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

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2024年2月20日

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  • 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 Flecher,
  • André Vincentelli,
  • Nicolas Massart,
  • Olivier Fouquet,
  • Marc Pierrot,
  • Sidney Chocron,
  • Guillaume Flicoteaux,
  • Philippe Mauriat,
  • Alexandre Ouattara,
  • Hadrien Roze,
  • Olivier Huet,
  • Marc-Olivier Fischer,
  • Raphel Bellaïche,
  • Ophélie Constant,
  • Quentin De Roux,
  • L. Y. André,
  • Arnaud Meffert,
  • Jean-Claude Merle,
  • Lucile 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,
  • Elie Fadel,
  • Dominique Fabre,
  • Julien Guihaire,
  • Iolande Ion,
  • Jean Baptiste Menager,
  • Delphine Mitilian,
  • Olaf Mercier,
  • François Stephan,
  • Jacques Thes,
  • Jerôme Jouan,
  • Thibault Duburcq,
  • Valentin Loobuyck,
  • Mouhammed Moussa,
  • Sabrina Manganiello,
  • Agnes Mugnier,
  • Natacha Rousse,
  • Olivier Desebbe,
  • Jean-Luc Fellahi,
  • Roland Henaine,
  • Matteo Pozzi,
  • Zakaria Riad,
  • Christophe Guervilly,
  • Sami Hraiech,
  • Laurent Papazian,
  • Matthias Castanier,
  • Charles Chanavaz,
  • Cyril Cadoz,
  • Sebastien Gette,
  • Guillaume Louis,
  • Erick Portocarrero,
  • Philippe Gaudard,
  • Kais Brini,
  • Nicolas Bischoff,
  • Antoine Kimmoun,
  • Bruno Levy,
  • 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 Provenchere,
  • 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,
  • Corentin Lacroix,
  • Nicolas Brechot,
  • Alain Combes,
  • Juliette Chommeloux,
  • Cosimo D’alessandro,
  • Pierre Demondion,
  • Alexandre Demoule,
  • Martin Dres,
  • Guillaume Fadel,
  • Muriel Fartoukh,
  • Guillaume Hekimian,
  • 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,
  • Amedeo Anselmi,
  • Karl Bounader,
  • Yoann Launey,
  • Thomas Lebouvier,
  • Alessandro Parasido,
  • Florian Reizine,
  • Maxime Esvan,
  • Philippe Seguin,
  • Emmanuel Besnier,
  • Dorothée Carpentier,
  • Thomas Clavier,
  • Anne Olland,
  • Marion Villard,
  • Fanny Bounes,
  • François Labaste,
  • Vincent Minville,
  • Antoine Guillon,
  • Yannick Fedun

摘要

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).