title: Risk of circuit infection in septic patients on extracorporeal membrane oxygenation: a preliminary study.
abstract: Extracorporeal membrane oxygenation (ECMO) is the ultimate treatment option to improve gas exchange and decrease the aggressiveness of mechanical ventilation in septic patients with uncontrolled severe lung failure. However, potential microbiological colonization of the artificial surfaces of membrane oxygenator (MO) remains a critical issue in patients with bacteremia. The current study investigates the risk of MO infection in 10 consecutive septic patients on long-term treatment with ECMO. The flushing fluids of all investigated MOs were sterile. After incubation with nutrient solution for 14 days in one MO Enterococci spp. were isolated. In the patient concerned, a diffuse, unaccountable bleeding diathesis had developed, which stopped after exchange of the MO. Analysis of clinical parameters showed that D dimers had increased and fibrinogen levels had decreased before exchange of this MO, but standard markers of infection had remained unremarkable. In conclusion, circuit infection may be a potential cause for unexplained clinical deterioration of patients on ECMO, which therefore should be considered as an indication for exchange of the device.
authors.affiliation: Department of Internal Medicine II, Institute for Medical Microbiology and Hygiene, University Medical Center of Regensburg, Franz-Josef-Strauss Allee 11, Regensburg, Germany. thomas.mueller@klinik.uniregensburg.de
authors.forename: Thomas
authors.initials: T
authors.lastname: Müller
authors.forename: Matthias
authors.initials: M
authors.lastname: Lubnow
authors.forename: Alois
authors.initials: A
authors.lastname: Philipp
authors.forename: Wulf
authors.initials: W
authors.lastname: Schneider-Brachert
authors.forename: Daniele
authors.initials: D
authors.lastname: Camboni
authors.forename: Christof
authors.initials: C
authors.lastname: Schmid
authors.forename: Karla
authors.initials: K
authors.lastname: Lehle
mesh_terms: D000328:Adult; D001424:Bacterial Infections / Q000209:etiology*; D015199:Extracorporeal Membrane Oxygenation / Q000009:adverse effects*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010107:Oxygenators, Membrane / Q000382:microbiology*; D012307:Risk Factors; D018805:Sepsis / Q000150:complications* / Q000628:therapy