title: Nosocomial infections in adult cardiogenic shock patients supported by venoarterial extracorporeal membrane oxygenation.
abstract: BACKGROUND
  Incidence and impact on adult patients' outcomes of nosocomial infections (NIs) occurring during venoarterial extracorporeal membrane oxygenation (VA-ECMO) support for refractory cardiogenic shock have rarely been described.
  
  
  METHODS
  We retrospectively reviewed the charts of a large series of patients who received VA-ECMO in our intensive care unit (ICU) from January 2003 through December 2009. Incidence, types, risk factors, and impact on outcomes of NIs occurring during ECMO support were analyzed.
  
  
  RESULTS
  Among 220 patients (49 ± 16 years old, simplified acute physiology score (SAPS) II 61 ± 20) who underwent ECMO support for >48 hours for a total of 2942 ECMO days, 142 (64%) developed NIs. Ventilator-associated pneumonia (VAP), bloodstream infections, cannula infections, and mediastinitis infections occurred in 55%, 18%, 10% and 11% of the patients, respectively. More critical condition at ICU admission, but not antibiotics at the time of ECMO cannulation, was associated with subsequently developing NIs (hazard ratio, 0.73; 95% confidence interval [CI], .50-1.05; P = .09). Infected patients had longer durations of mechanical ventilation, ECMO support, and hospital stays. Independent predictors of death were infection with severe sepsis or septic shock (odds ratio, 1.93; 95% CI, 1.26-2.94; P = .002) and SAPS II, whereas immunosuppression and myocarditis as the reason for ECMO support were associated with better outcomes.
  
  
  CONCLUSIONS
  Cardiogenic shock patients who received the latest generation VA-ECMO still had a high risk of developing NIs, particularly VAP. Strategies aimed at preventing these infections may improve the outcomes of these critically ill patients.
authors.affiliation: Service de Réanimation Médicale, Institut de Cardiologie, Paris Cedex 13, France.
authors.forename: Matthieu
authors.initials: M
authors.lastname: Schmidt
authors.forename: Nicolas
authors.initials: N
authors.lastname: Bréchot
authors.forename: Sarah
authors.initials: S
authors.lastname: Hariri
authors.forename: Marguerite
authors.initials: M
authors.lastname: Guiguet
authors.forename: Charles Edouard
authors.initials: CE
authors.lastname: Luyt
authors.forename: Ralouka
authors.initials: R
authors.lastname: Makri
authors.forename: Pascal
authors.initials: P
authors.lastname: Leprince
authors.forename: Jean-Louis
authors.initials: JL
authors.lastname: Trouillet
authors.forename: Alain
authors.initials: A
authors.lastname: Pavie
authors.forename: Jean
authors.initials: J
authors.lastname: Chastre
authors.forename: Alain
authors.initials: A
authors.lastname: Combes
mesh_terms: D000328:Adult; D000368:Aged; D003428:Cross Infection / Q000150:complications* / Q000382:microbiology; D015199:Extracorporeal Membrane Oxygenation / Q000379:methods*; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D012770:Shock, Cardiogenic / Q000382:microbiology* / Q000601:surgery / Q000628:therapy*; D018709:Statistics, Nonparametric; D016019:Survival Analysis; D016896:Treatment Outcome