Abstract：
BACKGROUND: Data on multiple consecutive health care-associated infections (HAIs) in patients undergoing extracorporeal membrane oxygenation (ECMO) are limited. We aim to identify the characteristics and outcomes of multiple, consecutive HAIs.
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.
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.
摘要：
背景：接受体外膜氧合（ECMO）的患者中多次连续的医疗保健相关感染（HAIs）的数据有限。我们的目标是确定多个，连续的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。
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。
