First nosocomial infections in children supported by veno-arterial extracorporeal membrane oxygenation (VA-ECMO)

Article Article scientifique Article First nosocomial infections in children supported by veno-arterial extracorporeal membrane oxygenation (VA-ECMO) eng 2023-02-23 2023-02-23 author Cousin Vladimir Pediatric Intensive Care Unit, Department of Pediatrics, Gynecology and Obstetrics, Geneva University Hospitals, Geneva, Switzerland. Vladimir.cousin@hcuge.ch. 659628 author Rodriguez-Vigouroux Robert Geneva University Hospitals, Geneva, Switzerland. 715859 author Karam Oliver Section of Pediatric Critical Care, Department of Pediatrics, Yale School of Medicine, New Haven, CT, USA. author Rimensberger Peter Pediatric Intensive Care Unit, Department of Pediatrics, Gynecology and Obstetrics, Geneva University Hospitals, Geneva, Switzerland. 134965 author Posfay Barbe Klara Pediatric Infectious Diseases Unit, Department of Pediatrics, Gynecology and Obstetrics, Geneva University Hospitals, Geneva, Switzerland. 39230 Département de Pédiatrie, Gynécologie et Obstétrique (PETRI) 89 10.1186/s12887-023-03908-3 36823601 1471-2431 PMC9948414 https://bmcpediatr.biomedcentral.com/articles/10.1186/s12887-023-03908-3 Background: Veno-arterial Extracorporeal Membrane Oxygenation (VA-ECMO) is a standard procedure for patient with refractory shock in Pediatric Intensive Care Unit (PICU). There is a paucity of data on the time relationship between VA-ECMO support, nosocomial infection occurrence, and PICU length of stay (LOS). The aim of this study was to determine the characteristics and impact of ECMO-related infections. Methods: This is a retrospective study from 01/2008 to 12/2014, enrolling children with a VA-ECMO support for > 6 h. We recorded the first PICU infection during the VA-ECMO run, defined as a positive microbiological sample with clinical signs of infection or clinical signs of severe infection without positive sample. Results: During the study period, 41 patients (25/41 male) were included, with a median age of 41.2 months (IQR 12.9-89.9) and a 53% mortality rate. Median time on VA-ECMO was 4.2 d (IQR 2-7.1), median PICU LOS was 14.7 d (IQR 4,7-26,9). Overall, 34% patients developed an infection, with an incidence of 60/1000 VA-ECMO days. Median time to first infection was 4 d (IQR 3-5), with Pseudomonas spp. being the most commonly detected microorganism (42%). Infected sites were ventilator-associated pneumonia (9/14), sternotomy infection (2/14), bloodstream (2/14) and urinary tract infections (1/14). Longer VA-ECMO support (> 5 d) (OR 5.9 (CI 95% 1.4-24.6; p = 0.01) and longer PICU stay (> 14 d) (OR 12 (95% CI 2.2-65.5; p = 0.004) were associated with infection. Conclusion: In this single-center study, we underlined the high proportion and early occurrence of infections in patient on VA-ECMO, mostly in the first week. As infection was an early event, it may prolong the duration of VA-ECMO support and PICU LOS. Further research is needed to better understand the impact of infections on VA-ECMO and develop prevention strategies. ECMO Infection Nosocomial PICU Humans Male Child Infant Child, Preschool Treatment Outcome Extracorporeal Membrane Oxygenation / adverse effects Cross Infection / etiology Retrospective Studies Hospital Mortality Dewey 616 Dewey 618 56 Département de médecine 221 58 Département de pédiatrie, gynécologie et obstétrique 223 false 515 Recherche en infectiologie pédiatrique et en pédiatrie générale 853 BMC pediatrics 23 1 95d8e7d0-0637-4066-84ab-dca0bbe300d1 Article (Published version) Public Article-scientifique-from-europePmc.pdf 1182792 application/pdf CC BY-4.0 20c1d3b8744e0654385b6d0c7c726b805d888b9a95ab6290115bf1827b719948 7f61cb8a-ffc6-4674-80d7-22a7f5271852 Appendix Public 12887_2023_3908_MOESM1_ESM.docx 691590 application/vnd.openxmlformats-officedocument.wordprocessingml.document ccde72f46ef16f4abea7bfc39614d85b7a02e388c069e28d4d94499062188c1d openAccess Faculté de médecine / Section de médecine clinique / Département de médecine Faculté de médecine / Section de médecine clinique / Département de pédiatrie, gynécologie et obstétrique

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Rodriguez-Vigouroux, Robert