Hao Tong, Jin Chenhui, Hu Dingji, Wu Changde, Zhu Yike, Xie Jianfeng, Huang Lili, Xu Jingyuan, Chang Wei, Liu Ling, Guo Fengmei, Qiu Haibo, Yang Yi, Liu Songqiao
Jiangsu Provincial Key Laboratory of Critical Care Medicine, Department of Critical Care Medicine, Trauma Center, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China.
The First Clinical Medical College, Nanjing Medical University, Nanjing, China.
J Thorac Dis. 2024 Jul 30;16(7):4429-4439. doi: 10.21037/jtd-23-1912. Epub 2024 Jul 18.
Limited data are available regarding the current microbiological characteristics of extracorporeal membrane oxygenation (ECMO)-related infections in intensive care units (ICUs) in China. This retrospective study aimed to determine the epidemiology, risk factors and impact on the outcome of ECMO-related infections.
A retrospective observational study from January 2014 to December 2019 was performed, and adult patients receiving ECMO support for more than 48 hours were included in this study. The primary outcome was the incidence rate of ECMO-related infection. Clinical data were recorded, and risk factors associated with an increased risk of ECMO-related infection were analyzed.
A total of 174 adult patients who received ECMO and underwent ECMO for 1,670 days were included in this study. Forty-six patients (26.4%) developed ECMO-related infections, corresponding to 27.5 first episodes/1,000 ECMO days. The most common ECMO-related infection observed was ventilator-associated pneumonia (VAP). Infected patients had longer durations of mechanical ventilation {20.2 [interquartile range (IQR), 12.6, 30.7] 9.0 (IQR, 5.8, 14.7) days, P<0.001}, ECMO support [11.6 (IQR, 8.1, 17.3) 7.6 (IQR, 5.6, 9.7) days, P<0.001] and hospital stays (28.2±20.7 22.0±15.6 days, P<0.001). The factors independently associated with ECMO-related infection were a dynamic decrease in lymphocyte count [adjusted odds ratio (OR) =3.578, 95% confidence interval (CI): 2.175-4.906, P<0.001] and ECMO duration (adjusted OR =1.207, 95% CI: 1.096-1.330, P<0.001). Compared to patients without infection, infected patients had greater hospital mortality (39.1% 78.3%, P<0.001) and 90-day mortality (40.6% 87.0%, P<0.001). ECMO-related infections were associated with worse outcomes (adjusted Kaplan-Meier curve, log rank test P<0.001).
Patients supported by ECMO had a high risk of developing ECMO-related infection. The most common ECMO-related infection observed was VAP. A dynamic decrease in lymphocyte counts was significantly associated with an increased risk of ECMO-related infection.
关于中国重症监护病房（ICU）中体外膜肺氧合（ECMO）相关感染的当前微生物学特征，可用数据有限。这项回顾性研究旨在确定ECMO相关感染的流行病学、危险因素及其对预后的影响。
进行了一项2014年1月至2019年12月的回顾性观察性研究，纳入接受ECMO支持超过48小时的成年患者。主要结局是ECMO相关感染的发生率。记录临床数据，并分析与ECMO相关感染风险增加相关的危险因素。
本研究共纳入174例接受ECMO并进行了1670天ECMO治疗的成年患者。46例患者（26.4%）发生了ECMO相关感染，相当于每1000个ECMO日发生27.5例首发感染。观察到的最常见的ECMO相关感染是呼吸机相关性肺炎（VAP）。感染患者的机械通气时间更长{20.2[四分位数间距（IQR），12.6，30.7]对9.0（IQR，5.8，14.7）天，P<0.001}、ECMO支持时间更长[11.6（IQR，8.1，17.3）对7.6（IQR，5.6，9.7）天，P<0.001]和住院时间更长（28.2±20.7对22.0±15.6天，P<0.001）。与ECMO相关感染独立相关的因素是淋巴细胞计数动态下降[调整后的优势比（OR）=3.578，95%置信区间（CI）：2.175 - 4.906，P<0.001]和ECMO持续时间（调整后的OR =1.207，95%CI：1.096 - 1.330，P<0.001）。与未感染患者相比，感染患者的医院死亡率更高（39.1%对78.3%，P<0.001）和90天死亡率更高（40.6%对87.0%，P<0.001）。ECMO相关感染与更差的预后相关（调整后的Kaplan-Meier曲线，对数秩检验P<0.001）。
接受ECMO支持的患者发生ECMO相关感染的风险很高。观察到的最常见的ECMO相关感染是VAP。淋巴细胞计数动态下降与ECMO相关感染风险增加显著相关。
