Lung. 2018 Nov;47(6):626-630. doi: 10.1016/j.hrtlng.2018.07.004. Epub 2018 Aug 27.
Critically ill patients requiring extracorporeal membrane oxygenation (ECMO) are at increased risk for developing nosocomial infections owing to their underlying disease process along with numerous invasive monitoring devices.
We retrospectively analyzed the rate, type, pathogens, outcomes, and risk factors of nosocomial infections that developed during adult patients on ECMO at our institution from 2012-2015.
Compared to current ELSO reported adult nosocomial infections rate of 20.5%, we report our rate of 26% (CI 17.2%-34.7%). No significant differences were observed in mortality (42.3% vs. 36.5%; p=0.598), and presence of either antibiotics prior to ECMO (57.7% vs. 56.7%; p=0.934) or culture-proven infection prior to ECMO (19.2% vs. 32.4%; p=0.201). Patients who developed nosocomial infections had longer duration of ECMO (13 vs. 5 days; p<0.001), longer length of stay (36.5 vs. 18.5 days; p=0.004), and more days on ventilator (29 vs. 12.5; p=0.002). Duration of ECMO (OR=1.20, 95% CI 1.02-1.39; p=0.020) and duration of ECMO greater than 10 days (OR=14.65, 95% CI 1.81-118.78; p=0.012) were independent risk factors for developing nosocomial infections. However, there was no difference in mortality when duration of ECMO >10 days was compared with ≤10 days (28.5% vs. 43.1%; p=0.154).
Nosocomial infections have no effect on survival in adult ECMO patients. Presence of either antibiotics or infection prior to ECMO has no effect on developing nosocomial infections while on ECMO. Duration of ECMO longer than 10 days is a major risk factor for developing nosocomial infection.
需要体外膜肺氧合（ECMO）的重症患者由于其潜在疾病过程以及众多侵入性监测设备，发生医院感染的风险增加。
我们回顾性分析了2012年至2015年在我院接受ECMO治疗的成年患者发生医院感染的发生率、类型、病原体、结局及危险因素。
与目前体外生命支持组织（ELSO）报告的成年患者医院感染率20.5%相比，我们报告的感染率为26%（可信区间17.2%-34.7%）。在死亡率（42.3%对36.5%；p=0.598）、ECMO治疗前使用抗生素情况（57.7%对56.7%；p=0.934）或ECMO治疗前经培养证实的感染情况（19.2%对32.4%；p=0.201）方面未观察到显著差异。发生医院感染的患者ECMO治疗时间更长（13天对5天；p<0.001）、住院时间更长（36.5天对18.5天；p=0.004）、机械通气天数更多（29天对12.5天；p=0.002）。ECMO治疗时间（比值比=1.20，95%可信区间1.02-1.39；p=0.020）以及ECMO治疗时间大于10天（比值比=14.65，95%可信区间1.81-118.78；p=0.012）是发生医院感染的独立危险因素。然而，将ECMO治疗时间>10天与≤10天进行比较时，死亡率无差异（28.5%对43.1%；p=0.154）。
医院感染对成年ECMO患者的生存无影响。ECMO治疗前使用抗生素或存在感染对ECMO治疗期间发生医院感染无影响。ECMO治疗时间超过10天是发生医院感染的主要危险因素。
