title: Nosocomial Infection in Adult Patients Undergoing Veno-Arterial Extracorporeal Membrane Oxygenation.
abstract: Data on the frequency of nosocomial infections during extracorporeal membrane oxygenation (ECMO) in adult populations remain scarce. We investigated the risk factors for nosocomial infections in adult patients undergoing venoarterial ECMO (VA-ECMO) support. From January 2011 to December 2015, a total of 259 patients underwent ECMO. Of these, patients aged 17 years or less and patients undergoing ECMO for less than 48 hours were excluded. Of these, 61 patients diagnosed with cardiogenic shock were evaluated. Mean patient age was 60.6 ± 14.3 years and 21 (34.4%) patients were female. The mean preoperative Sequential Organ Failure Assessment (SOFA) score was 8.6 ± 2.2. The mean duration of ECMO support was 6.8 ± 7.4 days. The rates of successful ECMO weaning and survival to discharge were 44.3% and 31.1%, respectively. There were 18 nosocomial infections in 14 (23.0%) patients. These included respiratory tract infections in 9 cases and bloodstream infections in a further 9. In multivariate analysis, independent predictors of infection during ECMO were the preoperative creatinine level (hazard ratio [HR], 2.176; 95% confidence interval [CI], 1.065-4.447; P = 0.033) and the duration of ECMO support (HR, 1.400; 95% CI, 1.081-1.815; P = 0.011). A higher preoperative creatinine level and an extended duration of ECMO support are risk factors for infection. Therefore, to avoid the development of nosocomial infections, strategies to shorten the length of ECMO support should be applied whenever possible.
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea.
authors.forename: Gwan Sic
authors.identifier: http://orcid.org/0000-0002-0648-0178
authors.initials: GS
authors.lastname: Kim
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea.
authors.forename: Kyo Seon
authors.identifier: http://orcid.org/0000-0001-7397-4680
authors.initials: KS
authors.lastname: Lee
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
authors.forename: Choung Kyu
authors.identifier: http://orcid.org/0000-0002-9898-2545
authors.initials: CK
authors.lastname: Park
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea.
authors.forename: Seung Ku
authors.identifier: http://orcid.org/0000-0001-7558-9102
authors.initials: SK
authors.lastname: Kang
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea.
authors.forename: Do Wan
authors.identifier: http://orcid.org/0000-0003-2262-2882
authors.initials: DW
authors.lastname: Kim
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea.
authors.forename: Sang Gi
authors.identifier: http://orcid.org/0000-0001-9394-4980
authors.initials: SG
authors.lastname: Oh
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea.
authors.forename: Bong Suk
authors.identifier: http://orcid.org/0000-0001-8389-190X
authors.initials: BS
authors.lastname: Oh
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea.
authors.forename: Yochun
authors.identifier: http://orcid.org/0000-0001-7165-3007
authors.initials: Y
authors.lastname: Jung
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea.
authors.forename: Seok
authors.identifier: http://orcid.org/0000-0002-0850-169X
authors.initials: S
authors.lastname: Kim
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea.
authors.forename: Ju Sik
authors.identifier: http://orcid.org/0000-0002-5167-3454
authors.initials: JS
authors.lastname: Yun
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea.
authors.forename: Sang Yun
authors.identifier: http://orcid.org/0000-0002-2084-8143
authors.initials: SY
authors.lastname: Song
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea.
authors.forename: Kook Joo
authors.identifier: http://orcid.org/0000-0003-0923-1414
authors.initials: KJ
authors.lastname: Na
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea.
authors.forename: In Seok
authors.identifier: http://orcid.org/0000-0002-2249-0667
authors.initials: IS
authors.lastname: Jeong
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea. bhahn@chonnam.ac.kr.
authors.forename: Byoung Hee
authors.identifier: http://orcid.org/0000-0002-7579-1359
authors.initials: BH
authors.lastname: Ahn
mesh_terms: D000328:Adult; D000368:Aged; D003404:Creatinine / Q000097:blood; D003428:Cross Infection / Q000453:epidemiology / Q000382:microbiology / Q000628:therapy*; D015199:Extracorporeal Membrane Oxygenation; D005260:Female; D006090:Gram-Negative Bacteria / Q000302:isolation & purification; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D016016:Proportional Hazards Models; D012141:Respiratory Tract Infections / Q000175:diagnosis / Q000628:therapy; D012307:Risk Factors; D012770:Shock, Cardiogenic / Q000209:etiology; D013997:Time Factors; D055815:Young Adult
chemical_list: D003404:Creatinine
keywords: Extracorporeal Membrane Oxygenation Support; Infection