PMID- 22990851
OWN - NLM
STAT- MEDLINE
DCOM- 20130710
LR  - 20211021
IS  - 1537-6591 (Electronic)
IS  - 1058-4838 (Print)
IS  - 1058-4838 (Linking)
VI  - 55
IP  - 12
DP  - 2012 Dec
TI  - Nosocomial infections in adult cardiogenic shock patients supported by 
      venoarterial extracorporeal membrane oxygenation.
PG  - 1633-41
LID - 10.1093/cid/cis783 [doi]
AB  - BACKGROUND: Incidence and impact on adult patients' outcomes of nosocomial 
      infections (NIs) occurring during venoarterial extracorporeal membrane 
      oxygenation (VA-ECMO) support for refractory cardiogenic shock have rarely been 
      described. METHODS: We retrospectively reviewed the charts of a large series of 
      patients who received VA-ECMO in our intensive care unit (ICU) from January 2003 
      through December 2009. Incidence, types, risk factors, and impact on outcomes of 
      NIs occurring during ECMO support were analyzed. RESULTS: Among 220 patients (49 
      +/- 16 years old, simplified acute physiology score (SAPS) II 61 +/- 20) who 
      underwent ECMO support for >48 hours for a total of 2942 ECMO days, 142 (64%) 
      developed NIs. Ventilator-associated pneumonia (VAP), bloodstream infections, 
      cannula infections, and mediastinitis infections occurred in 55%, 18%, 10% and 
      11% of the patients, respectively. More critical condition at ICU admission, but 
      not antibiotics at the time of ECMO cannulation, was associated with subsequently 
      developing NIs (hazard ratio, 0.73; 95% confidence interval [CI], .50-1.05; P = 
      .09). Infected patients had longer durations of mechanical ventilation, ECMO 
      support, and hospital stays. Independent predictors of death were infection with 
      severe sepsis or septic shock (odds ratio, 1.93; 95% CI, 1.26-2.94; P = .002) and 
      SAPS II, whereas immunosuppression and myocarditis as the reason for ECMO support 
      were associated with better outcomes. CONCLUSIONS: Cardiogenic shock patients who 
      received the latest generation VA-ECMO still had a high risk of developing NIs, 
      particularly VAP. Strategies aimed at preventing these infections may improve the 
      outcomes of these critically ill patients.
FAU - Schmidt, Matthieu
AU  - Schmidt M
AD  - Service de Reanimation Medicale, Institut de Cardiologie, Paris Cedex 13, France.
FAU - Brechot, Nicolas
AU  - Brechot N
FAU - Hariri, Sarah
AU  - Hariri S
FAU - Guiguet, Marguerite
AU  - Guiguet M
FAU - Luyt, Charles Edouard
AU  - Luyt CE
FAU - Makri, Ralouka
AU  - Makri R
FAU - Leprince, Pascal
AU  - Leprince P
FAU - Trouillet, Jean-Louis
AU  - Trouillet JL
FAU - Pavie, Alain
AU  - Pavie A
FAU - Chastre, Jean
AU  - Chastre J
FAU - Combes, Alain
AU  - Combes A
LA  - eng
PT  - Journal Article
DEP - 20120918
PL  - United States
TA  - Clin Infect Dis
JT  - Clinical infectious diseases : an official publication of the Infectious Diseases 
      Society of America
JID - 9203213
SB  - IM
MH  - Adult
MH  - Aged
MH  - Cross Infection/*complications/microbiology
MH  - Extracorporeal Membrane Oxygenation/*methods
MH  - Female
MH  - Humans
MH  - Incidence
MH  - Male
MH  - Middle Aged
MH  - Risk Factors
MH  - Shock, Cardiogenic/*microbiology/surgery/*therapy
MH  - Statistics, Nonparametric
MH  - Survival Analysis
MH  - Treatment Outcome
PMC - PMC3888098
EDAT- 2012/09/20 06:00
MHDA- 2013/07/11 06:00
PMCR- 2013/12/15
CRDT- 2012/09/20 06:00
PHST- 2012/09/20 06:00 [entrez]
PHST- 2012/09/20 06:00 [pubmed]
PHST- 2013/07/11 06:00 [medline]
PHST- 2013/12/15 00:00 [pmc-release]
AID - cis783 [pii]
AID - 10.1093/cid/cis783 [doi]
PST - ppublish
SO  - Clin Infect Dis. 2012 Dec;55(12):1633-41. doi: 10.1093/cid/cis783. Epub 2012 Sep 
      18.