Mornese Pinna Simone, Sousa Casasnovas Iago, Olmedo María, Machado Marina, Juàrez Fernández Miriam, Devesa-Cordero Carolina, Galar Alicia, Alvarez-Uria Ana, Fernández-Avilés Francisco, García Carreño Jorge, Martínez-Sellés Manuel, De Rosa Francesco Giuseppe, Corcione Silvia, Bouza Emilio, Muñoz Patricia, Valerio Maricela
Servicio de Microbiología Clínica y Enfermedades Infecciosas, Hospital General Universitario Gregorio Marañón, 28009 Madrid, Spain.
Servicio de Cardiología, Hospital General Universitario Gregorio Marañón, CIBERCV, 28007 Madrid, Spain.
Microorganisms. 2023 Apr 20;11(4):1079. doi: 10.3390/microorganisms11041079.
The use of venoarterial (VA) extracorporeal membrane oxygenation therapy (ECMO) in patients admitted to cardiac intensive care units (CICU) has increased. Data regarding infections in this population are scarce. In this retrospective study, we analyzed the risk factors, outcome, and predictors of in-hospital mortality due to nosocomial infections in patients with ECMO admitted to a single coronary intensive care unit between July 2013 and March 2019 treated with VA-ECMO for >48 h. From 69 patients treated with VA-ECMO >48 h, (median age 58 years), 29 (42.0%) patients developed 34 episodes of infections with an infection rate of 0.92/1000 ECMO days. The most frequent were ventilator-associated pneumonia (57.6%), tracheobronchitis (9.1%), bloodstream infections (9.1%), skin and soft tissue infections (9.1%), and cytomegalovirus reactivation (9.1%). In-hospital mortality was 47.8%, but no association with nosocomial infections was found ( = 0.75). The number of days on ECMO (OR 1.14, 95% CI 1.01-1.30, = 0.029) and noninfectious complications were higher in the infected patients (OR: 3.8 95% CI = 1.05-14.1). A higher baseline creatinine value (OR: 8.2 95% CI = 1.12-60.2) and higher blood lactate level at 4 h after ECMO initiation (OR: 2.0 95% CI = 1.23-3.29) were significant and independent risk factors for mortality. Nosocomial infections in medical patients treated with VA-ECMO are very frequent, mostly Gram-negative respiratory infections. Preventive measures could play an important role for these patients.
入住心脏重症监护病房（CICU）的患者使用静脉-动脉（VA）体外膜肺氧合治疗（ECMO）的情况有所增加。关于这一人群感染的数据很少。在这项回顾性研究中，我们分析了2013年7月至2019年3月期间在单一冠心病重症监护病房接受VA-ECMO治疗超过48小时的ECMO患者医院感染导致住院死亡的危险因素、结局及预测因素。在69例接受VA-ECMO治疗超过48小时（中位年龄58岁）的患者中，29例（42.0%）患者发生了34次感染发作，感染率为0.92/1000 ECMO日。最常见的是呼吸机相关性肺炎（57.6%）、气管支气管炎（9.1%）、血流感染（9.1%）、皮肤和软组织感染（9.1%）以及巨细胞病毒再激活（9.1%）。住院死亡率为47.8%，但未发现与医院感染有关（P = 0.75）。感染患者的ECMO天数（比值比1.14，95%可信区间1.01 - 1.30，P = 0.029）和非感染性并发症更高（比值比：3.8，95%可信区间 = 1.05 - 14.1）。较高的基线肌酐值（比值比：8.2，95%可信区间 = 1.12 - 60.2）和ECMO启动后4小时较高的血乳酸水平（比值比：2.0，95%可信区间 = 1.23 - 3.29）是死亡的显著且独立危险因素。接受VA-ECMO治疗的内科患者医院感染非常常见，主要是革兰阴性菌呼吸道感染。预防措施对这些患者可能起到重要作用。
