Infection factors for patients treated with extracorporeal membrane oxygenation

doi:10.3877/cma.j.issn.2095-8773.2016.04.04

Abstract

Abstract:

Objective

To analyze the factors of hospital infection for patients treated with extracorporeal membrane oxygenation(ECMO).

Methods

The clinical data on hospital infection of patients undergoing ECMO support between January 2009 and March 2014 in Zhongshan People's Hospital of Guangdong Province were collected and retrospectively analyzed.

Results

There were 20 cases of hospital infection among 75 cases, with the infection rate of 26.7%. A total of 58 strains of pathogen were isolated, among which 43(74.1%) were Gram-negative and 15(25.9%) were Gram-positive. Acinetobacter baumannii(21 strains, 36.2%), Pseudomonas aeruginosa(18 strains, 31.0%) and coagulase-negative Staphylococci(11 strains, 20.0%) dominated multi-resistant strains. The mean hospitalization duration in infection group was significantly longer than that in non-infection group (36.5 d vs 7.0 d, Z=-2.090, P<0.05). The percent of patients with ECMO support time>48 h in infection group was 95.0%, and was significantly longer than that in non-infection group(52.7%)(χ²=11.375, P=0.001). Extended ECMO support increased the length of hospital stay, but did not increase the mortality. High levels of lactic acid increased the mortality of patients (Z =-2.598, P < 0.05).

Conclusions

Infection secondary to ECMO support is significantly related to hospital stay and ECMO support time. The hospital should take preventive measures to reduce the infection secondary to ECMO.

Key words: Extracorporeal membrane oxygenation, Infection factors, Hospital infection, Drug sensitivity, Resistant phenotype

Geqin Sun, Binfei Li, Zi Ye, Sufen Li, Haocheng Yang, Xueqin Feng, Haizhong Yan, Xihua Luo, Yuejing Mu. Infection factors for patients treated with extracorporeal membrane oxygenation[J]. Chinese Journal of Thoracic Surgery(Electronic Edition), 2016, 03(04): 209-215.

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Figures/Tables 4

References 20

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变量		非感染组(55例)	感染组(20例)	检验值	P值
性别[n(%)]		?	?	χ²＝0.151	0.697
?	男性	33(60.0)	11(55.0)	?	?
?	女性	22(40.0)	9(45.0)	?	?
年龄[n(%)]		?	?	χ²＝1.87	0.171
?	>50岁	18(32.7)	10(50.0)	?	?
?	<50岁	37(67.3)	10(50.0)	?	?
住院时间(d)		7.0 (2.0～23.0)	36.5(25.8～64.5)	Z＝－2.090	0.037
ECMO支持时间[n(%)]		?	?	χ²＝11.375	0.001
?	>48 h	29(52.7)	19(95.0)	?	?
?	≤48 h	26(47.3)	1(5.0)	?	?
ECMO模式[n(%)]		?	?	χ²＝1.86	0.386
?	V/V	3(5.5)	3(15.0)	?	?
?	V/A	52(94.5)	17(85.0)	?	?
胸片感染[n(%)]		?	?	χ²＝0.398	0.528
?	是	23(41.8)	10(50.0)	?	?
?	否	32(58.2)	10(50.0)	?	?
侵入性操作[n(%)]		?	?	χ²＝0.032	1.000
?	是	45(81.8)	16(80.0)	?	?
?	否	10(18.2)	4(20.0)	?	?
抗生素使用[n(%)]		?	?	χ²＝0.959	0.327
?	是	18(32.7)	9(45.0)	?	?
?	否	37(67.3)	11(55.0)	?	?
激素使用[n(%)]		?	?	χ²＝19.49	0.352
?	是	17(30.9)	4(20.0)	?	?
?	否	38(69.1)	16(80.0)	?	?

变量		非感染组(55例)	感染组(20例)	检验值	P值
性别[n(%)]		?	?	χ²＝0.151	0.697
?	男性	33(60.0)	11(55.0)	?	?
?	女性	22(40.0)	9(45.0)	?	?
年龄[n(%)]		?	?	χ²＝1.87	0.171
?	>50岁	18(32.7)	10(50.0)	?	?
?	<50岁	37(67.3)	10(50.0)	?	?
住院时间(d)		7.0 (2.0～23.0)	36.5(25.8～64.5)	Z＝－2.090	0.037
ECMO支持时间[n(%)]		?	?	χ²＝11.375	0.001
?	>48 h	29(52.7)	19(95.0)	?	?
?	≤48 h	26(47.3)	1(5.0)	?	?
ECMO模式[n(%)]		?	?	χ²＝1.86	0.386
?	V/V	3(5.5)	3(15.0)	?	?
?	V/A	52(94.5)	17(85.0)	?	?
胸片感染[n(%)]		?	?	χ²＝0.398	0.528
?	是	23(41.8)	10(50.0)	?	?
?	否	32(58.2)	10(50.0)	?	?
侵入性操作[n(%)]		?	?	χ²＝0.032	1.000
?	是	45(81.8)	16(80.0)	?	?
?	否	10(18.2)	4(20.0)	?	?
抗生素使用[n(%)]		?	?	χ²＝0.959	0.327
?	是	18(32.7)	9(45.0)	?	?
?	否	37(67.3)	11(55.0)	?	?
激素使用[n(%)]		?	?	χ²＝19.49	0.352
?	是	17(30.9)	4(20.0)	?	?
?	否	38(69.1)	16(80.0)	?	?

