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Bacterial Biofilms on Extracorporeal Membrane Oxygenation Catheters

Yeo, Hye Ju*,†; Yoon, Seong Hoon*,†; Lee, Seung Eun*,†; Cho, Woo Hyun*,†; Kim, Dohyung†,‡; Jeon, Doosoo*,†; Shin, Kyung-Hwa§; Kim, Yun Seong*,†

doi: 10.1097/MAT.0000000000000750
Adult Circulatory Support

Despite the advantages of extracorporeal membrane oxygenation (ECMO), secondary catheter infection remains a major concern during ECMO support. In this study, to clarify the mechanism of ECMO catheter-related infection, we evaluated the impact of infection on biofilm formation on the surfaces of ECMO catheters, and we investigated clinical factors associated with biofilm formation. Catheters used for ECMO were prospectively collected aseptically from the femoral vein, internal jugular vein, and femoral artery of 81 patients with acute cardiorespiratory failure between January 2015 and October 2016. Prepared catheter sections were investigated by fluorescence microscopy, confocal scanning laser microscopy, transmission electron microscopy, and using semiquantitative culture methods. Of the 81 patients, 51 were assigned to the infection group and 30 to a control group. Biofilms were identified in 43.1% patients in the infection group, and in 20% controls (p = 0.034). Extracorporeal membrane oxygenation flow, systemic infection, and carbapenem-resistant Acinetobacter baumannii (CRAB) infection were associated with biofilm formation in a univariate analysis (odds ratio [OR]: 1.00, 95% confidence interval [CI]: 1.00–1.00, p = 0.007; OR: 3.03, 95% CI: 1.06–8.69, p = 0.039; OR: 9.60, 95% CI: 2.94–31.30, p < 0.001, respectively). However, of these factors, only CRAB infection was found to independently predict the presence of a biofilm by a multivariate logistic regression analysis (OR: 9.60, 95% CI: 2.94–31.30; p < 0.001). Biofilms were more prevalent in patients with an infection than in uninfected controls. Carbapenem-resistant A. baumannii infection was identified as an independent risk factor for biofilm formation on ECMO catheters.

From the *Department of Pulmonology and Critical Care Medicine, Pusan National University Yangsan Hospital, Yangsan-si, Gyeongsangnam-do, Republic of Korea

Research Institute for Convergence of Biomedical Science and Technology Pusan National University Yangsan Hospital, Yangsan-si, Gyeongsangnam-do, Republic of Korea

Department of Thoracic and Cardiovascular Surgery, Pusan National University Yangsan Hospital, Yangsan-si, Gyeongsangnam-do, Republic of Korea

§Department of Laboratory Medicine, Pusan National University Hospital, Busan, Republic of Korea.

Submitted for consideration July 2017; accepted for publication in revised form December 2017.

Disclosure: The authors have no conflicts of interest to report.

This study was supported by Research Institute for Convergence of biomedical science and technology Grant (30-2014-021), Pusan National University Yangsan Hospital.

Correspondence: Yun Seong Kim, Department of Pulmonology and Critical Care Medicine, Pusan National University Yangsan Hospital, Geumo-ro 20, Beomeo-ri, Mulgeum-eup, Yangsan-si, Gyeongsangnam-do 626–770, Republic of Korea. Email: yskim@pusan.ac.kr.

Copyright © 2018 by the American Society for Artificial Internal Organs