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Cannula-Related Infection in Patients Supported by Peripheral ECMO

Clinical and Microbiological Characteristics

Allou, Nicolas*; Lo Pinto, Hugo*; Persichini, Romain*; Bouchet, Bruno*; Braunberger, Eric; Lugagne, Nathalie; Belmonte, Olivier§; Martinet, Olivier*; Delmas, Benjamin*; Dangers, Laurence*; Allyn, Jérôme*

doi: 10.1097/MAT.0000000000000771
Clinical Critical Care
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Little is known about cannula-related infection (CRI) in patients supported by extracorporeal membrane oxygenation (ECMO). The aim of this study was to assess the incidence, the risk factors, prognosis, and microbiological characteristics of CRI in patients supported by ECMO. This retrospective cohort study was conducted in one intensive care unit (ICU). Among 220 consecutive patients with peripheral ECMO, 39 (17.7%) developed CRI. The incidence of CRI was 17.2 per 1,000 ECMO days. The main isolated microorganisms were Enterobacteriaceae (38%), Staphylococcus spp. (28.2%; 8.5% were methicillin-sensitive Staphylococcus aureus and 19.7% were coagulase-negative staphylococci), and Pseudomonas aeruginosa (18.3%). Bacteremia was present in 23 cases (59.7%). In multivariate analysis, the risk factors for CRI were longer ECMO duration (p = 0.006) and higher Simplified Acute Physiology Score 2 (p = 0.004). Forty-one percentage of patients with CRI needed surgical management of the infected site. Cannula-related infection was not associated with higher in-hospital mortality (p = 0.73), but it was associated with a longer stay in ICU (p < 0.0001) and a longer stay in hospital (p = 0.002). In conclusion, CRI is frequent in patients with ECMO and associated with a longer stay in hospital. Risk factors for CRI were longer ECMO duration and higher Simplified Acute Physiology Score 2. Concomitant bacteremia was frequent (59.7%) and CRI should be strongly investigated in cases of positive blood culture.

From the *Réanimation Polyvalente, Centre Hospitalier Universitaire Félix Guyon, Saint Denis, Paris, France

Chirurgie Cardiaque, Centre Hospitalier Universitaire Félix Guyon, Saint Denis, Paris, France

Unité d’Hygiène et de lutte Contre les Infections Hospitalières, Centre Hospitalier Universitaire Felix Guyon, Saint Denis, Paris, France

§Bacteriologie, Centre Hospitalier Universitaire Felix Guyon, Saint Denis, Paris, France.

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

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

Support was provided solely from institutional and/or departmental sources. This study was internally funded.

This observational study was approved by the Institutional Review Board of the Committee of the French Intensive Care Society (CE SRLF17-21) and was declared to the Commission nationale de l’informatique et des liberté (CNIL MR-003, No. 2000694).

The need for informed consent was waived because of the observational and retrospective nature of the study.

The dataset used and/or analyzed during the current study are available from the corresponding author on reasonable request.

N.A. and H.L.P. had full access to all the data in the study, and they take responsibility for the integrity of the data and the accuracy of the data analysis. N.A., J.A., H.L.P., and B.B contributed to study concept and design. H.L.P., N.A., B.B., N.L., O.B., and E.B. contributed in acquisition of data. N.A., J.A., H.L.P., O.M., L.D., R.P., B.D., and E.B. contributed in analysis and interpretation of data. N.A. and J.A. contributed in drafting the article. N.A., J.A., H.L.P., O.M., R.P., B.D., and L.D contributed in critical revision of the article for important intellectual content. J.A., N.A., and L.D. contributed in statistical analysis. N.A., J.A., O.M., L.D., R.P., B.D, and E.B. contributed in administrative, technical, or material support. N.A., J.A., O.M., L.D, R.P., B.D., and E.B. contributed in study supervision.

Correspondence: Nicolas Allou, Hôpital Félix Guyon, Réanimation Polyvalente, Bellepierre 97405 Saint-Denis, Paris, France. Email: nicolas.allou@chu-reunion.fr.

Copyright © 2019 by the American Society for Artificial Internal Organs