Do patients receiving extracorporeal membrane-oxygenation need antibiotic prophylaxis? A systematic review and meta-analysis on 7,996 patients.

Autor: Orso D; Department of Emergency, University Hospital of Udine, Azienda Sanitaria Universitaria Friuli Centrale, 'Santa Maria della Misericordia', Piazzale Santa Maria della Misericordia 15, Udine, 33100, Italy. sd7782.do@gmail.com., Fodale CM; Department of Cardio-Thoraco-Vascular Sciences and Public Health, University Hospital of Padua, Via Giustiniani, 2, Padua, 35128, Italy., Fossati S; Department of Emergency, University Hospital of Udine, Azienda Sanitaria Universitaria Friuli Centrale, 'Santa Maria della Misericordia', Piazzale Santa Maria della Misericordia 15, Udine, 33100, Italy., Venturini S; Department of Infectious Diseases, Community Hospital of Pordenone, Azienda Sanitaria Friuli Occidentale, 'Santa Maria degli Angeli', Via Montereale 34, Pordenone, 33170, Italy., Fonda F; Department of Emergency, University Hospital of Udine, Azienda Sanitaria Universitaria Friuli Centrale, 'Santa Maria della Misericordia', Piazzale Santa Maria della Misericordia 15, Udine, 33100, Italy., Cugini F; Department of Emergency Medicine, Community Hospital of San Daniele del Friuli 'Ospedale Sant'Antonio', Azienda Sanitaria Friuli Centrale, Viale Trento Trieste 33, San Daniele del Friuli, 33038, Italy., Comisso I; Department of Emergency, University Hospital of Udine, Azienda Sanitaria Universitaria Friuli Centrale, 'Santa Maria della Misericordia', Piazzale Santa Maria della Misericordia 15, Udine, 33100, Italy., Crapis M; Department of Infectious Diseases, Community Hospital of Pordenone, Azienda Sanitaria Friuli Occidentale, 'Santa Maria degli Angeli', Via Montereale 34, Pordenone, 33170, Italy., Cacciavillani L; Department of Cardio-Thoraco-Vascular Sciences and Public Health, University Hospital of Padua, Via Giustiniani, 2, Padua, 35128, Italy., Bove T; Department of Emergency, University Hospital of Udine, Azienda Sanitaria Universitaria Friuli Centrale, 'Santa Maria della Misericordia', Piazzale Santa Maria della Misericordia 15, Udine, 33100, Italy.; Department of Medicine, University of Udine, Via Colugna 51, Udine, 33100, Italy.
Jazyk: angličtina
Zdroj: BMC anesthesiology [BMC Anesthesiol] 2024 Nov 12; Vol. 24 (1), pp. 410. Date of Electronic Publication: 2024 Nov 12.
DOI: 10.1186/s12871-024-02796-z
Abstrakt: Background: Patients undergoing Extracorporeal Membrane Oxygenation (ECMO) are particularly susceptible to infections: 42% experience sepsis and 26% develop a nosocomial infection (NI). Whether antibiotic prophylaxis is effective in reducing mortality and its effects on the rate of NIs is currently unclear.
Research Question: Can antibiotic prophylaxis decrease 30-day mortality for patients on ECMO? Can antibiotic prophylaxis prevent the occurrence of NIs in these patients?
Study Design and Methods: A systematic review and meta-analysis was conducted. We searched PubMed, Scopus, and CINAHL libraries from inception to June 12, 2024. Two researchers were involved in abstract screening and three researchers were involved in full text selection.
Results: A pooled population of 7,996 patients is represented by 5 retrospective studies. Reported mortality ranges between 46 and 58% and the NIs rate is between 14 and 62%. Regarding 30-day mortality, the random-effects model (I 2  = 65%) indicates a non-statistically significant difference between the antibiotic prophylaxis group and the non-prophylaxis group (OR 0.76; 95%CI 0.37-1.59). For the NIs rate, a fixed-effect model (I 2  = 36%) shows an OR of 0.81 (95%CI 0.71-0.92) in favor of the antibiotic prophylaxis group, with a number-needed-to-treat (NNT) of 39.7 patients.
Conclusion: According to a very low degree of certainty, antibiotic prophylaxis appears to have no impact on the 30-day mortality rate of ECMO recipients. The risk of NIs seems to decrease with antibiotic prophylaxis, even though the NNT is high. Prospective high-quality studies that address these specific clinical questions are necessary.
Clinical Trial Registration: PROSPERO: International prospective register of systematic reviews, 2024, CRD42024567037.
Competing Interests: Declarations Ethics approval and consent to participate Not applicable. Consent for publication Not applicable. Competing interests The authors declare no competing interests.
(© 2024. The Author(s).)
Databáze: MEDLINE
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