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Rates of nosocomial infection associated with interhospital transfer of patients receiving extracorporeal membrane oxygenation

Published online by Cambridge University Press:  25 June 2021

Joseph E. Marcus Open the ORCID record for Joseph E. Marcus [Opens in a new window] ,
Valerie G. Sams ,
James K. Aden ,
Andriy Batchinsky ,
Michal J. Sobieszczyk ,
Jason F. Okulicz  and
Alice E. Barsoumian
Joseph E. Marcus*
Affiliation:
Infectious Disease Service, Department of Internal Medicine, JBSA–Ft Sam Houston, San Antonio, Texas
Valerie G. Sams
Affiliation:
Department of Surgery, Brooke Army Medical Center, JBSA–Ft. Sam Houston, San Antonio, Texas
James K. Aden
Affiliation:
Biostatistics, Brooke Army Medical Center, JBSA–Ft Sam Houston, San Antonio, Texas
Andriy Batchinsky
Affiliation:
US Army Institute of Surgical Research, JBSA–Ft. Sam Houston, San Antonio, Texas
Michal J. Sobieszczyk
Affiliation:
Pulmonary Service, Department of Internal Medicine, JBSA–Ft Sam Houston, San Antonio, Texas
Jason F. Okulicz
Affiliation:
Infectious Disease Service, Department of Internal Medicine, JBSA–Ft Sam Houston, San Antonio, Texas
Alice E. Barsoumian
Affiliation:
Infectious Disease Service, Department of Internal Medicine, JBSA–Ft Sam Houston, San Antonio, Texas
*
Author for correspondence: Joseph E Marcus, Email: [email protected]
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Abstract

Objectives:

Critically ill patients requiring extracorporeal membrane oxygenation (ECMO) frequently require interhospital transfer to a center that has ECMO capabilities. Patients receiving ECMO were evaluated to determine whether interhospital transfer was a risk factor for subsequent development of a nosocomial infection.

Design:

Retrospective cohort study.

Setting:

A 425-bed academic tertiary-care hospital.

Patients:

All adult patients who received ECMO for >48 hours between May 2012 and May 2020.

Methods:

The rate of nosocomial infections for patients receiving ECMO was compared between patients who were cannulated at the ECMO center and patients who were cannulated at a hospital without ECMO capabilities and transported to the ECMO center for further care. Additionally, time to infection, organisms responsible for infection, and site of infection were compared.

Results:

In total, 123 patients were included in analysis. For the primary outcome of nosocomial infection, there was no difference in number of infections per 1,000 ECMO days (25.4 vs 29.4; P = .03) by univariate analysis. By Cox proportional hazard analysis, transport was not significantly associated with increased infections (hazard ratio, 1.7; 95% confidence interval, 0.8–4.2; P = .20).

Conclusion:

In this study, we did not identify an increased risk of nosocomial infection during subsequent hospitalization. Further studies are needed to identify sources of nosocomial infection in this high-risk population.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 43 , Issue 7 , July 2022 , pp. 864 - 869
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Copyright
© The Author(s), 2021. Published by Cambridge University Press on behalf of The Society for Healthcare Epidemiology of America

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Footnotes

PREVIOUS PRESENTATION. A portion of this work was presented at IDWeek 2020 on October 22, 2020, held virtually.

