Infectious complications in paediatric patients treated with extracorporeal membrane oxygenation

Abstract

Introduction: The aim of this study was to analyse the incidence, treatment and evolution of infections in children treated with ECMO.

Methods: A retrospective study based on a prospective database was performed. Children under the age of 18 years treated with ECMO from September 2006 to November 2015 were included. The patients' clinical characteristics were collected, together with ECMO technique, cultures and treatment of infection.

Results: One hundred patients with a median age of 11 months were analysed. Heart disease was diagnosed in 94 patients. An infection was suspected and antibiotic treatment was initiated in 51 patients, although only 22 of them were microbiologically confirmed. The most common infection was sepsis (49%), followed by pneumonia (35.3%) and urinary tract infection (9.8%). There were no differences in haematological parameters and acute phase reactants between children with infection and those without. Children who died had a higher incidence of infection during ECMO (60.4%) than the survivors (40.3%), but the difference did not reach statistical significance (P=.07). The duration of admission in the PICU was 57 days in patients with infection vs 37 days in patients without infection but the difference was not statistically significant (P=.067).

Conclusions: Infection in children with ECMO is common. There are no specific infection parameters and less than half of the clinical infections are confirmed microbiologically. There was no statistically significant correlation between infection and mortality or duration of PICU stay.

Keywords: Children; Cuidados intensivos pediátricos; Extracorporeal Membrane Oxygenation; Infecciones; Infections; Niños; Oxigenación por membrana extracorpórea; Paediatric intensive care; Sepsis.