体外膜肺氧合（ECMO）插管相关感染的特征与结局：一项欧洲多中心回顾性研究

Characteristics and outcomes of ECMO cannula-related infections: a European multicenter retrospective study.

作者信息

Ortuno Sofia, Massart Nicolas, Vidal Charles, de Montmollin Etienne, Bouglé Adrien, Nesseler Nicolas, Bidar Frank, Assouline Benjamin, Masi Paul, Henri Samuel, Hraiech Sami, Rozé Hadrien, Manicone Francesca, Luyt Charles-Edouard

机构信息

Service de Médecine Intensive-Réanimation, Institut de Cardiologie, Groupe Hospitalier Pitié-Salpêtrière, Sorbonne Université, Assistance Publique-Hôpitaux de Paris, 47-83, Boulevard de L'Hôpital, 75651, Paris Cedex 13, France.

Service de Réanimation, CH de Saint-Brieuc, Saint-Brieuc, France.

出版信息

Ann Intensive Care. 2025 Mar 20;15(1):36. doi: 10.1186/s13613-025-01446-y.

DOI:10.1186/s13613-025-01446-y

PMID:40113722

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11926307/

Abstract

OBJECTIVE

Only few data regarding epidemiology and management of ECMO cannula-related infections (ECMO-CRIs) exist. The aim of our study was to describe their epidemiology and prognosis, and to evaluate factors associated with outcome.

METHODS

We performed a multicenter retrospective study in 12 European ICUs, including patients with ECMO-CRI, defined as a clinical suspicion plus a positive bacterial sample of ECMO-cannulation site. Primary objective was to describe ECMO-CRI characteristics and outcomes. Secondary objectives were to evaluate the rates of infection recurrence, their risk factors, and to evaluate the impact of antimicrobial treatment duration on outcome.

RESULTS

During the study period, 109 patients with ECMO-CRI (78 having concomitant positive blood culture with the same pathogen) were included. Pathogens responsible for infections were predominantly Enterobacteriaceae, coagulase-negative Staphylococcus and Enterococcus spp., and 42% of episodes were polymicrobial. Rates of infection recurrence was 13% and ICU-mortality rate was 51%. Risk factors for death were concomitant bloodstream infection with same pathogen and septic shock Patients with antibiotic course ≤ 8 days had similar infection recurrence rate and outcomes (including mortality) than patients with prolonged (> 8 days) antibiotic course.

CONCLUSION

ECMO-CRIs are frequently associated with BSI and frequently polymicrobial. Duration of antimicrobial treatment for ECMO-CRI ≤ 8 days does not seem to be associated with an increased risk of recurrence or death, as compared to longer treatment.

摘要

目的

关于体外膜肺氧合（ECMO）插管相关感染（ECMO-CRI）的流行病学和管理的资料很少。我们研究的目的是描述其流行病学和预后，并评估与预后相关的因素。

方法

我们在12个欧洲重症监护病房进行了一项多中心回顾性研究，纳入了ECMO-CRI患者，定义为临床怀疑加上ECMO插管部位细菌样本呈阳性。主要目的是描述ECMO-CRI的特征和预后。次要目的是评估感染复发率、其危险因素，并评估抗菌治疗持续时间对预后的影响。

结果

在研究期间，纳入了109例ECMO-CRI患者（78例同时血培养有相同病原体阳性）。引起感染的病原体主要是肠杆菌科、凝固酶阴性葡萄球菌和肠球菌属，42%的感染为多微生物感染。感染复发率为13%，重症监护病房死亡率为51%。死亡的危险因素是同时发生相同病原体的血流感染和感染性休克。抗生素疗程≤8天的患者与抗生素疗程延长（>8天）的患者相比，感染复发率和预后（包括死亡率）相似。