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Crit Care
. 2024 Feb 20;28(1):54.
doi: 10.1186/s13054-024-04832-3. Healthcare-associated infections in patients with severe COVID-19 supported with extracorporeal membrane oxygenation: a nationwide cohort study
Nicolas Nesseler 1 2 3 4 , Alexandre Mansour 5 6 , Matthieu Schmidt 7 8 , Marylou Para 9 10 , Alizée Porto 11 , Pierre-Emmanuel Falcoz 12 13 14 , Nicolas Mongardon 15 16 17 , Claire Fougerou 18 19 , James T Ross 20 , Antoine Beurton 21 22 , Lucie Gaide-Chevronnay 23 , Pierre-Grégoire Guinot 24 , Guillaume Lebreton 25 26 , Erwan Flecher 27 , André Vincentelli 28 29 , Nicolas Massart 30 ; ECMOSARS Investigators; SFAR Research Network
Collaborators, Affiliations
Background: Both critically ill patients with coronavirus disease 2019 (COVID-19) and patients receiving extracorporeal membrane oxygenation (ECMO) support exhibit a high incidence of healthcare-associated infections (HAI). However, data on incidence, microbiology, resistance patterns, and the impact of HAI on outcomes in patients receiving ECMO for severe COVID-19 remain limited. We aimed to report HAI incidence and microbiology in patients receiving ECMO for severe COVID-19 and to evaluate the impact of ECMO-associated infections (ECMO-AI) on in-hospital mortality.
Methods: For this study, we analyzed data from 701 patients included in the ECMOSARS registry which included COVID-19 patients supported by ECMO in France.
Results: Among 602 analyzed patients for whom HAI and hospital mortality data were available, 214 (36%) had ECMO-AI, resulting in an incidence rate of 27 ECMO-AI per 1000 ECMO days at risk. Of these, 154 patients had bloodstream infection (BSI) and 117 patients had ventilator-associated pneumonia (VAP). The responsible microorganisms were Enterobacteriaceae (34% for BSI and 48% for VAP), Enterococcus species (25% and 6%, respectively) and non-fermenting Gram-negative bacilli (13% and 20%, respectively). Fungal infections were also observed (10% for BSI and 3% for VAP), as were multidrug-resistant organisms (21% and 15%, respectively). Using a Cox multistate model, ECMO-AI were not found associated with hospital death (HR = 1.00 95% CI [0.79-1.26], p = 0.986).
Conclusions: In a nationwide cohort of COVID-19 patients receiving ECMO support, we observed a high incidence of ECMO-AI. ECMO-AI were not found associated with hospital death. Trial registration number NCT04397588 (May 21, 2020).
Keywords: Bloodstream infections; ECLS; Nosocomial infections; SARS-CoV 2; Ventilator-associated pneumonia.
. 2024 Feb 20;28(1):54.
doi: 10.1186/s13054-024-04832-3. Healthcare-associated infections in patients with severe COVID-19 supported with extracorporeal membrane oxygenation: a nationwide cohort study
Nicolas Nesseler 1 2 3 4 , Alexandre Mansour 5 6 , Matthieu Schmidt 7 8 , Marylou Para 9 10 , Alizée Porto 11 , Pierre-Emmanuel Falcoz 12 13 14 , Nicolas Mongardon 15 16 17 , Claire Fougerou 18 19 , James T Ross 20 , Antoine Beurton 21 22 , Lucie Gaide-Chevronnay 23 , Pierre-Grégoire Guinot 24 , Guillaume Lebreton 25 26 , Erwan Flecher 27 , André Vincentelli 28 29 , Nicolas Massart 30 ; ECMOSARS Investigators; SFAR Research Network
Collaborators, Affiliations
- PMID: 38374103
- PMCID: PMC10877839
- DOI: 10.1186/s13054-024-04832-3
Background: Both critically ill patients with coronavirus disease 2019 (COVID-19) and patients receiving extracorporeal membrane oxygenation (ECMO) support exhibit a high incidence of healthcare-associated infections (HAI). However, data on incidence, microbiology, resistance patterns, and the impact of HAI on outcomes in patients receiving ECMO for severe COVID-19 remain limited. We aimed to report HAI incidence and microbiology in patients receiving ECMO for severe COVID-19 and to evaluate the impact of ECMO-associated infections (ECMO-AI) on in-hospital mortality.
Methods: For this study, we analyzed data from 701 patients included in the ECMOSARS registry which included COVID-19 patients supported by ECMO in France.
Results: Among 602 analyzed patients for whom HAI and hospital mortality data were available, 214 (36%) had ECMO-AI, resulting in an incidence rate of 27 ECMO-AI per 1000 ECMO days at risk. Of these, 154 patients had bloodstream infection (BSI) and 117 patients had ventilator-associated pneumonia (VAP). The responsible microorganisms were Enterobacteriaceae (34% for BSI and 48% for VAP), Enterococcus species (25% and 6%, respectively) and non-fermenting Gram-negative bacilli (13% and 20%, respectively). Fungal infections were also observed (10% for BSI and 3% for VAP), as were multidrug-resistant organisms (21% and 15%, respectively). Using a Cox multistate model, ECMO-AI were not found associated with hospital death (HR = 1.00 95% CI [0.79-1.26], p = 0.986).
Conclusions: In a nationwide cohort of COVID-19 patients receiving ECMO support, we observed a high incidence of ECMO-AI. ECMO-AI were not found associated with hospital death. Trial registration number NCT04397588 (May 21, 2020).
Keywords: Bloodstream infections; ECLS; Nosocomial infections; SARS-CoV 2; Ventilator-associated pneumonia.