Author:
Nesseler Nicolas,Mansour Alexandre,Schmidt Matthieu,Para Marylou,Porto Alizée,Falcoz Pierre-Emmanuel,Mongardon Nicolas,Fougerou Claire,Ross James T.,Beurton Antoine,Gaide-Chevronnay Lucie,Guinot Pierre-Grégoire,Lebreton Guillaume,Flecher Erwan,Vincentelli André,Massart Nicolas, ,Fouquet Olivier,Pierrot Marc,Chocron Sidney,Flicoteaux Guillaume,Mauriat Philippe,Ouattara Alexandre,Roze Hadrien,Huet Olivier,Fischer Marc-Olivier,Bellaïche Raphel,Constant Ophélie,De Roux Quentin,André L. Y.,Meffert Arnaud,Merle Jean-Claude,Picard Lucile,Skripkina Elena,Folliguet Thierry,Fiore Antonio,D’ostrevy Nicolas,Morgan Marie-Catherine,Nguyen Maxime,Terzi Nicolas,Colin Gwenhaël,Fabre Olivier,Astaneh Arash,Issard Justin,Fadel Elie,Fabre Dominique,Guihaire Julien,Ion Iolande,Menager Jean Baptiste,Mitilian Delphine,Mercier Olaf,Stephan François,Thes Jacques,Jouan Jerôme,Duburcq Thibault,Loobuyck Valentin,Moussa Mouhammed,Manganiello Sabrina,Mugnier Agnes,Rousse Natacha,Desebbe Olivier,Fellahi Jean-Luc,Henaine Roland,Pozzi Matteo,Riad Zakaria,Guervilly Christophe,Hraiech Sami,Papazian Laurent,Castanier Matthias,Chanavaz Charles,Cadoz Cyril,Gette Sebastien,Louis Guillaume,Portocarrero Erick,Gaudard Philippe,Brini Kais,Bischoff Nicolas,Kimmoun Antoine,Levy Bruno,Perez Pierre,Bourdiol Alexandre,Hourmant Yannick,Mahé Pierre-Joachim,Rozec Bertrand,Vourc’h Mickaël,Aubert Stéphane,Bazalgette Florian,Roger Claire,Jaquet Pierre,Lortat-Jacob Brice,Mordant Pierre,Nataf Patrick,Patrier Juliette,Provenchere Sophie,Roué Morgan,Sonneville Romain,Tran-Dinh Alexy,Wicky Paul-Henri,Al Zreibi Charles,Cholley Bernard,Guyonvarch Yannis,Hamada Sophie,Barbanti Claudio,Bertier Astrid,Harrois Anatole,Matiello Jordi,Kerforne Thomas,Lacroix Corentin,Brechot Nicolas,Combes Alain,Chommeloux Juliette,D’alessandro Cosimo,Demondion Pierre,Demoule Alexandre,Dres Martin,Fadel Guillaume,Fartoukh Muriel,Hekimian Guillaume,Juvin Charles,Leprince Pascal,Levy David,Luyt Charles Edouard,Schoell Thibaut,Fillâtre Pierre,Massart Nicolas,Jonas Maud,Allou Nicolas,Muccio Salvatore,Di Perna Dario,Ruggieri Vito-Giovanni,Mourvillier Bruno,Anselmi Amedeo,Bounader Karl,Launey Yoann,Lebouvier Thomas,Parasido Alessandro,Reizine Florian,Esvan Maxime,Seguin Philippe,Besnier Emmanuel,Carpentier Dorothée,Clavier Thomas,Olland Anne,Villard Marion,Bounes Fanny,Labaste François,Minville Vincent,Guillon Antoine,Fedun Yannick,
Abstract
Abstract
Background
Both critically ill patients with coronavirus disease 2019 (COVID-19) and patients receiving extracorporeal membrane oxygenation (ECMO) support exhibit a high incidence of healthcare-associated infections (HAI). However, data on incidence, microbiology, resistance patterns, and the impact of HAI on outcomes in patients receiving ECMO for severe COVID-19 remain limited. We aimed to report HAI incidence and microbiology in patients receiving ECMO for severe COVID-19 and to evaluate the impact of ECMO-associated infections (ECMO-AI) on in-hospital mortality.
Methods
For this study, we analyzed data from 701 patients included in the ECMOSARS registry which included COVID-19 patients supported by ECMO in France.
Results
Among 602 analyzed patients for whom HAI and hospital mortality data were available, 214 (36%) had ECMO-AI, resulting in an incidence rate of 27 ECMO-AI per 1000 ECMO days at risk. Of these, 154 patients had bloodstream infection (BSI) and 117 patients had ventilator-associated pneumonia (VAP). The responsible microorganisms were Enterobacteriaceae (34% for BSI and 48% for VAP), Enterococcus species (25% and 6%, respectively) and non-fermenting Gram-negative bacilli (13% and 20%, respectively). Fungal infections were also observed (10% for BSI and 3% for VAP), as were multidrug-resistant organisms (21% and 15%, respectively). Using a Cox multistate model, ECMO-AI were not found associated with hospital death (HR = 1.00 95% CI [0.79–1.26], p = 0.986).
Conclusions
In a nationwide cohort of COVID-19 patients receiving ECMO support, we observed a high incidence of ECMO-AI. ECMO-AI were not found associated with hospital death.
Trial registration number NCT04397588 (May 21, 2020).