Multiple-site decontamination to prevent acquired infection in patients with veno-venous ECMO support

Autor: Nicolas Massart, Christophe Camus, Nicolas Nesseler, Pierre Fillâtre, Erwan Flecher, Alexandre Mansour, Jean-Philippe Verhoye, Lucie Le Fevre, Charles-Edouard Luyt
Jazyk: angličtina
Rok vydání: 2023
Předmět:
Zdroj: Annals of Intensive Care, Vol 13, Iss 1, Pp 1-11 (2023)
Druh dokumentu: article
ISSN: 2110-5820
DOI: 10.1186/s13613-023-01120-1
Popis: Abstract Background Acute distress respiratory syndrome (ARDS) patients with veno-venous extra corporeal membrane oxygenation (ECMO) support are particularly exposed to ECMO-associated infection (ECMO-AI). Unfortunately, data regarding AI prophylaxis in this setting are lacking. Selective decontamination regimens decrease AI incidence, including ventilator-associated pneumonia (VAP) and bloodstream infection (BSI) in critically ill patients. We hypothesized that a multiple-site decontamination (MSD) regimen is associated with a reduction in the incidence of AI among VV-ECMO patients. Methods We conducted a retrospective observational study in three French ECMO referral centers from January 2010 to December 2021. All adult patients (> 18 years old) who received VV-ECMO support for ARDS were eligible. In addition to standard care (SC), 2 ICUs used MSD, which consists of the administration of topical antibiotics four times daily in the oropharynx and the gastric tube, once daily chlorhexidine body-wash and a 5-day nasal mupirocin course. AIs were compared between the 2 ICUs using MSD (MSD group) and the last ICU using SC. Results They were 241 patients available for the study. Sixty-nine were admitted in an ICU that applied MSD while the 172 others received standard care and constituted the SC group. There were 19 ECMO-AIs (12 VAP, 7 BSI) in the MSD group (1162 ECMO-days) compared to 143 AIs (104 VAP, 39 BSI) in the SC group (2376 ECMO-days), (p
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