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Infections complicating extracorporeal membrane oxygenation in patients with traumatic injuries

  • Samantha K. Schweickhardt
    Affiliations
    Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814, United States
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  • Valerie G. Sams
    Affiliations
    Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814, United States

    Department of Surgery, Brooke Army Medical Center, 3551 Roger Brooke Drive, JBSA Ft. Sam Houston, San Antonio, TX 78234, United States
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  • Jason S. Radowsky
    Affiliations
    Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814, United States

    Department of Surgery, Brooke Army Medical Center, 3551 Roger Brooke Drive, JBSA Ft. Sam Houston, San Antonio, TX 78234, United States
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  • Michal J. Sobieszczyk
    Affiliations
    Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814, United States

    Department of Medicine, Brooke Army Medical Center, 3551 Roger Brooke Drive, JBSA Ft. Sam Houston, San Antonio, TX 78234, United States
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  • Joseph E. Marcus
    Correspondence
    Corresponding author.
    Affiliations
    Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814, United States

    Department of Medicine, Brooke Army Medical Center, 3551 Roger Brooke Drive, JBSA Ft. Sam Houston, San Antonio, TX 78234, United States
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Published:November 23, 2022DOI:https://doi.org/10.1016/j.injury.2022.11.048

      Highlights

      • Extracorporeal membrane oxygenation (ECMO) is used with increased frequency for patients with traumatic injuries.
      • Infection rate (107.3 infections/100,000 ECMO days) is much greater than in other ECMO studies, with predominantly respiratory infections.
      • Gram-negative bacteria caused a majority of infections in this population regardless of time after cannulation or site.
      • Empiric antibiotics in trauma patients receiving ECMO with infections should cover Gram-negative bacteria.

      Abstract

      Introduction

      Extracorporeal Membrane Oxygenation (ECMO) has increasing utility in adult patients with traumatic injuries. There is currently limited data on the pathogens complicating a trauma patient's ECMO course, making empiric antibiotic decisions difficult. This study aims to characterize the types of infection among patients with traumatic injuries on ECMO.

      Methods

      A chart review was performed on all trauma patients at Brooke Army Medical Center receiving ECMO between February 2013 and July 2021. Charts were reviewed to identify pathogens by culture site as well as time to infection following cannulation.

      Results

      Twenty-one trauma patients underwent ECMO during the study period. The majority of patients were men (90%) with a median age of 30 [IQR 27–38], and a median ECMO course of 9.8 days [IQR 3.9–14.1]. Motor vehicle crashes (81%) accounted for the majority of mechanisms of injury. Of the 24 infections, the majority were respiratory (n = 13, 58/1000 ECMO days) followed by skin and soft tissue (n = 6, 26/1000 ECMO days), blood stream (n = 4, 18/1000 ECMO days), and urinary tract (n = 1, 5/1000 ECMO days). Gram-negative bacteria were the most commonly isolated organism from all sites and at all time periods following cannulation. Multi-drug resistant organisms accounted for 35% (n = 9) of infections and were independent of time from cannulation.

      Discussion/Conclusion

      This is the first study to describe infections in trauma patients requiring ECMO support. We observed majority Gram-negative infections regardless of culture site or time after cannulation. Thus, with infection in this population, empiric antibiotics should have broad spectrum coverage of Gram-negative organisms.

