Nosocomial infection rates in patients receiving extracorporeal membrane oxygenation across Australia and New Zealand

Abstract

Objective: Extracorporeal membrane oxygenation (ECMO) is a highly invasive method of cardiac and/or pulmonary support used for critically ill patients where less invasive therapies have failed. Nosocomial infection is one of the most frequent and serious complications of ECMO treatment. There are limited data on nosocomial infection in these patients in Australia and New Zealand. The aim of this study was to determine nosocomial infection prevalence in patients receiving ECMO. Methods: A prospective point prevalence study of adult, paediatric and neonatal patients receiving ECMO in 11 Australian and New Zealand intensive care units was undertaken for one week per month over 12 months. Results: 127 patients were enrolled; 100 adults, 20 paediatric and 7 neonates. Adult age range was 17-77 years (mean 48 years, IQR 34.5, 59.0), paediatric 39 days to 15 years (mean 6 years±6), and neonate was 1-25 days (mean 14 days±10). Sixty-four percent were male. Fifty-six percent of patients received VA ECMO, while 40% received VV ECMO. Mean days on ECMO at time of data collection was 6.2±6.9. Twenty-nine confirmed or suspected nosocomial infections were documented. There were nine confirmed bloodstream infections: four Staphylococcus species, four Candida species and one Enterobacter species; one confirmed ECMO cannula insertion site infection; and 20 suspected infections (16 respiratory system, two from an unknown source, one ECMO cannula, one urinary system) were identified. Seven other cannulae were documented as having signs of infection at the insertion site. In 80% of suspected hospital-acquired infections, antibiotics were commenced or changed. Conclusions: The estimated prevalence of nosocomial infection amongst patients receiving ECMO in Australia and New Zealand is high but lower than reported international estimates. Prevention of these infections through targeted interventions must be a priority for clinicians and researchers.L6337650832020-12-31 <br />