Which Antimicrobial Treatment for Patients with Bloodstream Infection During ECMO Support?

Overview

Journal Eur J Clin Microbiol Infect Dis

Publisher Springer

Date 2025 Feb 7

PMID 39920427

Authors

Nicolas Massart

Sofia Ortuno

Charles Vidal

Samuel Henri

Hadrien Roze

Adrien Bougle

Francesca Manicone

Frank Bidar

Benjamin Assouline

Paul Masi

Sami Hraiech

Nicolas Nesseler

Etienne de Montmollin

Charles-Edouard Luyt

Affiliations

Soon will be listed here.

Abstract

Ojective: We aim to describe a large, multicenter cohort of patients with bloodstream infection (BSI) acquired during extracorporeal membrane oxygenation (ECMO) support.

Methods: We conducted a retrospective observational study in 12 Europeans ICUs. Only patients who developed a BSI of unknown source during ECMO support were included in the present analysis. Primary aim was to describe BSI epidemiology in patients with ECMO support. Secondary objectives were to describe antimicrobial susceptibility of incriminated micro-organisms.

Results: One hundred and eighty-two patients were included. Main reason for ECMO support was ARDS, followed by cardiogenic shock and post-cardiotomy. Half of the patients (51.9%) received early antimicrobial therapy. Main incriminated microorganisms were Enterococcus sp. (37.4%), Enterobacterales (26.9%), coagulase negative Staphylococci (15.9%) and Gram negative bacilli (11.5%). Multi drug resistant organisms (MDRO) were incriminated in 26 (14.3%) BSI and were mainly extended spectrum producing-Enterobacterales (17/26). Antimicrobial therapy was considered as appropriate in 130 patients (71.4%). Patients who received inappropriate antimicrobial therapy were more frequently infected with MDRO. Only 59 (32.4%) of cases were susceptible to 3rd generation cephalosporin while association of piperacillin/tazobactam with vancomycin was considered appropriate in 155 cases (85.2%) as compared with 168 cases (92.3%) for carbapenems combined with vancomycin.

Conclusion: Enterococcus sp. was incriminated in about a third of BSI among patients with ECMO support. High appropriateness would only be obtained with piperacilline/tazobactam or carbapenems in association with vancomycin while 3rd generation cephalosporin would have failed in the majority of BSI cases.

Clinical Trial Number: Not applicable.

References

Tabah A, Buetti N, Staiquly Q, Ruckly S, Akova M, Aslan A . Epidemiology and outcomes of hospital-acquired bloodstream infections in intensive care unit patients: the EUROBACT-2 international cohort study. Intensive Care Med. 2023; 49(2):178-190. PMC: 9916499. DOI: 10.1007/s00134-022-06944-2. View

Prowle J, Echeverri J, Ligabo E, Sherry N, Taori G, Crozier T . Acquired bloodstream infection in the intensive care unit: incidence and attributable mortality. Crit Care. 2011; 15(2):R100. PMC: 3219371. DOI: 10.1186/cc10114. View

Vincent J, Rello J, Marshall J, Silva E, Anzueto A, Martin C . International study of the prevalence and outcomes of infection in intensive care units. JAMA. 2009; 302(21):2323-9. DOI: 10.1001/jama.2009.1754. View

Millar J, Fanning J, McDonald C, McAuley D, Fraser J . The inflammatory response to extracorporeal membrane oxygenation (ECMO): a review of the pathophysiology. Crit Care. 2016; 20(1):387. PMC: 5125043. DOI: 10.1186/s13054-016-1570-4. View

Al-Fares A, Pettenuzzo T, Del Sorbo L . Extracorporeal life support and systemic inflammation. Intensive Care Med Exp. 2019; 7(Suppl 1):46. PMC: 6658641. DOI: 10.1186/s40635-019-0249-y. View

Frerou A, Lesouhaitier M, Gregoire M, Uhel F, Gacouin A, Reizine F . Venoarterial extracorporeal membrane oxygenation induces early immune alterations. Crit Care. 2021; 25(1):9. PMC: 7788860. DOI: 10.1186/s13054-020-03444-x. View

