Gastrointestinal colonization with multidrug-resistant Gram-negative bacteria during extracorporeal membrane oxygenation: effect on the risk of subsequent infections and impact on patient outcome

Autor:	Antonio Pesenti, Laura Alagna, Alessandra Bandera, Stefano De Falco, Andrea Gori, Giacomo Grasselli, Nicolò Patroniti, Vittorio Scaravilli, Michela Bombino, Chiara Abbruzzese
Jazyk:	angličtina
Rok vydání:	2019
Předmět:	Colonization ARDS medicine.medical_specialty Health care-associated infection medicine.medical_treatment Critical Care and Intensive Care Medicine 03 medical and health sciences 0302 clinical medicine Internal medicine Extracorporeal membrane oxygenation Medicine 030212 general & internal medicine Survival rate Mechanical ventilation 0303 health sciences 030306 microbiology business.industry Research Incidence (epidemiology) lcsh:Medical emergencies. Critical care. Intensive care. First aid Retrospective cohort study lcsh:RC86-88.9 medicine.disease Multi-drug resistance Retrospective study Etiology business
Zdroj:	Annals of Intensive Care, Vol 9, Iss 1, Pp 1-9 (2019) Annals of Intensive Care
ISSN:	2110-5820
Popis:	Background In ICU patients, digestive tract colonization by multidrug-resistant (MDR) Gram-negative (G−) bacteria is a significant risk factor for the development of infections. In patients undergoing extracorporeal membrane oxygenation (ECMO), colonization by MDR bacteria and risk of subsequent nosocomial infections (NIs) have not been studied yet. The aim of this study is to evaluate the incidence, etiology, risk factors, impact on outcome of gastrointestinal colonization by MDR G− bacteria, and risk of subsequent infections in patients undergoing ECMO. Methods This is a retrospective analysis of prospectively collected data: 105 consecutive patients, treated with ECMO, were admitted to the ICU of an Italian tertiary referral center (San Gerardo Hospital, Monza, Italy) from January 2010 to November 2015. Rectal swabs for MDR G− bacteria were cultured at admission and twice a week. Only colonization and NIs by MDR G− bacteria were analyzed. Results Ninety-one included patients [48.5 (37–56) years old, 63% male, simplified acute physiology score II 37 (32–47)] underwent peripheral ECMO (87% veno-venous) for medical indications (79% ARDS). Nineteen (21%) patients were colonized by MDR G− bacteria. Male gender (OR 4.03, p = 0.029) and duration of mechanical ventilation (MV) before ECMO > 3 days (OR 3.57, p = 0.014) were associated with increased risk of colonization. Colonized patients had increased odds of infections by the colonizing germs (84% vs. 29%, p p = 0.002), MV (50 vs. 22 days, p p p = 0.480, OR 0.68). Infected patients had almost halved ICU survival (46% vs. 78%, p Conclusions In patients undergoing ECMO for respiratory and/or circulatory failure, colonization by MDR G− bacteria is frequent and associated with more the tenfold odds for subsequent infection. Those infections are associated with an increased risk of death.
Databáze:	OpenAIRE
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