Infection and Drug Resistance (Jun 2021)
Analysis of Nosocomial Infection and Risk Factors in Patients with ECMO Treatment
Abstract
Zhan-Jie Li,1,* Dong-Fang Zhang,2,* Wei-Hong Zhang3 1Department of Infection Control, First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, Jiangsu, People’s Republic of China; 2Department of Infection Control, Shanghai Fourth People’s Hospital Affiliated to Tongji University School of Medicine, Shanghai, 200434, People’s Republic of China; 3Office of the Dean, Jiangsu Shengze Hospital Affiliated to Nanjing Medical University, Suzhou, Jiangsu, 215228, People’s Republic of China*These authors contributed equally to this workCorrespondence: Wei-Hong ZhangOffice of the Dean, Jiangsu Shengze Hospital Affiliated to Nanjing Medical University, No. 1399, Shichang West Road, Shengze Town, Wujiang District, Suzhou, 215228, Jiangsu, People’s Republic of ChinaTel +86-512-63097006Email [email protected]: To investigate the drug resistance of nosocomial infection-related pathogens in patients who underwent extracorporeal membrane oxygenation (ECMO), analyzing the nosocomial infection-related risk factors.Methods: The medical records of 56 patients who received ECMO support treatment in the First Affiliated Hospital with Nanjing Medical University from January 2013 to December 2019 were selected. The nosocomial infection, pathogen distribution and drug resistance, and the influencing factors of nosocomial infection were analyzed. The predictive value of independent risk factors for nosocomial infection after ECMO was analyzed using the receiver operating characteristic (ROC) curve.Results: A total of 56 patients receiving ECMO treatment were included. The nosocomial infection rate was 28.57%, and the prevalence infection rate was 44.64%. Lower respiratory tract infection was the main infection site. Among these infectious patients, 53 strains of pathogens were detected. The results showed that the gram-negative bacteria were mainly Acinetobacter baumannii and Klebsiella pneumonia. Moreover, the drug resistance rate of Acinetobacter baumannii to most of the antibiotics was more than 65%, among which the drug resistance rate to carbapenems was 80%. The results of risk factors of nosocomial infection after ECMO were analyzed by univariate analysis, showing that ECMO treatment time, hospitalization time, antibacterial drug use time, ventilator use time, catheter intubation time and central venous intubation time were statistically significant (all p < 0.001). Multivariate analysis identified that ECMO treatment time was an independent risk factor. As showed by ROC curve, ECMO treatment time had a high predictive value for postoperative nosocomial infection. ECMO treatment times of more than 4.5 days were associated with an increased risk of nosocomial infection.Conclusion: The nosocomial infection rate after ECMO was relatively high, and the main pathogens are Gram-negative bacteria. The selection of antibiotics should be based on the results of pathogen drug sensitivity.Keywords: extracorporeal membrane oxygenation, nosocomial infection, risk factors, infection site