Massart N, Camus C, Nesseler N, Fillatre P, Flecher E, Mansour A . Multiple-site decontamination to prevent acquired infection in patients with veno-venous ECMO support. Ann Intensive Care. 2023; 13(1):27. PMC: 10079793. DOI: 10.1186/s13613-023-01120-1. View

Nesseler N, Mansour A, Schmidt M, Para M, Porto A, Falcoz P . Healthcare-associated infections in patients with severe COVID-19 supported with extracorporeal membrane oxygenation: a nationwide cohort study. Crit Care. 2024; 28(1):54. PMC: 10877839. DOI: 10.1186/s13054-024-04832-3. View

Massart N, Mansour A, Ross J, Piau C, Verhoye J, Tattevin P . Mortality due to hospital-acquired infection after cardiac surgery. J Thorac Cardiovasc Surg. 2020; 163(6):2131-2140.e3. DOI: 10.1016/j.jtcvs.2020.08.094. View

10.

Grasselli G, Scaravilli V, Di Bella S, Biffi S, Bombino M, Patroniti N . Nosocomial Infections During Extracorporeal Membrane Oxygenation: Incidence, Etiology, and Impact on Patients' Outcome. Crit Care Med. 2017; 45(10):1726-1733. DOI: 10.1097/CCM.0000000000002652. View

11.

Aubron C, Cheng A, Pilcher D, Leong T, Magrin G, Cooper D . Infections acquired by adults who receive extracorporeal membrane oxygenation: risk factors and outcome. Infect Control Hosp Epidemiol. 2012; 34(1):24-30. DOI: 10.1086/668439. View

12.

Schmidt M, Brechot N, Hariri S, Guiguet M, Luyt C, Makri R . Nosocomial infections in adult cardiogenic shock patients supported by venoarterial extracorporeal membrane oxygenation. Clin Infect Dis. 2012; 55(12):1633-41. PMC: 3888098. DOI: 10.1093/cid/cis783. View

13.

Lim S, Ahn S, Hong S, Chung C, Jeon K, Lee S . Clinical outcomes according to cannula configurations in patients with acute respiratory distress syndrome under veno-venous extracorporeal membrane oxygenation: a Korean multicenter study. Ann Intensive Care. 2020; 10(1):86. PMC: 7306930. DOI: 10.1186/s13613-020-00700-9. View

14.

Singer M, Deutschman C, Seymour C, Shankar-Hari M, Annane D, Bauer M . The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). JAMA. 2016; 315(8):801-10. PMC: 4968574. DOI: 10.1001/jama.2016.0287. View

15.

Magiorakos A, Srinivasan A, Carey R, Carmeli Y, Falagas M, Giske C . Multidrug-resistant, extensively drug-resistant and pandrug-resistant bacteria: an international expert proposal for interim standard definitions for acquired resistance. Clin Microbiol Infect. 2011; 18(3):268-81. DOI: 10.1111/j.1469-0691.2011.03570.x. View

16.

Lund B, Agvald-Ohman C, Hultberg A, Edlund C . Frequent transmission of enterococcal strains between mechanically ventilated patients treated at an intensive care unit. J Clin Microbiol. 2002; 40(6):2084-8. PMC: 130827. DOI: 10.1128/JCM.40.6.2084-2088.2002. View

17.

Bonten M, Gaillard C, van Tiel F, van der Geest S, Stobberingh E . Colonization and infection with Enterococcus faecalis in intensive care units: the role of antimicrobial agents. Antimicrob Agents Chemother. 1995; 39(12):2783-6. PMC: 163030. DOI: 10.1128/AAC.39.12.2783. View

18.

Freedberg D, Zhou M, Cohen M, Annavajhala M, Khan S, Moscoso D . Pathogen colonization of the gastrointestinal microbiome at intensive care unit admission and risk for subsequent death or infection. Intensive Care Med. 2018; 44(8):1203-1211. PMC: 6309661. DOI: 10.1007/s00134-018-5268-8. View