METHODS: This retrospective study included adult patients who underwent ECMO in a single cardiac ICU in China from May 2015 to December 2022. The incidence, clinical characteristics, risk factors, and impact on in-hospital mortality among patients with non-HAI, single HAI, and multiple HAIs were analyzed. Pathogens and infection sites for each new episode were compared.
RESULTS: Of 192 patients, 92 (47.92%) developed 141 separate infections, with 41 (21.35%) experiencing multiple infections during a single ECMO period. Respiratory tract infections (RTIs) constituted the majority (75.89%), and gram-negative bacteria were the predominant pathogens (71.63%). RTIs decreased from 86.9% in the first infection to 14.3% in the third (P < .001), while bloodstream infections increased from 10.9 % to 57.1% (P < .001). The proportion of gram-positive bacteria increased from 9.8% to 42.9% (P = .032). Prolonged ECMO duration was the only independent risk factor for multiple consecutive HAIs (odds ratio (OR)=1.220, P < .001).
CONCLUSIONS: Multiple consecutive HAIs during ECMO were frequent, with distinct microbiological changes between initial and subsequent HAIs.
方法:这项回顾性队列研究包括2015年5月至2022年12月在中国单一心脏重症监护病房接受ECMO的成年患者。发病率,临床特征,危险因素,并分析了非HAI患者对院内死亡率的影响,单身HAI,和多个HAIs。评估并比较了每种新感染的病原体和部位。
结果:192例患者,92例(47.92%)发生141例单独感染,41(21.35%)在单个ECMO期间经历多次感染。呼吸道感染(RTIs)占大多数(75.89%),病原菌以革兰阴性菌为主(71.63%)。RTIs的比例从第一次感染的86.9%下降到第三次感染的14.3%(p<0.001),而血流感染从10.9%增加到57.1%(p<0.001)。此外,从第一个到第三个HAI,革兰阳性菌的比例从9.8%增加到42.9%(p=0.032)。延长ECMO持续时间是多个连续HAI的唯一独立危险因素(OR=1.220;p<0.001)。
结论:ECMO支持期间连续多个HAIs的频率很高,在初始和后续HAIs之间具有明显的微生物变化。