Division of Infectious Diseases, University of Toronto, Toronto, Ontario, Canada.
Infection Prevention and Control, University Health Network, Toronto, Ontario, Canada.
Infect Control Hosp Epidemiol. 2023 Sep;44(9):1443-1450. doi: 10.1017/ice.2022.290. Epub 2022 Dec 1.
Extracorporeal membrane oxygenation (ECMO) has been widely used in the care of patients with respiratory failure from coronavirus disease 2019 (COVID-19). We characterized bloodstream infections (BSIs) and ventilator-associated pneumonias (VAPs) in COVID-19 patients supported with ECMO, and we investigated their impact on patient outcomes.
Retrospective cohort study from March 1, 2020, to June 30, 2021.
Academic tertiary-care referral center.
Consecutive adult patients admitted for COVID-19 who received ECMO.
We identified BSIs and VAPs and described their epidemiology and microbiology. Cumulative antimicrobial use and the specific management of BSIs were determined. Multivariate time-dependent Cox proportional hazards models were constructed to evaluate the impact of BSIs and VAPs on mortality, controlling for age, receipt of COVID-19-specific therapeutics, and new renal replacement therapy.
We identified 136 patients who received ECMO for COVID-19 pneumonia during the study period. BSIs and VAPs occurred in 81 patients (59.6%) and 93 patients (68.4%), respectively. The incidence of BSIs was 29.5 per 1,000 ECMO days and increased with duration of ECMO cannulation. Enterococci, Enterobacterales, and were the most common causes of BSIs, whereas , species, and comprised the majority of VAPs. Mean antibiotic use comprised 1,031 days of therapy per 1,000 ECMO days (SD, 496). We did not detect an association between BSIs or VAPs and mortality.
BSIs and VAPs are common in COVID-19 ECMO-supported patients. Efforts to optimize their diagnosis, prevention, and management should be prioritized.
体外膜肺氧合（ECMO）已广泛应用于 2019 冠状病毒病（COVID-19）所致呼吸衰竭患者的治疗。本研究旨在分析 COVID-19 患者接受 ECMO 治疗后发生血流感染（BSI）和呼吸机相关性肺炎（VAP）的特征，并探讨其对患者预后的影响。
2020 年 3 月 1 日至 2021 年 6 月 30 日期间进行的回顾性队列研究。
学术性三级医疗中心。
连续入组因 COVID-19 接受 ECMO 治疗的成年患者。
我们确定了 BSI 和 VAP 的发病情况，描述了其流行病学和微生物学特征。确定了累积抗菌药物使用情况以及 BSI 的具体管理方法。构建多变量时依 Cox 比例风险模型，以评估 BSI 和 VAP 对死亡率的影响，同时控制年龄、COVID-19 特异性治疗和新的肾脏替代治疗。
研究期间共纳入 136 例因 COVID-19 肺炎接受 ECMO 治疗的患者。81 例（59.6%）和 93 例（68.4%）患者分别发生了 BSI 和 VAP。BSI 的发生率为每 1000 个 ECMO 日 29.5 例，且随 ECMO 置管时间的延长而增加。BSI 的主要病原体为肠球菌、肠杆菌科和，而 VAP 的主要病原体为、和 。平均抗生素使用量为每 1000 个 ECMO 日 1031 天（SD，496 天）。我们未发现 BSI 或 VAP 与死亡率之间存在关联。
BSI 和 VAP 是 COVID-19 患者接受 ECMO 支持治疗后的常见并发症。应优先考虑优化其诊断、预防和管理。
