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 < 0.001, OR 12.9), longer ICU length of stay (LOS) (43 vs. 24 days, p = 0.002), MV (50 vs. 22 days, p < 0.001) and ECMO (28 vs. 12 days, p < 0.001), but did not have higher risk of death (survival rate 58% vs. 67%, p = 0.480, OR 0.68). Infected patients had almost halved ICU survival (46% vs. 78%, p < 0.001, OR 4.11).

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.

中文翻译：

---

在体外膜氧合作用过程中，具有多重耐药性的革兰氏阴性细菌在胃肠道中的定殖：影响后续感染的风险，并影响患者的治疗效果。

背景

在ICU患者中，多重耐药性（MDR）革兰氏阴性（G-）细菌在消化道中的定殖是感染发展的重要危险因素。在接受体外膜氧合（ECMO）的患者中，尚未研究MDR细菌定植和随后发生医院感染（NIs）的风险。这项研究的目的是评估发生ECMO的患者的发生率，病因，危险因素，对MDR G-细菌对胃肠道定殖结果的影响以及随后感染的风险。

方法

这是对前瞻性收集数据的回顾性分析：从2010年1月至2015年11月，连续105例接受ECMO治疗的患者被送往意大利三级转诊中心（意大利蒙扎的圣杰拉多医院）的重症监护病房。MDR G直肠拭子−细菌在入院时培养，每周两次。仅分析了MDR G-细菌的定植和NIs。

结果

包括九十一名患者[48.5（37-56）岁，男性63％，简化的急性生理学评分II 37（32-47）]接受了外围ECMO（87％静脉-静脉）作为医学指征（79％的ARDS）。19名（21％）患者被MDR G-细菌定植。男性（OR 4.03，p  = 0.029）和ECMO> 3天前的机械通气时间（MV）（OR 3.57，p  = 0.014）与定植风险增加相关。被定植的患者被定植细菌的感染几率增加（84％比29％，p  <0.001，或12.9），ICU住院时间更长（LOS）（43 vs. 24天，p  = 0.002），MV（50 vs. 22天，p  <0.001）和ECMO（28 vs. 12天，p <0.001），但没有更高的死亡风险（生存率58％vs. 67％，p  = 0.480，或0.68）。被感染的患者的ICU存活率几乎降低了一半（46％比78％，p  <0.001，或4.11）。

结论

在因呼吸系统和/或循环衰竭而接受ECMO的患者中，MDR G-细菌的定植很常见，并且与随后感染的几率十分相关。这些感染与死亡风险增加有关。