References

Grasselli, G, Scaravilli, V, Di Bella, S, et al. Nosocomial infections during extracorporeal membrane oxygenation: incidence, etiology, and impact on patients’ outcome. Crit Care Med 2017;45:1726–1733.CrossRefGoogle ScholarPubMed
Bizzarro, MJ, Conrad, SA, Kaufman, DA, Rycus, P. Infections acquired during extracorporeal membrane oxygenation in neonates, children, and adults. Pediatr Crit Care Med 2011;12:277–281.CrossRefGoogle Scholar
O’Hara, NB, Reed, HJ, Afshinnekoo, E, et al. Metagenomic characterization of ambulances across the USA. Microbiome 2017;5:125.CrossRefGoogle ScholarPubMed
Wepler, M, Stahl, W, von Baum, H, et al. Prevalence of nosocomial pathogens in German ambulances: the SEKURE study. Emerg Med J 2015;32:409–411.CrossRefGoogle ScholarPubMed
Mackay, WG, Whitehead, S, Purdue, N, et al. Infection control implications of the laundering of ambulance staff uniforms and reusable mops. J Hosp Infect 2017;96:59–62.CrossRefGoogle ScholarPubMed
Sutter, DE, Bradshaw, LU, Simkins, LH, et al. High incidence of multidrug-resistant gram-negative bacteria recovered from Afghan patients at a deployed US military hospital. Infect Control Hosp Epidemiol 2011;32:854–860.CrossRefGoogle Scholar
Ake, J, Scott, P, Wortmann, G, et al. Gram-negative multidrug-resistant organism colonization in a US military healthcare facility in Iraq. Infect Control Hosp Epidemiol 2011;32:545–552.CrossRefGoogle Scholar
Janvier, F, Delacour, H, Tesse, S, et al. Faecal carriage of extended-spectrum beta-lactamase-producing enterobacteria among soldiers at admission in a French military hospital after aeromedical evacuation from overseas. Eur J Clin Microbiol Infect Dis 2014;33:1719–1723.CrossRefGoogle Scholar
Kollef, MH, Von Harz, B, Prentice, D, et al. Patient transport from intensive care increases the risk of developing ventilator-associated pneumonia. Chest 1997;112:765–773.CrossRefGoogle ScholarPubMed
McCarthy, FH, McDermott, KM, Kini, V, et al. Trends in US extracorporeal membrane oxygenation use and outcomes: 2002–2012. Semin Thorac Cardiovasc Surg 2015;27:81–88.CrossRefGoogle Scholar
Uribarri, A, Cruz-Gonzalez, I, Dalmau, MJ, Rubia-Martin, MC, Ochoa, M, Sanchez, PL. Interhospital transfer in patients on ECMO support. an essential tool for a critical care network. Rev Esp Cardiol 2017;70:1147–1149.CrossRefGoogle ScholarPubMed
Foley, DS, Pranikoff, T, Younger, JG, et al. A review of 100 patients transported on extracorporeal life support. ASAIO 2002;48:612–619.CrossRefGoogle ScholarPubMed
Bryner, B, Cooley, E, Copenhaver, W, et al. Two decades’ experience with interfacility transport on extracorporeal membrane oxygenation. Ann Thorac Surg 2014;98:1363–1370.CrossRefGoogle ScholarPubMed
Biscotti, M, Agerstrand, C, Abrams, D, et al. One hundred transports on extracorporeal support to an extracorporeal membrane oxygenation center. Ann Thorac Surg 2015;100:34–39.CrossRefGoogle Scholar
Mendes, PV, de Albuquerque Gallo, C, Besen, B, et al. Transportation of patients on extracorporeal membrane oxygenation: a tertiary medical center experience and systematic review of the literature. Ann Intensive Care 2017;7:14.CrossRefGoogle ScholarPubMed
Peek, GJ, Mugford, M, Tiruvoipati, R, et al. Efficacy and economic assessment of conventional ventilatory support versus extracorporeal membrane oxygenation for severe adult respiratory failure (CESAR): a multicentre randomised controlled trial. Lancet 2009;374:1351–1363.CrossRefGoogle ScholarPubMed
Barbaro, RP, Odetola, FO, Kidwell, KM, et al. Association of hospital-level volume of extracorporeal membrane oxygenation cases and mortality. Analysis of the extracorporeal life support organization registry. Am J Respir Crit Care Med 2015;191:894–901.CrossRefGoogle ScholarPubMed
Coppola, CP, Tyree, M, Larry, K, DiGeronimo, R. A 22-year experience in global transport extracorporeal membrane oxygenation. J Pediatr Surg 2008;43:46–52.CrossRefGoogle ScholarPubMed
Ericsson, A, Frenckner, B, Broman, LM. Adverse events during inter-hospital transports on extracorporeal membrane oxygenation. Prehosp Emerg Care 2017;21:448–455.CrossRefGoogle ScholarPubMed
Marcus, JE, Piper, LC, Ainsworth, CR, et al. Infections in patients with burn injuries receiving extracorporeal membrane oxygenation. Burns 2019;45:1880–1887.CrossRefGoogle ScholarPubMed
Read, MD, Nam, JJ, Biscotti, M, et al. Evolution of the US military extracorporeal membrane oxygenation transport team. Military Med 2020;185:e2055–e2060.CrossRefGoogle ScholarPubMed
Schmidt, M, Brechot, N, Hariri, S, et al. Nosocomial infections in adult cardiogenic shock patients supported by venoarterial extracorporeal membrane oxygenation. Clin Infect Dis 2012;55:1633–1641.CrossRefGoogle ScholarPubMed
Centers for Disease Control and Prevention. Antibiotic Resistance Threats in the United States, 2019. Atlanta: US Department of Health and Human Services, CDC; 2019.Google Scholar
Magiorakos, AP, Srinivasan, A, Carey, RB, et al. Multidrug-resistant, extensively drug-resistant and pandrug-resistant bacteria: an international expert proposal for interim standard definitions for acquired resistance. Clin Microbiol Infect 2012;18:268–281.CrossRefGoogle ScholarPubMed
Pieri, M, Agracheva, N, Fumagalli, L, et al. Infections occurring in adult patients receiving mechanical circulatory support: the two-year experience of an Italian National Referral Tertiary Care Center. Med Intensiva 2013;37:468–475.CrossRefGoogle ScholarPubMed
Hsu, MS, Chiu, KM, Huang, YT, Kao, KL, Chu, SH, Liao, CH. Risk factors for nosocomial infection during extracorporeal membrane oxygenation. J Hosp Infect 2009;73:210–216.CrossRefGoogle ScholarPubMed
Kon, ZN, Bittle, GJ, Pasrija, C, et al. Venovenous versus venoarterial extracorporeal membrane oxygenation for adult patients with acute respiratory distress syndrome requiring precannulation hemodynamic support: a review of the ELSO registry. Ann Thorac Surg 2017;104:645–649.CrossRefGoogle ScholarPubMed
Juthani, BK, Macfarlan, J, Wu, J, Misselbeck, TS. Incidence of nosocomial infections in adult patients undergoing extracorporeal membrane oxygenation. Heart Lung 2018;47:626–630.CrossRefGoogle ScholarPubMed
Aubron, C, Cheng, AC, Pilcher, D, et al. Factors associated with outcomes of patients on extracorporeal membrane oxygenation support: a 5-year cohort study. Crit Care 2013;17:R73–R.CrossRefGoogle ScholarPubMed
Broman, LM, Holzgraefe, B, Palmér, K, Frenckner, B. The Stockholm experience: interhospital transports on extracorporeal membrane oxygenation. Crit Care 2015;19:278.CrossRefGoogle ScholarPubMed
Johnston, KJ, Thorpe, KE, Jacob, JT, Murphy, DJ. The incremental cost of infections associated with multidrug-resistant organisms in the inpatient hospital setting—a national estimate. Health Serv Res 2019;54:782–792.CrossRefGoogle ScholarPubMed
Neubeiser, A, Bonsignore, M, Tafelski, S, et al. Mortality attributable to hospital-acquired infections with multidrug-resistant bacteria in a large group of German hospitals. J Infect Public Health 2020;13:204–210.CrossRefGoogle Scholar