Service d'Anesthésie-Réanimations Chirurgicales, DMU CARE, DHU A-TVB, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Henri Mondor, 1 rue Gustave Eiffel, 94000, Créteil, France.
Faculté de Santé, Univ Paris Est Créteil, 94010, Créteil, France.
Crit Care. 2021 Jul 8;25(1):241. doi: 10.1186/s13054-021-03658-7.
Bloodstream infections (BSIs) are frequent on veno-arterial extracorporeal membrane oxygenation (V-A ECMO). Performing routine blood cultures (BCs) may identify early paucisymptomatic BSIs. We investigated the contribution of systematic daily BCs to detect BSIs on V-A ECMO.
This was a retrospective study including all adult patients requiring V-A ECMO and surviving more than 24 h. Our protocol included routine daily BCs, from V-A ECMO insertion up to 5 days after withdrawal; other BCs were performed on-demand.
On the 150 V-A ECMO included, 2146 BCs were performed (1162 routine and 984 on-demand BCs); 190 (9%) were positive, including 68 contaminants. Fifty-one (4%) routine BCs revealed BSIs; meanwhile, 71 (7%) on-demand BCs revealed BSIs (p = 0.005). Performing routine BCs was negatively associated with BSIs diagnosis (OR 0.55, 95% CI [0.38; 0.81], p = 0.002). However, 16 (31%) BSIs diagnosed by routine BCs would have been missed by on-demand BCs. Independent variables for BSIs diagnosis after routine BCs were: V-A ECMO for cardiac graft failure (OR 2.43, 95% CI [1.20; 4.92], p = 0.013) and sampling with on-going antimicrobial therapy (OR 2.15, 95% CI [1.08; 4.27], p = 0.029) or renal replacement therapy (OR 2.05, 95% CI [1.10; 3.81], p = 0.008). Without these three conditions, only two BSIs diagnosed with routine BCs would have been missed by on-demand BCs sampling.
Although routine daily BCs are less effective than on-demand BCs and expose to contamination and inappropriate antimicrobial therapy, a policy restricted to on-demand BCs would omit a significant proportion of BSIs. This argues for a tailored approach to routine daily BCs on V-A ECMO, based on risk factors for positivity.
在静脉-动脉体外膜肺氧合（V-A ECMO）中，血流感染（BSI）很常见。进行常规血培养（BC）可能会早期发现症状不明显的 BSI。我们研究了系统地每日进行 BC 以检测 V-A ECMO 上 BSI 的作用。
这是一项回顾性研究，包括所有需要 V-A ECMO 并存活超过 24 小时的成年患者。我们的方案包括从 V-A ECMO 插入到撤出后 5 天内常规每日进行 BC；其他 BC 则按需进行。
在包括的 150 例 V-A ECMO 中，进行了 2146 次 BC（1162 次常规和 984 次按需 BC）；有 190 次（9%）为阳性，包括 68 次污染。51 次（4%）常规 BC 显示 BSI；而 71 次（7%）按需 BC 显示 BSI（p=0.005）。进行常规 BC 与 BSI 诊断呈负相关（OR 0.55，95%CI [0.38;0.81]，p=0.002）。但是，16 次（31%）通过常规 BC 诊断的 BSI 将被按需 BC 漏诊。常规 BC 后 BSI 诊断的独立变量为：用于心脏移植物衰竭的 V-A ECMO（OR 2.43，95%CI [1.20;4.92]，p=0.013）和正在进行抗菌治疗时采样（OR 2.15，95%CI [1.08;4.27]，p=0.029）或肾脏替代治疗（OR 2.05，95%CI [1.10;3.81]，p=0.008）。如果没有这三种情况，则只有 2 次通过常规 BC 诊断的 BSI 将被按需 BC 采样漏诊。
尽管常规每日 BC 不如按需 BC 有效，并且易受污染和不适当的抗菌治疗影响，但仅按需进行 BC 的策略将遗漏很大一部分 BSI。这需要根据 V-A ECMO 上阳性的危险因素，对常规每日 BC 进行有针对性的方法。