抗生素名称	鲍曼不动杆菌（21株）			铜绿假单胞菌（18株）
抗生素名称	耐药率	中介	敏感度	耐药率	中介	敏感度
氨苄西林(AMP)	100	0	0	100	0	0
派拉西林(PIP)	100	0	0	16.7	50	33.3
派拉西林/他唑巴坦(TZP)	100	0	0	8.3	58.3	33.3
头孢唑啉(CZO)	100	0	0	100	0	0
头孢呋辛(CXM)	100	0	0	100	0	0
头孢他啶(CAZ)	100	0	0	8.3	8.3	83.3
头孢曲松(CRO)	100	0	0	88.9	11.1	0
头孢吡肟(FEP)	100	0	0	16.7	0	83.3
头孢替坦(CTT)	100	0	0	100	0	0
头孢呋辛酯(CXA)	100	0	0	100	0	0
氨曲南(ATM)	100	0	0	80	0	20
亚胺培南(IPM)	100	0	0	25	0	75
美罗培南(MEM)	100	0	0	25	0	75
阿米卡星(AMK)	100	0	0	16.7	0	83.3
庆大霉素(GEN)	84.6	15.4	0	16.7	0	83.3
呋喃妥英(NIT)	100	0	0	100	0	0
妥布霉素(TOB)	84.6	15.4	0	16.7	0	83.3
环丙沙星(CIP)	100	0	0	16.7	0	83.3
左氧氟沙星(LVX)	100	0	0	16.7	0	83.3
复方新诺明(SXT)	41.7	0	58.3	72.7	0	27.3
头孢西丁(FOX)	100	0	0	－	－	－
氨苄西林/舒巴坦(SAM)	100	0	0	－	－	－

抗生素名称	鲍曼不动杆菌（21株）			铜绿假单胞菌（18株）
抗生素名称	耐药率	中介	敏感度	耐药率	中介	敏感度
氨苄西林(AMP)	100	0	0	100	0	0
派拉西林(PIP)	100	0	0	16.7	50	33.3
派拉西林/他唑巴坦(TZP)	100	0	0	8.3	58.3	33.3
头孢唑啉(CZO)	100	0	0	100	0	0
头孢呋辛(CXM)	100	0	0	100	0	0
头孢他啶(CAZ)	100	0	0	8.3	8.3	83.3
头孢曲松(CRO)	100	0	0	88.9	11.1	0
头孢吡肟(FEP)	100	0	0	16.7	0	83.3
头孢替坦(CTT)	100	0	0	100	0	0
头孢呋辛酯(CXA)	100	0	0	100	0	0
氨曲南(ATM)	100	0	0	80	0	20
亚胺培南(IPM)	100	0	0	25	0	75
美罗培南(MEM)	100	0	0	25	0	75
阿米卡星(AMK)	100	0	0	16.7	0	83.3
庆大霉素(GEN)	84.6	15.4	0	16.7	0	83.3
呋喃妥英(NIT)	100	0	0	100	0	0
妥布霉素(TOB)	84.6	15.4	0	16.7	0	83.3
环丙沙星(CIP)	100	0	0	16.7	0	83.3
左氧氟沙星(LVX)	100	0	0	16.7	0	83.3
复方新诺明(SXT)	41.7	0	58.3	72.7	0	27.3
头孢西丁(FOX)	100	0	0	－	－	－
氨苄西林/舒巴坦(SAM)	100	0	0	－	－	－

变量		总例数	死亡组(33例)	存活组(25例)	检验值	P值
感染病原体		58	?	?	?	0.031^①
?	鲍曼不动杆菌	21	14(42.4)	7(28.0)	?	?
?	洋葱伯克霍尔德菌	1	0(0)	1(4.0)	?	?
?	大肠杆菌	2	0(0)	2(8.0)	?	?
?	肺炎克雷伯菌	1	0(0)	1(4.0)	?	?
?	铜绿假单胞菌	18	12(36.4)	6(24.0)	?	?
?	金黄色葡萄球菌	4	0(0)	4(16.0)	?	?
?	头状葡萄球菌	1	1(3.0)	0(0)	?	?
?	表皮葡萄球菌	3	1(3.0)	2(8.0)	?	?
?	溶血葡萄球菌	5	4(12.1)	1(4.0)	?	?
?	人型葡萄球菌	1	0(0)	1(4.0)	?	?
?	缓慢葡萄球菌	1	1(3.0)	0(0)	?	?
ECMO持续时间		58	6.73±2.91	6.96±4.77	Z＝－2.826	0.831
ECMO模式		?	?	?	?	?
?	静脉-动脉	50	29(87.9)	21(84.0)	χ²＝0.143	0.968
?	静脉-静脉	8	4(12.1)	4(16.0)	?	?
体温		58	36.50(36.50～36.70)	36.50(36.50～36.50)	Z＝－0.479	0.156
白细胞计数		58	13.18±6.59	15.12±6.44	Z＝－0.386	0.267
降钙素原		47	12.29±17.15	18.14±27.59	Z＝－0.853	0.522
乳酸		40	2.35(1.32～5.20)	1.27(0.96～2.09)	Z＝－2.598	0.046

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