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KMID : 0191120170320040593
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Journal of Korean Medical Science
2017 Volume.32 No. 4 p.593 ~ p.598
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Nosocomial Infection in Adult Patients Undergoing Veno-Arterial Extracorporeal Membrane Oxygenation
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Kim Gwan-Sic
Lee Kyo-Seon
Park Choung-Kyu
Kang Seung-Ku
Kim Do-Wan
Oh Sang-Gi
Oh Bong-Suk
Jung Yo-Chun
Kim Seok
Yun Ju-Sik
Song Sang-Yun
Na Kook-Joo
Jeong In-Seok
Ahn Byoung-Hee
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Abstract
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Data on the frequency of nosocomial infections during extracorporeal membrane oxygenation (ECMO) in adult populations remain scarce. We investigated the risk factors for nosocomial infections in adult patients undergoing venoarterial ECMO (VA-ECMO) support. From January 2011 to December 2015, a total of 259 patients underwent ECMO. Of these, patients aged 17 years or less and patients undergoing ECMO for less than 48 hours were excluded. Of these, 61 patients diagnosed with cardiogenic shock were evaluated. Mean patient age was 60.6 ± 14.3 years and 21 (34.4%) patients were female. The mean preoperative Sequential Organ Failure Assessment (SOFA) score was 8.6 ± 2.2. The mean duration of ECMO support was 6.8 ± 7.4 days. The rates of successful ECMO weaning and survival to discharge were 44.3% and 31.1%, respectively. There were 18 nosocomial infections in 14 (23.0%) patients. These included respiratory tract infections in 9 cases and bloodstream infections in a further 9. In multivariate analysis, independent predictors of infection during ECMO were the preoperative creatinine level (hazard ratio [HR], 2.176; 95% confidence interval [CI], 1.065?4.447; P = 0.033) and the duration of ECMO support (HR, 1.400; 95% CI, 1.081?1.815; P = 0.011). A higher preoperative creatinine level and an extended duration of ECMO support are risk factors for infection. Therefore, to avoid the development of nosocomial infections, strategies to shorten the length of ECMO support should be applied whenever possible.
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KEYWORD
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Extracorporeal Membrane Oxygenation Support, Infection
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