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Healthcare-associated infections in patients with severe COVID-19 supported with extracorporeal membrane oxygenation: a nationwide cohort study

2024; BioMed Central; Volume: 28; Issue: 1 Linguagem: Inglês

10.1186/s13054-024-04832-3

1466-609X

Nicolas Nesseler, Alexandre Mansour, Matthieu Schmidt, Marylou Para, Alizée Porto, Pierre‐Emmanuel Falcoz, Nicolas Mongardon, Claire Fougerou, James T. Ross, Antoine Beurton, Lucie Gaide‐Chevronnay, Pierre-Grégoire Guinot, Guillaume Lebreton, Erwan Flécher, André Vincentelli, Nicolas Massart, Olivier Fouquet, Marc Pierrot, Sidney Chocron, Guillaume Flicoteaux, Philippe Mauriat, Alexandre Ouattara, Hadrien Rozé, Olivier Huet, Marc‐Olivier Fischer, Raphel Bellaïche, Ophélie Constant, Quentin de Roux, Laurine Andre, Arnaud Meffert, Jean‐Claude Merle, L Picard, Elena Skripkina, Thierry Folliguet, Antonio Fiore, Nicolas D’ostrevy, Marie-Catherine Morgan, Maxime Nguyen, Nicolas Terzi, Gwenhaël Colin, Olivier Fabre, Arash Astaneh, Justin Issard, Élie Fadel, Dominique Fabre, Julien Guihaire, Iolande Ion, Jean-Baptiste Ménager, Délphine Mitilian, Olaf Mercier, François Stéphan, Jacques Thès, Jérôme Jouan, Thibault Duburcq, Valentin Loobuyck, Mouhammed Moussa, Sabrina Manganiello, A Mugnier, Natacha Rousse, Olivier Desebbe, Jean-Luc Fellahi, Roland Hénaine, Mattéo Pozzi, Zakaria Riad, Christophe Guervilly, Sami Hraiech, Laurent Papazian, Matthias Castanier, C. Chanavaz, Cyril Cadoz, Sébastien Gette, Guillaume Louis, Erick Portocarrero, Philippe Gaudard, Kais Brini, Nicolas Bischoff, Antoine Kimmoun, Bruno Lévy, Pierre Perez, Alexandre Bourdiol, Yannick Hourmant, Pierre-Joachim Mahé, Bertrand Rozec, Mickaël Vourc’h, Stéphane Aubert, Florian Bazalgette, Claire Roger, Pierre Jaquet, Brice Lortat‐Jacob, Pierre Mordant, Patrick Nataf, Juliette Patrier, Sophie Provenchère, Morgan Roué, Romain Sonneville, Alexy Tran‐Dinh, Paul-Henri Wicky, Charles Al Zreibi, Bernard Cholley, Yannis Guyonvarch, Sophie Hamada, Claudio Barbanti, Astrid Bertier, Anatole Harrois, Jordi Matiello, Thomas Kerforne, C. Lacroix, Nicolas Bréchot, Alain Combes, Juliette Chommeloux, Cosimo D’Alessandro, Pierre Demondion, Alexandre Demoule, Martin Dres, Guillaume Fadel, Muriel Fartoukh, Guillaume Hékimian, Charles Juvin, Pascal Leprince, David Levy, Charles Edouard Luyt, Thibaut Schoell, Pierre Fillâtre, Nicolas Massart, Maud Jonas, Nicolas Allou, Salvatore Muccio, Dario Di Perna, Vito Giovanni Ruggieri, Bruno Mourvillier, Amédéo Anselmi, Karl Bounader, Yoann Launey, Thomas Lebouvier, Alessandro Parasido, Florian Reizine, Maxime Esvan, Philippe Séguin, Emmanuel Besnier, Dorothée Carpentier, Thomas Clavier, Anne Olland, Marion Villard, Fanny Vardon‐Bounes, François Labaste, Vincent Minville, Antoine Guillon, Yannick Fédun,

Antibiotics Pharmacokinetics and Efficacy

Abstract Background Both critically ill patients with coronavirus disease 2019 (COVID-19) and patients receiving extracorporeal membrane oxygenation (ECMO) support exhibit a high incidence of healthcare-associated infections (HAI). However, data on incidence, microbiology, resistance patterns, and the impact of HAI on outcomes in patients receiving ECMO for severe COVID-19 remain limited. We aimed to report HAI incidence and microbiology in patients receiving ECMO for severe COVID-19 and to evaluate the impact of ECMO-associated infections (ECMO-AI) on in-hospital mortality. Methods For this study, we analyzed data from 701 patients included in the ECMOSARS registry which included COVID-19 patients supported by ECMO in France. Results Among 602 analyzed patients for whom HAI and hospital mortality data were available, 214 (36%) had ECMO-AI, resulting in an incidence rate of 27 ECMO-AI per 1000 ECMO days at risk. Of these, 154 patients had bloodstream infection (BSI) and 117 patients had ventilator-associated pneumonia (VAP). The responsible microorganisms were Enterobacteriaceae (34% for BSI and 48% for VAP), Enterococcus species (25% and 6%, respectively) and non-fermenting Gram-negative bacilli (13% and 20%, respectively). Fungal infections were also observed (10% for BSI and 3% for VAP), as were multidrug-resistant organisms (21% and 15%, respectively). Using a Cox multistate model, ECMO-AI were not found associated with hospital death (HR = 1.00 95% CI [0.79–1.26], p = 0.986). Conclusions In a nationwide cohort of COVID-19 patients receiving ECMO support, we observed a high incidence of ECMO-AI. ECMO-AI were not found associated with hospital death. Trial registration number NCT04397588 (May 21, 2020).