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

Figures & data

Table 1 Distribution and Constituent Ratio of Nosocomial Infection Site

Infection Site	Infection Case Numbers (n=25)	Constituent Ratio (%)
Lower respiratory tract	18	72.00
Blood	3	12.00
CAUTI	1	4.00
Surgical site	1	4.00
Antibiotic-associated diarrhea	1	4.00
Pleural cavity	1	4.00

Note: Antibiotic-associated diarrhea: diarrhea related to the intestinal dysbacteriosis, which caused by antibiotics.

Abbreviation: CAUTI, catheter-associated urinary tract infection.

Table 2 Distribution of Nosocomial Infection Pathogens Species

Pathogens	Strains (n=53)	Constituent Ratio (%)
Gram-negative bacteria	45	84.91%
Acinetobacter baumannii	15	28.30%
Klebsiella pneumoniae	8	15.09%
Enterobacter cloacae	5	9.43%
Stenotrophomonas maltophilia	4	7.55%
Citrobacter	3	5.66%
Other Gram-negative bacteria	10	18.87%
Fungi	8	15.09%
Candida glabrata	3	5.66%
Candida albicans	3	5.66%
Candida tropicalis	1	1.89%
Candida gaulli	1	1.89%

Table 3 Antimicrobial Resistance of Major Gram-Negative Bacteria

Antibacterials	Acinetobacter baumannii (n=15)				Klebsiella pneumoniae (n=8)
	Detected	Resistant	Resistance Rate (%)		Detected	Resistant		Resistance Rate (%)
Piperacillin	2	2	100.00		8	5		62.50
Piperacillin/tazobactam	15	12	80.00		8	1		12.50
Ampicillin/sulbactam	15	12	80.00		8	4		50.00
Cefoperazone/sulbactam	6	5	83.33		3	0		0.00
Ceftazidime	15	12	80.00		8	1		12.50
Cefepime	15	12	80.00		8	1		12.50
Cefuroxime	–	–	–		8	5		62.50
Cefazolin	–	–	–		8	5		62.50
Cefatriaxone	14	11	78.57		8	5		62.50
Cefotetan	–	–	–		8	1		12.50
Aztreonam	–	–	–		8	1		12.50
Meropenem	15	12	80.00		8	1		12.50
Imipenem	15	12	80.00		8	1		12.50
Minocycline	1	1	100.00		–	–		–
Tobramycin	14	11	78.57		8	1		12.50
Gentamicin	15	12	80.00		8	2		25.00
Amikacin	3	2	66.67		6	1		16.67
Ciprofloxacin	12	9	75.00		8	2		25.00
Levofloxacin	11	8	72.72		8	1		12.50
Sulfamethoxazole/trimethoprim	14	11	78.57		8	4		50.00

Note: - denotes no drug sensitivity test or natural drug resistance.

Table 4 Antimicrobial Resistance of Major Fungi

Antimicrobial Agents	Candida albicans			Candida glabrata
	Detected	Resistant	Resistance Rate (%)	Detected	Resistant	Resistance Rate (%)
Voriconazole	2	0	0.00	3	1	33.3
Fluconazole	2	0	0.00	3	1	33.3

Table 5 Univariate Analysis of the Nosocomial Infection in the Patients After ECMO

General Information	Non-Infection Group (n=40)			Infection Group (n=16)		X^2/Z	P
		Cases	Constituent Ratio (%)	Cases	Constituent Ratio (%)
Gender	Male	25	62.50	8	50.00	0.738	0.390
	Female	15	37.50	8	50.00
Age	47.43±15.09			51.13±13.18		−0.86	0.40
Hypertension	No	26	65.00	10	62.50	0.031	0.850
	Yes	14	35.00	6	37.50
Diabetes	No	34	85.00%	12	75.00%	0.779	0.377
	Yes	6	15.00%	4	25.00%
Treatment mode	VA	37	92.50%	15	93.75%	0.027	0.870
	VV	3	7.50%	1	6.25%
Installation	Incision	17	42.50%	10	62.50%	1.831	0.176
	Puncture	23	57.50%	6	37.50%
Discharge mode	Normal	34	85.00	15	93.75
	Death	6	15.00	1	6.25
ECMO treatment time^#		4.00 (3.00~ 6.00)		9.50 (5.25~12.50))		−3.94*	<0.001
Hospitalization time^#		15.50 (7.00~ 23.00)		55.50 (21.25~83.75)		−3.52*	<0.001
Antibacterial drug use time#		8.00 (5.00~17.00)		30.50 (13.25~55.25)		−3.87*	<0.001
Ventilator use time^#		3.00 (1.25~6.00)		11.00 (3.00~24.50)		−2.79*	0.005
Catheter intubation time^#		7.00 (4.00~11.00))		21.50 (11.00~49.00)		−4.26*	<0.001
Central venous intubation time		6.58±5.01		25.00±17.70		−6.08*	<0.001

Note: *Denotes p < 0.05; ^#Denotes non-normal distribution after SK normality test.

Table 6 Multivariate Analysis of the Nosocomial Infection in the Patients After ECMO

Related Factors	B	SE	Wald Value	OR Value	95% CI		P value
Length of stay in the same period	−0.01	0.02	0.34	0.99	0.96	1.02	0.56
Days of ECMO treatment	0.36	0.17	4.38	1.44	1.02	2.02	0.04
Days of antibiotic use	0.08	0.09	0.74	1.08	0.91	1.28	0.39
Days of ventilator use	0.06	0.11	0.30	1.06	0.85	1.33	0.59
Days of central venous intubation	0.11	0.14	0.64	1.11	0.86	1.45	0.42
Days of catheter intubation	−0.03	0.11	0.06	0.98	0.79	1.20	0.81

Abbreviations: B, regression coefficient; SE, standard error; OR, odds ratio; CI, confidence intervals; ECMO, extracorporeal membrane oxygenation.

Figure 1 (A) Critical value of ECMO treatment time for predicting the risk of nosocomial infection after ECMO; (B) ROC curve analysis of the predictive value of ECMO treatment time on related nosocomial infections after ECMO.