Division of Infectious Diseases, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA.
Department of Pharmacy Services, Mayo Clinic, Rochester, Minnesota, USA.
Clin Infect Dis. 2021 Aug 16;73(4):e988-e996. doi: 10.1093/cid/ciab118.
The use of extracorporeal membrane oxygenation (ECMO) in critically ill adults is increasing. There are currently no guidelines for antimicrobial prophylaxis. We analyzed 7 years of prophylactic antimicrobial use across 3 time series for patients on ECMO at our institution in the development, improvement, and streamlining of our ECMO antimicrobial prophylaxis protocol.
In this quasi-experimental interrupted time series analysis, we evaluated the impact of an initial ECMO antimicrobial prophylaxis protocol, implemented in 2014, on antimicrobial use and National Healthcare Safety Network-reportable infection rates. Then, following a revision and streamlining of the protocol in November 2018, we reevaluated the same metrics.
Our study population included 338 intensive care unit patients who received ECMO between July 2011 and November 2019. After implementation of the first version of the protocol, we did not observe significant changes in antimicrobial use or infection rates in these patients; however, following revision and streamlining of the protocol, we demonstrated a significant reduction in broad-spectrum antimicrobial use for prophylaxis in patients on ECMO without any evidence of a compensatory increase in infection rates.
Our final protocol significantly reduces broad-spectrum antimicrobial use for prophylaxis in patients on ECMO. We propose a standard antimicrobial prophylaxis regimen for patients on ECMO based on current evidence and our experience.Summary: There are no guidelines for antimicrobial prophylaxis in patients on extracorporeal membrane oxygenation (ECMO). A rational approach employing concepts of antimicrobial stewardship can drive logical antimicrobial selection for prophylaxis in patients on ECMO without adversely impacting outcomes.
体外膜肺氧合（ECMO）在危重症成人中的应用正在增加。目前尚无针对抗菌预防的指南。我们通过对我院 3 个时间序列中接受 ECMO 治疗的患者的预防性抗菌药物使用情况进行了 7 年的分析，制定、改进和简化了 ECMO 抗菌预防方案。
在这项准实验性的中断时间序列分析中，我们评估了最初的 ECMO 抗菌预防方案（于 2014 年实施）对我院患者的抗菌药物使用和国家医疗保健安全网络报告的感染率的影响。然后，在 2018 年 11 月对方案进行修订和简化后，我们重新评估了相同的指标。
我们的研究人群包括 2011 年 7 月至 2019 年 11 月期间在重症监护病房接受 ECMO 治疗的 338 名患者。在方案实施的第一版之后，我们没有观察到这些患者的抗菌药物使用或感染率发生显著变化；然而，在方案修订和简化之后，我们发现在 ECMO 患者中，广谱抗菌药物用于预防的使用显著减少，而没有证据表明感染率有补偿性增加。
我们最终的方案显著减少了 ECMO 患者的预防性广谱抗菌药物使用。根据当前的证据和我们的经验，我们提出了一种 ECMO 患者的标准抗菌预防方案。
体外膜肺氧合（ECMO）患者的抗菌预防没有指南。采用抗菌药物管理概念的合理方法可以在不影响结果的情况下，为 ECMO 患者的预防选择合理的抗菌药物。