      Keywords

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      References

        • Patakas D.A.
        • et al.
        Extracorporeal oxygenation in the adult respiratory-distress syndrome.
        N Engl J Med. 1972; 287: 49
        • Sauer C.M.
        • Yuh D.D.
        • Bonde P.
        Extracorporeal membrane oxygenation use has increased by 433% in adults in the United States from 2006 to 2011.
        ASAIO J. 2015; 61: 31-36
        • Peek G.J.
        • et al.
        Efficacy and economic assessment of conventional ventilatory support versus extracorporeal membrane oxygenation for severe adult respiratory failure (CESAR): a multicentre randomised controlled trial.
        Lancet. 2009; 374: 1351-1363
        • Biffi S.
        • et al.
        Infections during extracorporeal membrane oxygenation: epidemiology, risk factors, pathogenesis and prevention.
        Int J Antimicrob Agents. 2017; 50: 9-16
        • Komori A.
        • et al.
        The impact of infection complications after trauma differs according to trauma severity.
        Sci Rep. 2021; 11: 13803
        • Glance L.G.
        • et al.
        Increases in mortality, length of stay, and cost associated with hospital-acquired infections in trauma patients.
        Arch Surg. 2011; 146: 794-801
        • Burke C.R.
        • et al.
        Extracorporeal life support is safe in trauma patients.
        Injury. 2017; 48: 121-126
        • Swol J.
        • et al.
        Indications and outcomes of extracorporeal life support in trauma patients.
        J Trauma Acute Care Surg. 2018; 84: 831-837
      1. Rating the severity of tissue damage. I. The abbreviated scale.
        JAMA. 1971; 215: 277-280
        • Baker S.P.
        • et al.
        The injury severity score: a method for describing patients with multiple injuries and evaluating emergency care.
        J Trauma. 1974; 14: 187-196
        • Magiorakos A.P.
        • et al.
        Multidrug-resistant, extensively drug-resistant and pandrug-resistant bacteria: an international expert proposal for interim standard definitions for acquired resistance.
        Clin Microbiol Infect. 2012; 18: 268-281
        • Bizzarro M.J.
        • et al.
        Infections acquired during extracorporeal membrane oxygenation in neonates, children, and adults.
        Pediatr Crit Care Med. 2011; 12: 277-281
        • Grasselli G.
        • et al.
        Nosocomial Infections During Extracorporeal Membrane Oxygenation: Incidence, Etiology, and Impact on Patients' Outcome.
        Crit Care Med. 2017; 45: 1726-1733
        • Wang J.
        • et al.
        Characteristics of venous-venous extracorporeal membrane oxygenation related bloodstream infections.
        J Card Surg. 2022; 37: 1431-1434
        • Regel G.
        • et al.
        Pattern of organ failure following severe trauma.
        World J Surg. 1996; 20: 422-429
        • Marcus J.E.
        • et al.
        Infections in patients with burn injuries receiving extracorporeal membrane oxygenation.
        Burns. 2019; 45: 1880-1887
        • Hsu M.S.
        • et al.
        Risk factors for nosocomial infection during extracorporeal membrane oxygenation.
        J Hosp Infect. 2009; 73: 210-216
        • Combes A.
        • et al.
        Extracorporeal Membrane Oxygenation for Severe Acute Respiratory Distress Syndrome.
        N Engl J Med. 2018; 378: 1965-1975
        • Huang J.E.
        • et al.
        Predictive survival factors of the traumatically injured on venovenous extracorporeal membrane oxygenation: A Bayesian model.
        J Trauma Acute Care Surg. 2020; 88: 153-159
        • Pieri M.
        • et al.
        Infections occurring in adult patients receiving mechanical circulatory support: the two-year experience of an Italian National Referral Tertiary Care Center.
        Med Intensiva. 2013; 37: 468-475
        • van Duin D.
        • et al.
        Timeline of health care-associated infections and pathogens after burn injuries.
        Am J Infect Control. 2016; 44: 1511-1516
        • Gorrie C.L.
        • et al.
        Gastrointestinal Carriage Is a Major Reservoir of Klebsiella pneumoniae Infection in Intensive Care Patients.
        Clin Infect Dis. 2017; 65: 208-215
        • Manges A.R.
        • Johnson J.R.
        Reservoirs of Extraintestinal Pathogenic Escherichia coli.
        Microbiol Spectr. 2015; 3
        • Holmes C.L.
        • et al.
        Pathogenesis of Gram-Negative Bacteremia.
        Clin Microbiol Rev. 2021; 34
        • Shah A.
        • et al.
        Reducing Broad-Spectrum Antimicrobial Use in Extracorporeal Membrane Oxygenation: Reduce AMMO Study.
        Clin Infect Dis. 2021; 73: e988-e996
        • Yeo H.J.
        • et al.
        Chlorhexidine bathing of the exposed circuits in extracorporeal membrane oxygenation: an uncontrolled before-and-after study.
        Crit Care. 2020; 24: 595
        • Glater-Welt L.B.
        • et al.
        Nosocomial Bloodstream Infections in Patients Receiving Extracorporeal Life Support: Variability in Prevention Practices: A Survey of the Extracorporeal Life Support Organization Members.
        J Intens Care Med. 2016; 31: 654-669
        • Pluim T.
        • et al.
        The morbidity and mortality of patients with fungal infections before and during extracorporeal membrane oxygenation support.
        Pediatr Crit Care Med. 2012; 13: e288-e293
        • Pappas P.G.
        • et al.
        Clinical Practice Guideline for the Management of Candidiasis: 2016 Update by the Infectious Diseases Society of America.
        Clin Infect Dis. 2016; 62: e1-50
        • Kao L.S.
        • et al.
        Antimicrobial prophylaxis and infection surveillance in extracorporeal membrane oxygenation patients: a multi-institutional survey of practice patterns.
        ASAIO J. 2011; 57: 231-238
        • Pelz R.K.
        • et al.
        Double-blind placebo-controlled trial of fluconazole to prevent candidal infections in critically ill surgical patients.
        Ann Surg. 2001; 233: 542-548
        • Pfaller M.A.
        • et al.
        Bacterial and fungal pathogens isolated from patients with bloodstream infection: frequency of occurrence and antimicrobial susceptibility patterns from the SENTRY Antimicrobial Surveillance Program (2012-2017).
        Diagn Microbiol Infect Dis. 2020; 97115016