Department of Medicine (DIMED), University of Padua, 13 Gallucci Street, 35121, Padua, Italy.
Institute of Anesthesia and Critical Care, Padua University Hospital, Padua, Italy.
Crit Care. 2024 Aug 27;28(1):279. doi: 10.1186/s13054-024-05068-x.
Veno-venous extracorporeal membrane oxygenation (V-V ECMO) is a rapidly expanding life-support technique worldwide. The most common indications are severe hypoxemia and/or hypercapnia, unresponsive to conventional treatments, primarily in cases of acute respiratory distress syndrome. Concerning potential contraindications, there is no mention of microbiological history, especially related to multi-drug resistant (MDR) bacteria isolated before V-V ECMO placement. Our study aims to investigate: (i) the prevalence and incidence of MDR Gram-negative (GN) bacteria in a cohort of V-V ECMOs; (ii) the risk of 1-year mortality, especially in the case of predetected MDR GN bacteria; and (iii) the impact of annual hospital V-V ECMO volume on the probability of acquiring MDR GN bacteria.
All consecutive adults admitted to the Intensive Care Units of 5 Italian university-affiliated hospitals and requiring V-V ECMO were screened. Exclusion criteria were age < 18 years, pregnancy, veno-arterial or mixed ECMO-configuration, incomplete records, survival < 24 h after V-V ECMO. A standard protocol of microbiological surveillance was applied and MDR profiles were identified using in vitro susceptibility tests. Cox-proportional hazards models were applied for investigating mortality.
Two hundred and seventy-nine V-V ECMO patients (72% male) were enrolled. The overall MDR GN bacteria percentage was 50%: 21% (n.59) detected before and 29% (n.80) after V-V ECMO placement. The overall 1-year mortality was 42%, with a higher risk observed in predetected patients (aHR 2.14 [1.33-3.47], p value 0.002), while not in 'V-V ECMO-acquired MDR GN bacteria' group (aHR 1.51 [0.94-2.42], p value 0.090), as compared to 'non-MDR GN bacteria' group (reference). Same findings were found considering only infections. A larger annual hospital V-V ECMO volume was associated with a lower probability of acquiring MDR GN bacteria during V-V ECMO course (aOR 0.91 [0.86-0.97], p value 0.002).
21% of MDR GN bacteria were detected before; while 29% after V-V ECMO connection. A history of MDR GN bacteria, isolated before V-V ECMO, was an independent risk factor for mortality. The annual hospital V-V ECMO volume affected the probability of acquiring MDR GN bacteria. Trial Registration ClinicalTrial.gov Registration Number NCTNCT06199141, date 12.26.2023.
静脉-静脉体外膜肺氧合（V-V ECMO）是一种在全球范围内迅速发展的生命支持技术。最常见的适应证是严重的低氧血症和/或高碳酸血症，对常规治疗无反应，主要发生在急性呼吸窘迫综合征病例中。关于潜在的禁忌证，没有提到微生物学史，特别是与 V-V ECMO 放置前分离的多药耐药（MDR）细菌有关。我们的研究旨在调查：（i）V-V ECMO 患者队列中 MDR 革兰氏阴性（GN）细菌的流行率和发生率；（ii）1 年死亡率的风险，特别是在预先检测到 MDR GN 细菌的情况下；（iii）医院每年 V-V ECMO 量对获得 MDR GN 细菌的概率的影响。
对 5 家意大利大学附属医院的重症监护病房收治的所有连续成年 V-V ECMO 患者进行筛查。排除标准为年龄<18 岁、妊娠、静脉-动脉或混合 ECMO 配置、记录不完整、V-V ECMO 后生存时间<24 小时。应用标准的微生物监测方案，并使用体外药敏试验确定 MDR 特征。应用 Cox 比例风险模型调查死亡率。
共纳入 279 例 V-V ECMO 患者（72%为男性）。总体 MDR GN 细菌百分比为 50%：21%（n=59）在 V-V ECMO 前检出，29%（n=80）在 V-V ECMO 后检出。总的 1 年死亡率为 42%，在预先检测到的患者中风险更高（aHR 2.14[1.33-3.47]，p 值=0.002），而在“V-V ECMO 获得性 MDR GN 细菌”组中则没有（aHR 1.51[0.94-2.42]，p 值=0.090），与“非 MDR GN 细菌”组（参考）相比。同样的发现也适用于仅考虑感染的情况。较大的医院每年 V-V ECMO 量与 V-V ECMO 过程中获得 MDR GN 细菌的概率较低相关（aOR 0.91[0.86-0.97]，p 值=0.002）。
21%的 MDR GN 细菌在 V-V ECMO 前检出；而在 V-V ECMO 连接后检出 29%。V-V ECMO 前分离的 MDR GN 细菌史是死亡的独立危险因素。医院每年 V-V ECMO 量影响获得 MDR GN 细菌的概率。
ClinicalTrials.gov 注册号 NCT06199141，注册日期 2023 年 12 月 26 日。
