Analysis of Nosocomial Infection and Risk Factors in Patients with ECMO Treatment

Abstract

Objective

To investigate the drug resistance of nosocomial infection-related pathogens in patients who underwent extracorporeal membrane oxygenation (ECMO), analyzing the nosocomial infection-related risk factors.

Methods

The medical records of 56 patients who received ECMO support treatment in the First Affiliated Hospital with Nanjing Medical University from January 2013 to December 2019 were selected. The nosocomial infection, pathogen distribution and drug resistance, and the influencing factors of nosocomial infection were analyzed. The predictive value of independent risk factors for nosocomial infection after ECMO was analyzed using the receiver operating characteristic (ROC) curve.

Results

A total of 56 patients receiving ECMO treatment were included. The nosocomial infection rate was 28.57%, and the prevalence infection rate was 44.64%. Lower respiratory tract infection was the main infection site. Among these infectious patients, 53 strains of pathogens were detected. The results showed that the gram-negative bacteria were mainly Acinetobacter baumannii and Klebsiella pneumonia. Moreover, the drug resistance rate of Acinetobacter baumannii to most of the antibiotics was more than 65%, among which the drug resistance rate to carbapenems was 80%. The results of risk factors of nosocomial infection after ECMO were analyzed by univariate analysis, showing that ECMO treatment time, hospitalization time, antibacterial drug use time, ventilator use time, catheter intubation time and central venous intubation time were statistically significant (all p < 0.001). Multivariate analysis identified that ECMO treatment time was an independent risk factor. As showed by ROC curve, ECMO treatment time had a high predictive value for postoperative nosocomial infection. ECMO treatment times of more than 4.5 days were associated with an increased risk of nosocomial infection.

Conclusion

The nosocomial infection rate after ECMO was relatively high, and the main pathogens are Gram-negative bacteria. The selection of antibiotics should be based on the results of pathogen drug sensitivity.

Keywords:

• extracorporeal membrane oxygenation
• nosocomial infection
• risk factors
• infection site

Acknowledgments

We would like to acknowledge the reviewers for their helpful comments on this paper. Zhan-Jie Li and Dong-Fang Zhang are co-first authors for this study.

Ethical Statement

The patient in our case has signed the informed consent. All patients provided informed consent. This study was designed following the Declaration of Helsinki and approved by the ethics committee of Jiangsu Shengze Hospital affiliated to Nanjing Medical University. The ethics number is 2019-SR-075

Consent for Publication

We had obtained from the patient for written informed consent for publication.

Author Contributions

All authors made substantial contributions to conception and design, acquisition of data, or analysis and interpretation of data; took part in drafting the article or revising it critically for important intellectual content; agreed to submit to the current journal; gave final approval for the version to be published; and agreed to be accountable for all aspects of the work.

Disclosure

The authors declare that they have no conflicts of interest.