Bloodstream infections in COVID-19 patients undergoing extracorporeal membrane oxygenation in ICU: An observational cohort study

Simone Carelli; Antonio Maria Dell'Anna; Luca Montini; Giulia Bernardi; Mariangela Gozza; Salvatore Lucio Cutuli; Daniele Natalini; Filippo Bongiovanni; Eloisa Sofia Tanzarella; Gabriele Pintaudi; Maria Grazia Bocci; Alessandra Bisanti; Giuseppe Bello; Domenico Luca Grieco; Gennaro De Pascale; Massimo Antonelli

doi:10.1016/j.hrtlng.2023.07.012

Bloodstream infections in COVID-19 patients undergoing extracorporeal membrane oxygenation in ICU: An observational cohort study

Heart Lung. 2023 Nov-Dec:62:193-199. doi: 10.1016/j.hrtlng.2023.07.012. Epub 2023 Aug 8.

Authors

Simone Carelli¹, Antonio Maria Dell'Anna², Luca Montini³, Giulia Bernardi², Mariangela Gozza², Salvatore Lucio Cutuli², Daniele Natalini², Filippo Bongiovanni², Eloisa Sofia Tanzarella², Gabriele Pintaudi², Maria Grazia Bocci², Alessandra Bisanti², Giuseppe Bello², Domenico Luca Grieco², Gennaro De Pascale³, Massimo Antonelli³

Affiliations

¹ Dipartimento di Scienze dell'Emergenza, Anestesiologiche e della Rianimazione. Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy. Electronic address: simone.carelli@policlinicogemelli.it.
² Dipartimento di Scienze dell'Emergenza, Anestesiologiche e della Rianimazione. Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy.
³ Dipartimento di Scienze dell'Emergenza, Anestesiologiche e della Rianimazione. Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy; Istituto di Anestesiologia e Rianimazione. Università Cattolica del Sacro Cuore, Rome, Italy.

PMID: 37562337
DOI: 10.1016/j.hrtlng.2023.07.012

Abstract

Background: COVID-19 patients undergoing ECMO are at highly increased risk of nosocomial infections.

Objectives: To study incidence, clinical outcomes and microbiological features of bloodstream infections (BSI) occurring during ECMO in COVID-19 patients.

Methods: Observational prospective cohort study enrolling consecutive COVID-19 patients undergoing veno-venous-ECMO in an Italian ICU from March 2020 to March 2022.

Results: In the study population of 68 patients (age 53 [49-60] years, 82% males), 30 (44%) developed bloodstream infections (BSI group) while 38 did not (N-BSI group) with an incidence of 32 events/1000 days of ECMO. In BSI group pre-ECMO respiratory support was shorter (6 [4-9] vs 9 [5-12] days, p = 0.02) and ECMO treatment was longer (18 [10-29] vs 11 [7-18] days, p = 0.03) than in N-BSI group. The overall ECMO and ICU mortality were 50% and 59%, respectively, without any inter-group difference (p = 1.00). A longer ECMO treatment was independently correlated with higher rate of BSI (p = 0.04, OR [95% CI] 1.06 [1.02-1.11]). Sixteen primary and 14 secondary infectious events were documented. Gram-positive pathogens were more common in primary than secondary BSI (88% vs 43%, p = 0.02) and Enterococcus faecalis (56%) was the most frequent one. Conversely, Gram-negative microorganisms were more often isolated in secondary rather than primary BSI (57% vs 13%, p = 0.02), with Acinetobacter baumannii (21%) and Pseudomonas aeruginosa (21%) as most represented species. The administration of Sars-CoV-2 antiviral drug showed independent correlation with a reduced rate of ICU mortality (p = 0.01, OR [95% CI] 0.22 [0.07-0.73]).

Conclusions: Bloodstream infections represented a frequent complication without worsening clinical outcomes in our COVID-19 patients undergoing ECMO. Primary and secondary BSI events showed peculiar microbiological profiles.

Keywords: Acute Respiratory Distress Syndrome; Bloodstream Infections; COVID-19; ExtraCorporeal Membrane Oxygenation.