872 infection control & hospital epidemiology july 2018, vol. 39, no. 7


table 1. Comparison of Clinical Characteristics Between Patients With or Without Bloodstream Infection During Venovenous Extracorporeal Membrane Oxygenation


Characteristics


Age, median y (range) Male


Immunocompromised state


SOFA score on VV ECMO initiation (range) Duration of MV before VV ECMO, d (range) Reason for VV ECMO Bacterial pneumonia


Acute exacerbation of ILD Viral pneumonia Trauma Asphyxia Otherb


Cannulation site for VV ECMO Femoro-jugular veins Femoro-femoral veins


Mixed with arterial cannulation Broad-spectrum antibiotics Parenteral nutrition support


Corticoteroid Antifungal agents


Transfusion, cumulative volume (range) Red blood cell, mL


Platelets concentrate, mL Single donor platelets, mL Fresh frozen plasma, mL Cryoprecipitate, mL


Indwelling catheters Arterial catheter


Total days of arterial catheter (range) CVC


Total days CVC (range) Continuous renal replacement therapy


Non-BSI (n=100), No. (%)a


60 (51–68) 76 (76) 31 (31)


11 (8–14) 2 (0–6)


40 (40) 16 (16) 13 (13) 4 (4) 2 (2)


25 (25) 74 (74)


24 (24) 2 (2)


63 (63) 92 (92) 27 (27) 45 (45)


2,730 (1,560–5,200) 620 (0–1,860) 0 (0–490) 0 (0–1260) 0 (0–230)


100 (100) 13 (7–20) 90 (90.0) 10 (5–18) 43 (43)


BSI (n=21), No. (%)a


56 (50–65) 12 (57) 8 (38)


8 (7–13) 2 (0–5)


7 (33) 5 (24) 6 (29) 1 (5) 0 (0)


2 (10) .502


17 (81) 3 (14) 1 (5)


14 (67) 19 (91) 6 (29)


11 (52)


5,980 (3,900–8,060) 1,680 (280–4,440) 490 (0–1,470) 900 (0–2,070) 0 (0–320)


21 (100)


20 (10–31) 19 (90.5) 12 (9–38) 10 (48)


.751 .684 .883 .537


.004 .034 .023 .169 .735


>.999 .017


>.999 .107 .698


NOTE. BSI, bloodstream infection; CVC, central venous catheter; ECMO, extracorporeal membrane oxygenation; ILD,


interstitial lung disease; MV, mechanical ventilation; SOFA, sequential organ failure assessment; VV, venovenous. aUnless otherwise specified. bRadiation therapy-induced pneumonitis, pulmonary tuberculosis, diffuse alveolar hemorrhage, and airway occlusion by tumor mass or blood clot.


Comparisons of clinical characteristics between patients


with or without BSI are shown in Table 1. Duration of arterial catheterization was longer in patients with BSI, but the dura- tion of central venous catheterization was not different from patients without BSI. In addition, there was no significant difference in the proportion of patients using steroids or broad-spectrum antibiotics during ECMO support. However, cumulative blood transfusions during ECMO were sig- nificantly higher in patients with BSI than in those without BSI. After adjusting for potential confounding factors, dura- tion of arterial catheterization (adjusted odds ratio [aOR], 1.25; 95% confidence interval [CI], 1.03–1.52) and total units of transfused bloods (aOR, 1.01; 95% CI, 1.00–1.02) were independently associated with BSI (Table 2).


was significantly lower (25% vs 60%; P=.003) than in patients without BSI and the median duration of ECMO was longer (23 days [range, 10–32 days] vs 13 days [range, 7–23 days]; P=.010). In addition, we detected trends toward increased mortality in the ICU (76% vs 55%; P=.073) and during hospitalization (76% vs 58%; P=.120). However, there was no difference in length of stay in the ICU or at the hospital in general (Supplemental Table 1).


In patients with BSI, the successful weaning rate of ECMO discussion


The reported incidence rates of BSI occurring in patients requiring ECMO support for circulatory failure or mixed


P Value .498


.078 .527 .396 .803 .327


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