PDF(Pubmed)
Abstract：
UNASSIGNED: Limited data are available regarding the current microbiological characteristics of extracorporeal membrane oxygenation (ECMO)-related infections in intensive care units (ICUs) in China. This retrospective study aimed to determine the epidemiology, risk factors and impact on the outcome of ECMO-related infections.
UNASSIGNED: A retrospective observational study from January 2014 to December 2019 was performed, and adult patients receiving ECMO support for more than 48 hours were included in this study. The primary outcome was the incidence rate of ECMO-related infection. Clinical data were recorded, and risk factors associated with an increased risk of ECMO-related infection were analyzed.
UNASSIGNED: A total of 174 adult patients who received ECMO and underwent ECMO for 1,670 days were included in this study. Forty-six patients (26.4%) developed ECMO-related infections, corresponding to 27.5 first episodes/1,000 ECMO days. The most common ECMO-related infection observed was ventilator-associated pneumonia (VAP). Infected patients had longer durations of mechanical ventilation {20.2 [interquartile range (IQR), 12.6, 30.7] vs. 9.0 (IQR, 5.8, 14.7) days, P<0.001}, ECMO support [11.6 (IQR, 8.1, 17.3) vs. 7.6 (IQR, 5.6, 9.7) days, P<0.001] and hospital stays (28.2±20.7 vs. 22.0±15.6 days, P<0.001). The factors independently associated with ECMO-related infection were a dynamic decrease in lymphocyte count [adjusted odds ratio (OR) =3.578, 95% confidence interval (CI): 2.175-4.906, P<0.001] and ECMO duration (adjusted OR =1.207, 95% CI: 1.096-1.330, P<0.001). Compared to patients without infection, infected patients had greater hospital mortality (39.1% vs. 78.3%, P<0.001) and 90-day mortality (40.6% vs. 87.0%, P<0.001). ECMO-related infections were associated with worse outcomes (adjusted Kaplan-Meier curve, log rank test P<0.001).
UNASSIGNED: Patients supported by ECMO had a high risk of developing ECMO-related infection. The most common ECMO-related infection observed was VAP. A dynamic decrease in lymphocyte counts was significantly associated with an increased risk of ECMO-related infection.
UNASSIGNED: A retrospective observational study from January 2014 to December 2019 was performed, and adult patients receiving ECMO support for more than 48 hours were included in this study. The primary outcome was the incidence rate of ECMO-related infection. Clinical data were recorded, and risk factors associated with an increased risk of ECMO-related infection were analyzed.
UNASSIGNED: A total of 174 adult patients who received ECMO and underwent ECMO for 1,670 days were included in this study. Forty-six patients (26.4%) developed ECMO-related infections, corresponding to 27.5 first episodes/1,000 ECMO days. The most common ECMO-related infection observed was ventilator-associated pneumonia (VAP). Infected patients had longer durations of mechanical ventilation {20.2 [interquartile range (IQR), 12.6, 30.7] vs. 9.0 (IQR, 5.8, 14.7) days, P<0.001}, ECMO support [11.6 (IQR, 8.1, 17.3) vs. 7.6 (IQR, 5.6, 9.7) days, P<0.001] and hospital stays (28.2±20.7 vs. 22.0±15.6 days, P<0.001). The factors independently associated with ECMO-related infection were a dynamic decrease in lymphocyte count [adjusted odds ratio (OR) =3.578, 95% confidence interval (CI): 2.175-4.906, P<0.001] and ECMO duration (adjusted OR =1.207, 95% CI: 1.096-1.330, P<0.001). Compared to patients without infection, infected patients had greater hospital mortality (39.1% vs. 78.3%, P<0.001) and 90-day mortality (40.6% vs. 87.0%, P<0.001). ECMO-related infections were associated with worse outcomes (adjusted Kaplan-Meier curve, log rank test P<0.001).
UNASSIGNED: Patients supported by ECMO had a high risk of developing ECMO-related infection. The most common ECMO-related infection observed was VAP. A dynamic decrease in lymphocyte counts was significantly associated with an increased risk of ECMO-related infection.
摘要：
■关于中国重症监护病房（ICU）中体外膜氧合（ECMO）相关感染的当前微生物学特征的数据有限。这项回顾性研究旨在确定流行病学，危险因素和对ECMO相关感染结局的影响。
■2014年1月至2019年12月进行了一项回顾性观察研究，接受ECMO支持超过48小时的成年患者纳入本研究.主要结果是ECMO相关感染的发生率。记录临床数据，并分析与ECMO相关感染风险增加相关的危险因素.
■本研究共纳入174名接受ECMO并接受ECMO1,670天的成年患者。46名患者(26.4%)出现ECMO相关感染,对应于27.5首次发作/1,000ECMO天。观察到的最常见的ECMO相关感染是呼吸机相关性肺炎（VAP）。感染患者的机械通气持续时间较长{20.2[四分位距（IQR），12.6,30.7]vs.9.0(IQR，5.8，14.7）天，P<0.001}，ECMO支持[11.6(IQR，8.1,17.3)vs.7.6(IQR，5.6,9.7)天,P<0.001]和住院时间（28.2±20.7vs.22.0±15.6天，P<0.001)。与ECMO相关感染独立相关的因素是淋巴细胞计数动态降低[调整比值比（OR）=3.578，95％置信区间（CI）：2.175-4.906，P<0.001]和ECMO持续时间（调整后OR=1.207，95％CI：1.096-1.330，P<0.001）。与没有感染的患者相比，感染患者的住院死亡率更高(39.1%vs.78.3%,P<0.001）和90天死亡率（40.6%vs.87.0%,P<0.001)。ECMO相关感染与较差的预后相关(调整后的Kaplan-Meier曲线，对数秩检验P<0.001)。
■由ECMO支持的患者发生ECMO相关感染的风险很高。观察到的最常见的ECMO相关感染是VAP。淋巴细胞计数的动态减少与ECMO相关感染的风险增加显着相关。
■2014年1月至2019年12月进行了一项回顾性观察研究，接受ECMO支持超过48小时的成年患者纳入本研究.主要结果是ECMO相关感染的发生率。记录临床数据，并分析与ECMO相关感染风险增加相关的危险因素.
■本研究共纳入174名接受ECMO并接受ECMO1,670天的成年患者。46名患者(26.4%)出现ECMO相关感染,对应于27.5首次发作/1,000ECMO天。观察到的最常见的ECMO相关感染是呼吸机相关性肺炎（VAP）。感染患者的机械通气持续时间较长{20.2[四分位距（IQR），12.6,30.7]vs.9.0(IQR，5.8，14.7）天，P<0.001}，ECMO支持[11.6(IQR，8.1,17.3)vs.7.6(IQR，5.6,9.7)天,P<0.001]和住院时间（28.2±20.7vs.22.0±15.6天，P<0.001)。与ECMO相关感染独立相关的因素是淋巴细胞计数动态降低[调整比值比（OR）=3.578，95％置信区间（CI）：2.175-4.906，P<0.001]和ECMO持续时间（调整后OR=1.207，95％CI：1.096-1.330，P<0.001）。与没有感染的患者相比，感染患者的住院死亡率更高(39.1%vs.78.3%,P<0.001）和90天死亡率（40.6%vs.87.0%,P<0.001)。ECMO相关感染与较差的预后相关(调整后的Kaplan-Meier曲线，对数秩检验P<0.001)。
■由ECMO支持的患者发生ECMO相关感染的风险很高。观察到的最常见的ECMO相关感染是VAP。淋巴细胞计数的动态减少与ECMO相关感染的风险增加显着相关。
