Different characteristics of bloodstream infection during venoarterial and venovenous extracorporeal membrane oxygenation in adult patients

Abstract Currently, there is scarcity of data on whether differences exist in clinical characteristics and outcomes of bloodstream infection (BSI) between venoarterial (VA) and venovenous (VV) extracorporeal membrane oxygenation (ECMO) and whether they differ between Candida BSI and bacteremia in ad...

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Autores principales:	Hyoung Soo Kim, Sunghoon Park, Ho Hyun Ko, Sang Ook Ha, Sun Hee Lee, Yong Kyun Kim
Formato:	article
Lenguaje:	EN
Publicado:	Nature Portfolio 2021
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/5bdabf99de6d4c3d8c1ed45f3d6af2ae
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spelling	oai:doaj.org-article:5bdabf99de6d4c3d8c1ed45f3d6af2ae2021-12-02T14:41:55ZDifferent characteristics of bloodstream infection during venoarterial and venovenous extracorporeal membrane oxygenation in adult patients10.1038/s41598-021-89108-42045-2322https://doaj.org/article/5bdabf99de6d4c3d8c1ed45f3d6af2ae2021-05-01T00:00:00Zhttps://doi.org/10.1038/s41598-021-89108-4https://doaj.org/toc/2045-2322Abstract Currently, there is scarcity of data on whether differences exist in clinical characteristics and outcomes of bloodstream infection (BSI) between venoarterial (VA) and venovenous (VV) extracorporeal membrane oxygenation (ECMO) and whether they differ between Candida BSI and bacteremia in adult ECMO patients. We retrospectively reviewed data of patients who required ECMO for > 48 h and had BSIs while receiving ECMO between January 2015 and June 2020. Cases with a positive blood culture result within 24 h of ECMO implantation were excluded. We identified 94 (from 64 of 194 patients) and 38 (from 17 of 56 patients) BSI episodes under VA and VV ECMO, respectively. Fifty nine BSIs of VA ECMO (59/94, 62.8%) occurred in the first 2 weeks after ECMO implantation, whereas 24 BSIs of VV ECMO (24/38, 63.2%) occurred after 3 weeks of ECMO implantation. Gram-negative bacteremia (39/59, 66.1%) and gram-positive bacteremia (10/24, 41.7%) were the most commonly identified BSI types in the first 2 weeks after VA ECMO implantation and after 3 weeks of VV implantation, respectively. Timing of Candida BSI was early (6/11, 54.5% during the first 2 weeks) in VA ECMO and late (6/9, 66.7% after 3 weeks of initiation) in VV ECMO. Compared with bacteremia, Candida BSI showed no differences in clinical characteristics and outcomes during VA and VV ECMO, except the significant association with prior exposure to carbapenem in VA ECMO (vs. gram-negative bacteremia [P = 0.006], vs. gram-positive bacteremia [P = 0.03]). Our results suggest that ECMO modes may affect BSI clinical features and timing. In particular, Candida BSI occurrence during the early course of VA ECMO is not uncommon, especially in patients with prior carbapenem exposure; however, it usually occurs during the prolonged course of VV ECMO. Consequently, routine blood culture surveillance and empiric antifungal therapy might be warranted in targeted populations of adult ECMO patients, regardless of levels of inflammatory markers and severity scores.Hyoung Soo KimSunghoon ParkHo Hyun KoSang Ook HaSun Hee LeeYong Kyun KimNature PortfolioarticleMedicineRScienceQENScientific Reports, Vol 11, Iss 1, Pp 1-10 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Hyoung Soo Kim Sunghoon Park Ho Hyun Ko Sang Ook Ha Sun Hee Lee Yong Kyun Kim Different characteristics of bloodstream infection during venoarterial and venovenous extracorporeal membrane oxygenation in adult patients
description	Abstract Currently, there is scarcity of data on whether differences exist in clinical characteristics and outcomes of bloodstream infection (BSI) between venoarterial (VA) and venovenous (VV) extracorporeal membrane oxygenation (ECMO) and whether they differ between Candida BSI and bacteremia in adult ECMO patients. We retrospectively reviewed data of patients who required ECMO for > 48 h and had BSIs while receiving ECMO between January 2015 and June 2020. Cases with a positive blood culture result within 24 h of ECMO implantation were excluded. We identified 94 (from 64 of 194 patients) and 38 (from 17 of 56 patients) BSI episodes under VA and VV ECMO, respectively. Fifty nine BSIs of VA ECMO (59/94, 62.8%) occurred in the first 2 weeks after ECMO implantation, whereas 24 BSIs of VV ECMO (24/38, 63.2%) occurred after 3 weeks of ECMO implantation. Gram-negative bacteremia (39/59, 66.1%) and gram-positive bacteremia (10/24, 41.7%) were the most commonly identified BSI types in the first 2 weeks after VA ECMO implantation and after 3 weeks of VV implantation, respectively. Timing of Candida BSI was early (6/11, 54.5% during the first 2 weeks) in VA ECMO and late (6/9, 66.7% after 3 weeks of initiation) in VV ECMO. Compared with bacteremia, Candida BSI showed no differences in clinical characteristics and outcomes during VA and VV ECMO, except the significant association with prior exposure to carbapenem in VA ECMO (vs. gram-negative bacteremia [P = 0.006], vs. gram-positive bacteremia [P = 0.03]). Our results suggest that ECMO modes may affect BSI clinical features and timing. In particular, Candida BSI occurrence during the early course of VA ECMO is not uncommon, especially in patients with prior carbapenem exposure; however, it usually occurs during the prolonged course of VV ECMO. Consequently, routine blood culture surveillance and empiric antifungal therapy might be warranted in targeted populations of adult ECMO patients, regardless of levels of inflammatory markers and severity scores.
format	article
author	Hyoung Soo Kim Sunghoon Park Ho Hyun Ko Sang Ook Ha Sun Hee Lee Yong Kyun Kim
author_facet	Hyoung Soo Kim Sunghoon Park Ho Hyun Ko Sang Ook Ha Sun Hee Lee Yong Kyun Kim
author_sort	Hyoung Soo Kim
title	Different characteristics of bloodstream infection during venoarterial and venovenous extracorporeal membrane oxygenation in adult patients
title_short	Different characteristics of bloodstream infection during venoarterial and venovenous extracorporeal membrane oxygenation in adult patients
title_full	Different characteristics of bloodstream infection during venoarterial and venovenous extracorporeal membrane oxygenation in adult patients
title_fullStr	Different characteristics of bloodstream infection during venoarterial and venovenous extracorporeal membrane oxygenation in adult patients
title_full_unstemmed	Different characteristics of bloodstream infection during venoarterial and venovenous extracorporeal membrane oxygenation in adult patients
title_sort	different characteristics of bloodstream infection during venoarterial and venovenous extracorporeal membrane oxygenation in adult patients
publisher	Nature Portfolio
publishDate	2021
url	https://doaj.org/article/5bdabf99de6d4c3d8c1ed45f3d6af2ae
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Different characteristics of bloodstream infection during venoarterial and venovenous extracorporeal membrane oxygenation in adult patients

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