Children's Healthcare of Atlanta at Egleston and Emory University School of Medicine, Atlanta, GA, USA.
Children's Hospital Colorado and University of Colorado School of Medicine, Aurora, Colorado, USA.
J Perinatol. 2019 Oct;39(10):1384-1391. doi: 10.1038/s41372-019-0435-5. Epub 2019 Aug 5.
To characterize the risk of bloodstream (BSI) and urinary tract infection (UTI) and describe antibiotic use in infants with congenital diaphragmatic hernia (CDH) requiring extracorporeal membrane oxygenation (ECMO).
The Children's Hospitals Neonatal Database was queried for infants with CDH and ECMO treatment from 2010 to 2016. The outcomes included BSI, UTI, and antimicrobial medication. Member institutions completed a survey on infection practices.
Eighteen of the 338 patients identified (5.3%) had ≥1 BSI during their ECMO course. The likelihood of BSI increased with time: 1.2/1000 ECMO days; 0.6% (2/315) in the first week and rising to 14.6/1000; 8.6% (5/58) after 21 days (p = 0.002). More than 95% of patients received antibiotics each week on ECMO.
Confirmed BSI is rare in infants with CDH treated with ECMO in the first week, but increases with the duration of ECMO. Use of antibiotics was extensive and did not correspond to infection frequency.
描述需要体外膜肺氧合（ECMO）治疗的先天性膈疝（CDH）婴儿血流感染（BSI）和尿路感染（UTI）的风险，并描述抗生素的使用情况。
本研究通过查询 2010 年至 2016 年期间患有 CDH 并接受 ECMO 治疗的婴儿的儿童医院新生儿数据库，评估了血流感染（BSI）、尿路感染（UTI）和抗菌药物的使用情况。成员机构完成了一项关于感染实践的调查。
在 338 名患者中，有 18 名（5.3%）在 ECMO 治疗期间发生了≥1 次 BSI。BSI 的发生概率随时间增加：1.2/1000 ECMO 天；第 1 周为 0.6%（2/315），第 21 天后上升至 14.6/1000；8.6%（5/58）（p=0.002）。超过 95%的患者在 ECMO 治疗期间每周接受抗生素治疗。
在 ECMO 治疗的前 1 周内，患有 CDH 的婴儿中确诊的 BSI 罕见，但随着 ECMO 持续时间的延长而增加。抗生素的使用非常广泛，但与感染频率不相符。
