title: Bloodstream infections in pediatric ECLS: usefulness of daily blood culture monitoring and predictive value of biological markers. The British Columbia experience.
abstract: BACKGROUND
  The incidence of bloodstream infection (BSI) in extracorporeal life support (ECLS) is reported between 0.9 and 19.5%. In January 2006, the Extracorporeal Life Support Organization (ELSO) reported an overall incidence of 8.78% distributed as follows: respiratory: 6.5% (neonatal), 20.8% (pediatric); cardiac: 8.2% (neonatal) and 12.6% (pediatric).
  
  
  METHODS
  At BC Children's Hospital (BCCH) daily surveillance blood cultures (BC) are performed and antibiotic prophylaxis is not routinely recommended. Positive BC (BC+) were reviewed, including resistance profiles, collection time of BC+, time to positivity and mortality. White blood cell count, absolute neutrophile count, immature/total ratio, platelet count, fibrinogen and lactate were analyzed 48, 24 and 0 h prior to BSI. A univariate linear regression analysis was performed.
  
  
  RESULTS
  From 1999 to 2005, 89 patients underwent ECLS. After exclusion, 84 patients were reviewed. The attack rate was 22.6% (19 BSI) and 13.1% after exclusion of coagulase-negative staphylococci (n = 8). BSI patients were significantly longer on ECLS (157 h) compared to the no-BSI group (127 h, 95% CI: 106-148). Six BSI patients died on ECLS (35%; 4 congenital diaphragmatic hernias, 1 hypoplastic left heart syndrome and 1 after a tetralogy repair). BCCH survival on ECLS was 71 and 58% at discharge, which is comparable to previous reports. No patient died primarily because of BSI. No BSI predictor was identified, although lactate may show a decreasing trend before BSI (P = 0.102).
  
  
  CONCLUSIONS
  Compared with ELSO, the studied BSI incidence was higher with a comparable mortality. We speculate that our BSI rate is explained by underreporting of "contaminants" in the literature, the use of broad-spectrum antibiotic prophylaxis and a higher yield with daily monitoring BC. We support daily surveillance blood cultures as an alternative to antibiotic prophylaxis in the management of patients on ECLS.
authors.affiliation: Division of Neonatal Intensive Care, Department of Pediatrics, The British Columbia Children's Hospital, 1R47-4480 Oak Street, Vancouver, BC, V6H 3V4, Canada.
authors.forename: Gregor W
authors.initials: GW
authors.lastname: Kaczala
authors.forename: Stephane C
authors.initials: SC
authors.lastname: Paulus
authors.forename: Nawaf
authors.initials: N
authors.lastname: Al-Dajani
authors.forename: Wilson
authors.initials: W
authors.lastname: Jang
authors.forename: Edith
authors.initials: E
authors.lastname: Blondel-Hill
authors.forename: Simon
authors.initials: S
authors.lastname: Dobson
authors.forename: Arthur
authors.initials: A
authors.lastname: Cogswell
authors.forename: Avash J
authors.initials: AJ
authors.lastname: Singh
mesh_terms: D000293:Adolescent; D015415:Biomarkers / Q000097:blood; D001769:Blood / Q000382:microbiology; D002675:Child, Preschool; D005112:Extracorporeal Circulation / Q000009:adverse effects*; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008828:Microbiological Techniques; D011237:Predictive Value of Tests; D012189:Retrospective Studies
chemical_list: D015415:Biomarkers