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Vol. 149. Issue 10.
Pages 423-428 (November 2017)
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Vol. 149. Issue 10.
Pages 423-428 (November 2017)
Original article
DOI: 10.1016/j.medcle.2017.03.028
Risk factors for nosocomial infections in patients receiving extracorporeal membrane oxygenation supportive therapy
Factores de riesgo de las infecciones nosocomiales en pacientes que reciben oxigenación por membrana extracorpórea
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Geqin Suna, Binfei Lib,
Corresponding author
binfeili@126.com

Corresponding author.
, Haili Lana, Juan Wanga, Lanfei Lua, Xueqin Fenga, Xihua Luoa, Haizhong Yana, Yuejing Mua
a Department of Examination Medical Center, Zhongshan Affiliated Hospital, Sun Yat-sen University, Zhongshan, Guangdong, China
b Department of Anesthesiology, Zhongshan Affiliated Hospital, Sun Yat-sen University, Zhongshan, Guangdong, China
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Tables (5)
Table 1. Risk factor analysis of the patients receiving ECMO.
Table 2. Major pathogens and drug susceptibilities in the ECMO-NI patients.
Table 3. Features of the patients with ECMO-secondary infections.
Table 4. Drug-resistance phenotypes in major pathogens.
Table 5. Drug-resistance phenotypes in major pathogens.
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Abstract
Background and objective

The aim of this study was to analyze risk factors for nosocomial infection (NI) in patients receiving extracorporeal membrane oxygenation (ECMO) support.

Patients and methods

Clinical NI data were collected from patients who received ECMO support therapy, and analyzed retrospectively.

Results

Among 75 ECMO patients, 20 were found to have developed NI (infection rate 26.7%); a total of 58 pathogens were isolated, including 43 strains of gram-negative bacteria (74.1%) and 15 strains of gram-positive bacteria (25.9%). Multi-drug resistant strains were highly concentrated and were mainly shown to be Acinetobacter baumannii, Pseudomonas aeruginosa, and coagulase-negative staphylococci. Incidence of NI was related to the duration of ECMO support therapy and the total length of hospital stay, and the differences were statistically significant (P<0.05). A prolonged period of ECMO support extended the hospital stay, but it did not increase the mortality rate. However, an elevated level of lactic acid increased the mortality rate in this study population.

Conclusions

ECMO-associated secondary NIs correlated significantly with the length of hospital stay and with the duration of ECMO support. Therefore, to reduce the incidence of ECMO-associated NIs, preventive strategies that aim to shorten the duration of ECMO support therapy and avoid lengthy hospitalization should be applied, wherever possible.

Keywords:
Extracorporeal membrane oxygenation
Infection factors
Nosocomial infection
Drug susceptibility
Drug-resistance phenotype
Resumen
Antecedentes y objetivo

El objetivo de este estudio fue analizar los factores de riesgo de la infección nosocomial (IN) en pacientes que reciben soporte de extracorporeal membrane oxygenation (ECMO, «oxigenación por membrana extracorpórea»).

Pacientes y métodos

Se recolectaron los datos clínicos de las IN de los pacientes que recibieron tratamiento de soporte ECMO, analizándose retrospectivamente.

Resultados

Entre los 75 pacientes con ECMO, se encontró que 20 habían desarrollado IN (tasa de infección del 26,7%), aislándose un total de 58 patógenos, incluyendo 43 cepas de bacterias gramnegativas (74,1%) y 15 cepas de bacterias grampositivas (25,9%). Las cepas resistentes a múltiples fármacos se hallaban altamente concentradas, componiéndose principalmente de Acinetobacter baumannii, Pseudomonas aeruginosa y estafilococos coagulasa negativos. La incidencia de IN se relacionó con la duración del tratamiento de soporte ECMO y la estancia hospitalaria total, siendo las diferencias estadísticamente significativas (p<0,05). Un período prolongado de soporte ECMO ampliaba la estancia hospitalaria, aunque no incrementaba la tasa de mortalidad. Sin embargo, la elevación del nivel de ácido láctico incrementaba la tasa de mortalidad en esta población de estudio.

Conclusiones

Las IN secundarias asociadas a ECMO guardaron una correlación considerable con la duración de la estancia hospitalaria y la duración del soporte ECMO. Por tanto, para reducir la incidencia de las IN asociadas a ECMO, deberán aplicarse estrategias en aras de reducir la duración del tratamiento de soporte ECMO y evitar la hospitalización prolongada, cuando ello sea posible.

Palabras clave:
Oxigenación por membrana extracorpórea
Factores de infección
Infección nosocomial
Susceptibilidad a fármacos
Fenotipo de resistencia a fármacos

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