Pediatric Intensive Care Unit, Department of Pediatrics, Gynecology and Obstetrics, Geneva University Hospitals, Geneva, Switzerland.
Geneva University Hospitals, Geneva, Switzerland.
BMC Pediatr. 2023 Feb 23;23(1):89. doi: 10.1186/s12887-023-03908-3.
Veno-arterial Extracorporeal Membrane Oxygenation (VA-ECMO) is a standard procedure for patient with refractory shock in Pediatric Intensive Care Unit (PICU). There is a paucity of data on the time relationship between VA-ECMO support, nosocomial infection occurrence, and PICU length of stay (LOS). The aim of this study was to determine the characteristics and impact of ECMO-related infections.
This is a retrospective study from 01/2008 to 12/2014, enrolling children with a VA-ECMO support for > 6 h. We recorded the first PICU infection during the VA-ECMO run, defined as a positive microbiological sample with clinical signs of infection or clinical signs of severe infection without positive sample.
During the study period, 41 patients (25/41 male) were included, with a median age of 41.2 months (IQR 12.9-89.9) and a 53% mortality rate. Median time on VA-ECMO was 4.2 d (IQR 2-7.1), median PICU LOS was 14.7 d (IQR 4,7-26,9). Overall, 34% patients developed an infection, with an incidence of 60/1000 VA-ECMO days. Median time to first infection was 4 d (IQR 3-5), with Pseudomonas spp. being the most commonly detected microorganism (42%). Infected sites were ventilator-associated pneumonia (9/14), sternotomy infection (2/14), bloodstream (2/14) and urinary tract infections (1/14). Longer VA-ECMO support (> 5 d) (OR 5.9 (CI 95% 1.4-24.6; p = 0.01) and longer PICU stay (> 14 d) (OR 12 (95% CI 2.2-65.5; p = 0.004) were associated with infection.
In this single-center study, we underlined the high proportion and early occurrence of infections in patient on VA-ECMO, mostly in the first week. As infection was an early event, it may prolong the duration of VA-ECMO support and PICU LOS. Further research is needed to better understand the impact of infections on VA-ECMO and develop prevention strategies.
体外膜肺氧合（VA-ECMO）是小儿重症监护病房（PICU）中治疗难治性休克患者的标准程序。关于 VA-ECMO 支持、医院感染发生和 PICU 住院时间（LOS）之间的时间关系，数据很少。本研究的目的是确定 ECMO 相关感染的特征和影响。
这是一项回顾性研究，时间范围为 2008 年 1 月至 2014 年 12 月，纳入了接受 VA-ECMO 支持时间超过 6 小时的儿童患者。我们记录了 VA-ECMO 运行期间的第一例 PICU 感染，定义为有临床感染症状或严重感染但无阳性样本的微生物阳性样本。
在研究期间，共纳入 41 名患者（25/41 名男性），中位年龄为 41.2 个月（IQR 12.9-89.9），死亡率为 53%。VA-ECMO 中位时间为 4.2 天（IQR 2-7.1），PICU 中位住院时间为 14.7 天（IQR 4、7-26.9）。总体而言，34%的患者发生感染，发病率为 60/1000 VA-ECMO 天。首次感染的中位时间为 4 天（IQR 3-5），最常见的检测到的微生物是铜绿假单胞菌（42%）。感染部位为呼吸机相关性肺炎（14 例中的 9 例）、胸骨切开术感染（14 例中的 2 例）、血流感染（14 例中的 2 例）和尿路感染（14 例中的 1 例）。较长的 VA-ECMO 支持时间（>5 天）（OR 5.9（95%CI 1.4-24.6；p=0.01）和较长的 PICU 住院时间（>14 天）（OR 12（95%CI 2.2-65.5；p=0.004）与感染相关。
在这项单中心研究中，我们强调了患者在接受 VA-ECMO 治疗时感染的比例较高且发生较早，主要发生在第一周。由于感染是一个早期事件，它可能会延长 VA-ECMO 支持和 PICU LOS 的时间。需要进一步研究以更好地了解感染对 VA-ECMO 的影响，并制定预防策略。
