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Nosocomial Infections in Adult Patients Supported by Extracorporeal Membrane Oxygenation in a Cardiac Intensive Care Unit

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...

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Autores principales: 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
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10143322/
https://www.ncbi.nlm.nih.gov/pubmed/37110503
http://dx.doi.org/10.3390/microorganisms11041079
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author 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
author_facet 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
author_sort Mornese Pinna, Simone
collection PubMed
description 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 (p = 0.75). The number of days on ECMO (OR 1.14, 95% CI 1.01–1.30, p = 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. Conclusions: 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.
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spelling pubmed-101433222023-04-29 Nosocomial Infections in Adult Patients Supported by Extracorporeal Membrane Oxygenation in a Cardiac Intensive Care Unit 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 Microorganisms Article 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 (p = 0.75). The number of days on ECMO (OR 1.14, 95% CI 1.01–1.30, p = 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. Conclusions: 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. MDPI 2023-04-20 /pmc/articles/PMC10143322/ /pubmed/37110503 http://dx.doi.org/10.3390/microorganisms11041079 Text en © 2023 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
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
Nosocomial Infections in Adult Patients Supported by Extracorporeal Membrane Oxygenation in a Cardiac Intensive Care Unit
title Nosocomial Infections in Adult Patients Supported by Extracorporeal Membrane Oxygenation in a Cardiac Intensive Care Unit
title_full Nosocomial Infections in Adult Patients Supported by Extracorporeal Membrane Oxygenation in a Cardiac Intensive Care Unit
title_fullStr Nosocomial Infections in Adult Patients Supported by Extracorporeal Membrane Oxygenation in a Cardiac Intensive Care Unit
title_full_unstemmed Nosocomial Infections in Adult Patients Supported by Extracorporeal Membrane Oxygenation in a Cardiac Intensive Care Unit
title_short Nosocomial Infections in Adult Patients Supported by Extracorporeal Membrane Oxygenation in a Cardiac Intensive Care Unit
title_sort nosocomial infections in adult patients supported by extracorporeal membrane oxygenation in a cardiac intensive care unit
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10143322/
https://www.ncbi.nlm.nih.gov/pubmed/37110503
http://dx.doi.org/10.3390/microorganisms11041079
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