Bacteria in Extracorporeal Membrane Oxygenation Circuit Clots of a Patient With Persistent Bacteremia: A Case Report.

Autor:	Drop JG; From the Department of Pediatric Hematology, Erasmus MC Medical Center-Sophia Children's, Rotterdam, The Netherlands.; Department of Neonatal and Pediatric Intensive Care, Division of Pediatric Intensive Care, Erasmus University Medical Center, Rotterdam, The Netherlands.; Department of Cardiology, Erasmus MC University Medical Center, Rotterdam, The Netherlands., Verhage L; Department of Cardiology, Erasmus MC University Medical Center, Rotterdam, The Netherlands., van Westreenen M; Department of Medical Microbiology and Infectious Diseases, Erasmus MC University Medical Center, Rotterdam, the Netherlands., Wildschut ED; Department of Neonatal and Pediatric Intensive Care, Division of Pediatric Intensive Care, Erasmus University Medical Center, Rotterdam, The Netherlands., de Hoog M; Department of Neonatal and Pediatric Intensive Care, Division of Pediatric Intensive Care, Erasmus University Medical Center, Rotterdam, The Netherlands., van Beusekom H; Department of Cardiology, Erasmus MC University Medical Center, Rotterdam, The Netherlands., van Ommen CH; From the Department of Pediatric Hematology, Erasmus MC Medical Center-Sophia Children's, Rotterdam, The Netherlands.
Jazyk:	angličtina
Zdroj:	ASAIO journal (American Society for Artificial Internal Organs : 1992) [ASAIO J] 2023 Nov 01; Vol. 69 (11), pp. e463-e466. Date of Electronic Publication: 2023 May 17.
DOI:	10.1097/MAT.0000000000001980
Abstrakt:	A neonate with pulmonary hypertension was supported with extracorporeal membrane oxygenation (ECMO). During ECMO support, the patient developed Enterococcus faecalis bacteremia, treated with targeted antibiotics. Despite the maximum dose of antibiotics, routine blood cultures remained positive throughout the ECMO treatment. A circuit change was performed due to buildup of thrombotic material and disseminated intravascular coagulation (DIC) inside the circuit. Thrombus formation was more extensive in the first than the second circuit. Gram-positive diplococci were present in all initial circuit clots and gram-positive masses surrounded by fibrin were found inside thrombi of the second circuit. Scanning electron microscopy (SEM) revealed a dense fibrin network with embedded red blood cells and bacteria in the first circuit. In the second circuit, SEM analysis revealed scattered micro thrombi. Polymerase chain reaction for identification of bacteria in the thrombus of the first circuit showed the same bacteria as found in blood cultures and did not achieve a sufficient signal in the second circuit. This case report shows that bacteria can nestle in thrombi of an ECMO circuit and that there is a rationale for a circuit change in a patient with persistent positive blood cultures and DIC. Competing Interests: Disclosure: The authors have no conflict of interest to report. (Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the ASAIO.)
Databáze:	MEDLINE
Externí odkaz:	Zobrazit plný text záznamu