Xu Wenzeng, Fu Yiqi, Yao Yake, Zhou Jianying, Zhou Hua
Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310003, People's Republic of China.
Infect Drug Resist. 2022 Jul 29;15:4117-4126. doi: 10.2147/IDR.S372913. eCollection 2022.
The effect of nosocomial infections (NIs) in adult patients undergoing ECMO has been rarely reported in China. Moreover, the effect of NIs on ECMO patients' mortality is still unclear and inconclusive according to literature data. In this study, we examined the prevalence, risk factors, causative organisms, and effects on outcomes of NIs in ECMO patients.
A total of 79 nonsurgical patients (mean age 53.3±15.2 year (yr); 66% male) who underwent ECMO between January 2011 and September 2020 were enrolled in this retrospective study. Patients' demographic and clinical data and ECMO parameters were collected from all patients.
Among 79 patients who underwent ECMO for a total of 1253 ECMO days (mean time 15.9±14.1 d), 42 developed NIs. We observed 30 ventilator-associated pneumonia (VAP), 19 bloodstream infections (BSIs), and 4 urinary tract infections, corresponding to 23.9/1000 ECMO days, 15.2/1000 ECMO days, and 3.2/1000 ECMO days, respectively. ECMO duration (22.0±16.5 VS 8.9±5.3 d, P < 0.001), invasive mechanical ventilation (IMV) duration (27.4±20.5 VS 11.4±10.1 d, P < 0001), and ICU length of stay (35.9±22.9 VS 15.7±9.2 d, P < 0.001) were longer in patients with NIs. The independent risk factors for NIs were ECMO duration (Odds Ratio [OR], 1.414; 95% Confidence Interval [CI], (1.051-1.238); P = 0.002) and viral pneumonia (OR, 5.788; 95% CI, (1.551-21.596); P = 0.009). Gram-negative bacteria were the most common causative organisms of NIs; ), and were the most common bacteria. BSI (OR, 8.106; 95% CI, (1.384-47.474); P = 0.02) was an independent predictor for mortality.
NIs are common complications in patients during ECMO treatment, especially VAP, followed by BSI. Also, BSI can negatively affect the survival rate.
在中国，关于接受体外膜肺氧合（ECMO）治疗的成年患者发生医院感染（NI）的影响鲜有报道。此外，根据文献数据，NI对ECMO患者死亡率的影响仍不明确且尚无定论。在本研究中，我们调查了ECMO患者NI的发生率、危险因素、致病微生物及其对预后的影响。
本回顾性研究纳入了2011年1月至2020年9月期间接受ECMO治疗的79例非手术患者（平均年龄53.3±15.2岁；66%为男性）。收集了所有患者的人口统计学和临床数据以及ECMO参数。
79例接受ECMO治疗的患者共进行了1253个ECMO日（平均时间15.9±14.1天），其中42例发生了NI。我们观察到30例呼吸机相关性肺炎（VAP）、19例血流感染（BSI）和4例尿路感染，分别对应23.9/1000个ECMO日、15.2/1000个ECMO日和3.2/1000个ECMO日。发生NI的患者ECMO持续时间（22.0±16.5天对8.9±5.3天，P<0.001）、有创机械通气（IMV）持续时间（27.4±20.5天对11.4±10.1天，P<0.001）和重症监护病房（ICU）住院时间（35.9±22.9天对15.7±9.2天，P<0.001）更长。NI的独立危险因素为ECMO持续时间（比值比[OR]，1.414；95%置信区间[CI]，[1.051 - 1.238]；P = 0.002）和病毒性肺炎（OR，5.788；95% CI，[1.551 - 21.596]；P = 0.009）。革兰氏阴性菌是NI最常见的致病微生物； 是最常见的细菌。BSI（OR，8.106；95% CI，[1.384 - 47.474]；P = 0.02）是死亡率的独立预测因素。
NI是ECMO治疗患者常见的并发症，尤其是VAP，其次是BSI。此外，BSI会对生存率产生负面影响。
