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Med Intensiva. 2013 Oct;37(7):468-75. doi: 10.1016/j.medin.2012.08.009. Epub 2012 Oct 3.

Infections occurring in adult patients receiving mechanical circulatory support: the two-year experience of an Italian National Referral Tertiary Care Center.

[Article in English, Spanish]

Author information

1
Department of Cardiothoracic and Vascular Anesthesia and Intensive Care, Istituto Scientifico San Raffaele, Milan, Italy.

Abstract

OBJECTIVE:

Infection during mechanical circulatory support is a frequent adverse complication. We analyzed infections occurring in this population in a national tertiary care center, and assessed the differences existing between the setting of extracorporeal membrane oxygenation (ECMO) and ventricular assist devices (VADs).

DESIGN, SETTING, AND PARTICIPANTS:

An observational study was made of patients treated with ECMO or VAD in the San Raffaele Scientific Institute (Italy) between 2009 and 2011.

INTERVENTIONS:

None.

RESULTS:

Thirty-nine percent of the 46 patients with ECMO and 69% of the 15 patients with VAD developed infection. We observed a mortality rate of 36.1% during mechanical circulatory support and of 55.7% during the global hospitalization period. Although Gram-negative infections were predominant overall, patients with ECMO were more prone to develop Candida infection (29%), and patients with VAD tended to suffer Staphylococcus infection (18%). Patients with infection had longer ECMO support (p=0.03), VAD support (p=0.01), stay in the intensive care unit (p=0.002), and hospital admission (p=0.03) than patients without infection. Infection (regression coefficient=3.99, 95% CI 0.93-7.05, p=0.02), body mass index (regression coefficient=0.46, 95% CI 0.09-0.83, p=0.02), fungal infection (regression coefficient=4.96, 95% CI 1.42-8.44, p=0.009) and obesity (regression coefficient=10.47, 95% CI 1.77-19.17, p=0.02) were predictors of the duration of ECMO support. Stepwise logistic regression analysis showed the SOFA score at the time of implant (OR=12.33, 95% CI 1.15-132.36, p=0.04) and VAD (OR=1.27, 95% CI 1.04-1.56, p=0.02) to be associated with infection.

CONCLUSIONS:

Infection is a major challenge during ECMO and VAD support. Each mechanical circulatory support configuration is associated with specific pathogens; fungal infections play a major role.

KEYWORDS:

Dispositivos de asistencia ventricular; Extracorporeal membrane oxygenation; Infección; Infection; Oxigenación con membrana extracorpórea; Ventricular assist devices

PMID:
23040766
DOI:
10.1016/j.medin.2012.08.009
[Indexed for MEDLINE]
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