To the Editor, In a recent review published in Intensive Care Medicine, Abrams et al. listed the research agenda of extracorporeal membrane oxygenation (ECMO)-associated infections. One of the questions was “how should cannula-associated infection be defined?” [1]. Literature on ECMO cannula-associated infections is very scarce [2, 3], and no clear definition is available. Then, diagnostic workup of cannula-related infections is currently derived from central catheter-related infection guidelines. For catheter-related infection, a positive catheter tip culture is a diagnostic criterion [4]. However, this attitude cannot be fully transposed to ECMO cannula-related infections, as cannula cannot be easily removed and changed for tip culture. We therefore aimed at evaluating the performance of cannula swab and subcutaneous needle aspirate for predicting the results of the cannula’s tip culture. In this prospective observational pilot study, patients treated by ECMO at the Besancon University Hospital (France) were enrolled. When patients had sepsis or local signs of cannula-associated infection, cannula swab and subcutaneous needle aspirate (Fig. 1d) of both arterial and venous cannulas were systematically obtained for culture. For subcutaneous needle aspirate, after cleaning with an antiseptic solution, a catheter for peripheral venous access was inserted on 1 to 3 cm along the ECMO cannula. If no exudate was aspirated, 1 mL of saline was injected and re-aspirated. The aspirate was sent for bacterial culture. Quantitative culture was not performed, and all positive cultures were considered. At the time of ECMO weaning, the cannula tips were also collected for culture. Culture of cannula swab and subcutaneous needle aspirate were considered as “positive AND fully correspondent” with the cannula tip if it detected all the pathogens of the cannula tip. Culture of cannula swab and subcutaneous needle aspirate were considered as “positive AND not fully correspondent” if the culture was positive but some pathogens were lacking or were different.

中文翻译：

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ECMO 插管相关感染：插管拭子和皮下针吸样本对预测插管尖端培养的兴趣

致编辑，在最近发表在重症监护医学上的一篇评论中，艾布拉姆斯等人。列出了体外膜肺氧合 (ECMO) 相关感染的研究议程。问题之一是“应如何定义套管相关感染？” [1]。ECMO 插管相关感染的文献非常稀少 [2, 3]，也没有明确的定义。然后，套管相关感染的诊断检查目前来自中心导管相关感染指南。对于导管相关感染，导管尖端培养阳性是诊断标准 [4]。然而，这种态度不能完全转移到 ECMO 插管相关感染，因为插管不能轻易移除和更换以进行尖端培养。因此，我们旨在评估插管拭子和皮下针吸的性能，以预测插管尖端培养的结果。在这项前瞻性观察性试点研究中，招募了在贝桑松大学医院（法国）接受 ECMO 治疗的患者。当患者出现败血症或套管相关感染的局部体征时，系统地获取动脉和静脉套管的套管拭子和皮下针吸物（图 1d）进行培养。对于皮下针吸，用消毒液清洗后，沿 ECMO 套管 1 至 3 cm 处插入外周静脉通路导管。如果没有吸出渗出液，则注入 1 mL 生理盐水并重新吸出。抽吸物用于细菌培养。未进行定量培养，并且考虑了所有阳性培养物。在 ECMO 脱机时，还收集了插管尖端进行培养。如果检测到套管尖端的所有病原体，则套管拭子和皮下针吸物的培养被认为与套管尖端“阳性且完全对应”。如果培养呈阳性但某些病原体缺乏或不同，则套管拭子和皮下针吸物的培养被认为是“阳性且不完全对应”。