Infectious Disease Service, Department of Medicine, Brooke Army Medical Center 3551 Roger Brooke Drive, Joint Base San Antonio, TX 78234 United States; Department of Medicine, Uniformed Services University of Health Sciences, 4301 Jones Bridge Rd, Bethesda, MD 20814 United States.
Infectious Disease Service, Department of Medicine, Brooke Army Medical Center 3551 Roger Brooke Drive, Joint Base San Antonio, TX 78234 United States; Department of Medicine, Uniformed Services University of Health Sciences, 4301 Jones Bridge Rd, Bethesda, MD 20814 United States.
Heart Lung. 2023 Jul-Aug;60:15-19. doi: 10.1016/j.hrtlng.2023.02.020. Epub 2023 Mar 3.
While guidance exists for management of blood stream infections with various invasive devices, there are currently limited data to guide antibiotic selection and duration for bacteremia in patients receiving extracorporeal membrane oxygenation (ECMO).
To evaluate the treatment and outcomes of thirty-six patients with Staphylococcus aureus and Enterococcus bacteremia on ECMO support.
Blood culture data was retrospectively analyzed from patients with Staphylococcus aureus bacteremia (SAB) or Enterococcus bacteremia who underwent ECMO support between March 2012 and September 2021 at Brooke Army Medical Center.
Of the 282 patients who received ECMO during this study period, there 25 (9%) patients developed Enterococcus bacteremia and 16 (6%) developed SAB. SAB occurred earlier in ECMO as compared to Enterococcus (median day 2 IQR (1-5) vs. 22 (12-51), p = 0.01). The most common duration of antibiotics was 28 days after clearance for SAB and 14 days after clearance for Enterococcus. 2 (5%) patients underwent cannula exchange with primary bacteremia, and 7 (17%) underwent circuit exchange. 1/3 (33%) patients with SAB and 3/10 (30%) patients with Enterococcus bacteremia who remained cannulated after completion of antibiotics had a second episode of SAB or Enterococcus bacteremia.
This single center case series is the first to describe the specific treatment and outcomes of patients receiving ECMO complicated by SAB and Enterococcus bacteremia. For patients who remain on ECMO after completion of antibiotics, there is a risk of a second episode of Enterococcus bacteremia or SAB.
虽然有各种侵入性器械引起的血流感染管理指南，但目前数据有限，无法指导接受体外膜氧合 (ECMO) 支持的患者菌血症的抗生素选择和疗程。
评估 36 例金黄色葡萄球菌和肠球菌菌血症患者在 ECMO 支持下的治疗和结局。
回顾性分析 2012 年 3 月至 2021 年 9 月在 Brooke 陆军医疗中心接受 ECMO 支持的金黄色葡萄球菌菌血症 (SAB) 或肠球菌菌血症患者的血培养数据。
在本研究期间接受 ECMO 的 282 例患者中，有 25 例（9%）患者发生肠球菌菌血症，16 例（6%）发生 SAB。与肠球菌相比，SAB 发生在 ECMO 早期（中位数第 2 天 IQR（1-5）与 22 天（12-51），p=0.01）。SAB 的抗生素治疗时间中位数为清除后 28 天，肠球菌为清除后 14 天。2 例（5%）患者因原发性菌血症进行了导管交换，7 例（17%）患者进行了回路交换。33%（1/3）的 SAB 患者和 30%（3/10）的肠球菌菌血症患者在完成抗生素治疗后仍留置导管，再次发生 SAB 或肠球菌菌血症。
这是首例描述接受 ECMO 治疗并发 SAB 和肠球菌菌血症患者具体治疗和结局的单中心病例系列研究。对于完成抗生素治疗后仍留置 ECMO 的患者，存在再次发生肠球菌菌血症或 SAB 的风险。
