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Different characteristics of bloodstream infection during venoarterial and venovenous extracorporeal membrane oxygenation in adult patients

Currently, there is scarcity of data on whether differences exist in clinical characteristics and outcomes of bloodstream infection (BSI) between venoarterial (VA) and venovenous (VV) extracorporeal membrane oxygenation (ECMO) and whether they differ between Candida BSI and bacteremia in adult ECMO...

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Autores principales: Kim, Hyoung Soo, Park, Sunghoon, Ko, Ho Hyun, Ha, Sang Ook, Lee, Sun Hee, Kim, Yong Kyun
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Nature Publishing Group UK 2021
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Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8097062/
https://www.ncbi.nlm.nih.gov/pubmed/33947970
http://dx.doi.org/10.1038/s41598-021-89108-4
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author Kim, Hyoung Soo
Park, Sunghoon
Ko, Ho Hyun
Ha, Sang Ook
Lee, Sun Hee
Kim, Yong Kyun
author_facet Kim, Hyoung Soo
Park, Sunghoon
Ko, Ho Hyun
Ha, Sang Ook
Lee, Sun Hee
Kim, Yong Kyun
author_sort Kim, Hyoung Soo
collection PubMed
description Currently, there is scarcity of data on whether differences exist in clinical characteristics and outcomes of bloodstream infection (BSI) between venoarterial (VA) and venovenous (VV) extracorporeal membrane oxygenation (ECMO) and whether they differ between Candida BSI and bacteremia in adult ECMO patients. We retrospectively reviewed data of patients who required ECMO for > 48 h and had BSIs while receiving ECMO between January 2015 and June 2020. Cases with a positive blood culture result within 24 h of ECMO implantation were excluded. We identified 94 (from 64 of 194 patients) and 38 (from 17 of 56 patients) BSI episodes under VA and VV ECMO, respectively. Fifty nine BSIs of VA ECMO (59/94, 62.8%) occurred in the first 2 weeks after ECMO implantation, whereas 24 BSIs of VV ECMO (24/38, 63.2%) occurred after 3 weeks of ECMO implantation. Gram-negative bacteremia (39/59, 66.1%) and gram-positive bacteremia (10/24, 41.7%) were the most commonly identified BSI types in the first 2 weeks after VA ECMO implantation and after 3 weeks of VV implantation, respectively. Timing of Candida BSI was early (6/11, 54.5% during the first 2 weeks) in VA ECMO and late (6/9, 66.7% after 3 weeks of initiation) in VV ECMO. Compared with bacteremia, Candida BSI showed no differences in clinical characteristics and outcomes during VA and VV ECMO, except the significant association with prior exposure to carbapenem in VA ECMO (vs. gram-negative bacteremia [P = 0.006], vs. gram-positive bacteremia [P = 0.03]). Our results suggest that ECMO modes may affect BSI clinical features and timing. In particular, Candida BSI occurrence during the early course of VA ECMO is not uncommon, especially in patients with prior carbapenem exposure; however, it usually occurs during the prolonged course of VV ECMO. Consequently, routine blood culture surveillance and empiric antifungal therapy might be warranted in targeted populations of adult ECMO patients, regardless of levels of inflammatory markers and severity scores.
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spelling pubmed-80970622021-05-05 Different characteristics of bloodstream infection during venoarterial and venovenous extracorporeal membrane oxygenation in adult patients Kim, Hyoung Soo Park, Sunghoon Ko, Ho Hyun Ha, Sang Ook Lee, Sun Hee Kim, Yong Kyun Sci Rep Article Currently, there is scarcity of data on whether differences exist in clinical characteristics and outcomes of bloodstream infection (BSI) between venoarterial (VA) and venovenous (VV) extracorporeal membrane oxygenation (ECMO) and whether they differ between Candida BSI and bacteremia in adult ECMO patients. We retrospectively reviewed data of patients who required ECMO for > 48 h and had BSIs while receiving ECMO between January 2015 and June 2020. Cases with a positive blood culture result within 24 h of ECMO implantation were excluded. We identified 94 (from 64 of 194 patients) and 38 (from 17 of 56 patients) BSI episodes under VA and VV ECMO, respectively. Fifty nine BSIs of VA ECMO (59/94, 62.8%) occurred in the first 2 weeks after ECMO implantation, whereas 24 BSIs of VV ECMO (24/38, 63.2%) occurred after 3 weeks of ECMO implantation. Gram-negative bacteremia (39/59, 66.1%) and gram-positive bacteremia (10/24, 41.7%) were the most commonly identified BSI types in the first 2 weeks after VA ECMO implantation and after 3 weeks of VV implantation, respectively. Timing of Candida BSI was early (6/11, 54.5% during the first 2 weeks) in VA ECMO and late (6/9, 66.7% after 3 weeks of initiation) in VV ECMO. Compared with bacteremia, Candida BSI showed no differences in clinical characteristics and outcomes during VA and VV ECMO, except the significant association with prior exposure to carbapenem in VA ECMO (vs. gram-negative bacteremia [P = 0.006], vs. gram-positive bacteremia [P = 0.03]). Our results suggest that ECMO modes may affect BSI clinical features and timing. In particular, Candida BSI occurrence during the early course of VA ECMO is not uncommon, especially in patients with prior carbapenem exposure; however, it usually occurs during the prolonged course of VV ECMO. Consequently, routine blood culture surveillance and empiric antifungal therapy might be warranted in targeted populations of adult ECMO patients, regardless of levels of inflammatory markers and severity scores. Nature Publishing Group UK 2021-05-04 /pmc/articles/PMC8097062/ /pubmed/33947970 http://dx.doi.org/10.1038/s41598-021-89108-4 Text en © The Author(s) 2021 https://creativecommons.org/licenses/by/4.0/Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) .
spellingShingle Article
Kim, Hyoung Soo
Park, Sunghoon
Ko, Ho Hyun
Ha, Sang Ook
Lee, Sun Hee
Kim, Yong Kyun
Different characteristics of bloodstream infection during venoarterial and venovenous extracorporeal membrane oxygenation in adult patients
title Different characteristics of bloodstream infection during venoarterial and venovenous extracorporeal membrane oxygenation in adult patients
title_full Different characteristics of bloodstream infection during venoarterial and venovenous extracorporeal membrane oxygenation in adult patients
title_fullStr Different characteristics of bloodstream infection during venoarterial and venovenous extracorporeal membrane oxygenation in adult patients
title_full_unstemmed Different characteristics of bloodstream infection during venoarterial and venovenous extracorporeal membrane oxygenation in adult patients
title_short Different characteristics of bloodstream infection during venoarterial and venovenous extracorporeal membrane oxygenation in adult patients
title_sort different characteristics of bloodstream infection during venoarterial and venovenous extracorporeal membrane oxygenation in adult patients
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8097062/
https://www.ncbi.nlm.nih.gov/pubmed/33947970
http://dx.doi.org/10.1038/s41598-021-89108-4
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