Acquired infection during neonatal and pediatric extracorporeal membrane oxygenation

Katherine Cashen, Ron Reeder, Heidi J. Dalton, Robert A. Berg, Thomas Patrick Shanley, Christopher J.L. Newth, Murray M. Pollack, David Wessel, Joseph Carcillo, Rick Harrison, J. Michael Dean, Robert Tamburro, Kathleen L. Meert*

*Corresponding author for this work

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Introduction: Our objectives are to (1) describe the pathogens, site, timing and risk factors for acquired infection during neonatal and pediatric ECMO and (2) explore the association between acquired infection and mortality. Methods: Secondary analysis of prospective data collected by the Collaborative Pediatric Critical Care Research Network between December 2012 and September 2014. Clinical factors associated with acquired infection were assessed with multivariable Cox regression. Factors associated with mortality were assessed with logistic regression. Results: Of 481 patients, 247 (51.3%) were neonates and 400 (83.2%) received venoarterial ECMO. Eighty (16.6%) patients acquired one or more infections during ECMO; 60 (12.5%) patients had bacterial, 21 (4.4%) had fungal and 11 (2.3%) had viral infections. The site of infection included respiratory for 53 (11.0%) patients, bloodstream for 21 (4.4%), urine for 20 (4.2%) and other for 7 (1.5%). Candida species were most common. Median time to infection was 5.2 days (IQR 2.3, 9.6). On multivariable analysis, a greater number of procedures for ECMO cannula placement was independently associated with increased risk of acquired infection during ECMO (Hazard Ratio 2.13 (95% CI 1.22, 3.72), p<0.01) and receiving ECMO in a neonatal ICU compared to a pediatric or cardiac ICU was associated with decreased risk (Hazard Ratio pediatric ICU 4.25 (95% CI 2.20, 8.20), cardiac ICU 2.91 (95% CI 1.48, 5.71), neonatal ICU as reference, p<0.001). Acquired infection was not independently associated with mortality. Conclusion: ECMO procedures and location may contribute to acquired infection risk; however, acquired infection did not predict mortality in this study.

Original languageEnglish (US)
Pages (from-to)472-482
Number of pages11
JournalPerfusion (United Kingdom)
Volume33
Issue number6
DOIs
StatePublished - Sep 1 2018

Fingerprint

Intensive care units
Extracorporeal Membrane Oxygenation
Pediatrics
Oxygenation
mortality
Membranes
Infection
Hazards
regression
secondary analysis
Mortality
Neonatal Intensive Care Units
Candida
Pathogens
logistics
Logistics
Virus Diseases
Critical Care
Respiratory Tract Infections
Logistic Models

Keywords

  • extracorporeal membrane oxygenation
  • infection
  • mortality
  • neonatal
  • pediatrics

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Safety Research
  • Cardiology and Cardiovascular Medicine
  • Advanced and Specialized Nursing

Cite this

Cashen, K., Reeder, R., Dalton, H. J., Berg, R. A., Shanley, T. P., Newth, C. J. L., ... Meert, K. L. (2018). Acquired infection during neonatal and pediatric extracorporeal membrane oxygenation. Perfusion (United Kingdom), 33(6), 472-482. https://doi.org/10.1177/0267659118766436
Cashen, Katherine ; Reeder, Ron ; Dalton, Heidi J. ; Berg, Robert A. ; Shanley, Thomas Patrick ; Newth, Christopher J.L. ; Pollack, Murray M. ; Wessel, David ; Carcillo, Joseph ; Harrison, Rick ; Dean, J. Michael ; Tamburro, Robert ; Meert, Kathleen L. / Acquired infection during neonatal and pediatric extracorporeal membrane oxygenation. In: Perfusion (United Kingdom). 2018 ; Vol. 33, No. 6. pp. 472-482.
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abstract = "Introduction: Our objectives are to (1) describe the pathogens, site, timing and risk factors for acquired infection during neonatal and pediatric ECMO and (2) explore the association between acquired infection and mortality. Methods: Secondary analysis of prospective data collected by the Collaborative Pediatric Critical Care Research Network between December 2012 and September 2014. Clinical factors associated with acquired infection were assessed with multivariable Cox regression. Factors associated with mortality were assessed with logistic regression. Results: Of 481 patients, 247 (51.3{\%}) were neonates and 400 (83.2{\%}) received venoarterial ECMO. Eighty (16.6{\%}) patients acquired one or more infections during ECMO; 60 (12.5{\%}) patients had bacterial, 21 (4.4{\%}) had fungal and 11 (2.3{\%}) had viral infections. The site of infection included respiratory for 53 (11.0{\%}) patients, bloodstream for 21 (4.4{\%}), urine for 20 (4.2{\%}) and other for 7 (1.5{\%}). Candida species were most common. Median time to infection was 5.2 days (IQR 2.3, 9.6). On multivariable analysis, a greater number of procedures for ECMO cannula placement was independently associated with increased risk of acquired infection during ECMO (Hazard Ratio 2.13 (95{\%} CI 1.22, 3.72), p<0.01) and receiving ECMO in a neonatal ICU compared to a pediatric or cardiac ICU was associated with decreased risk (Hazard Ratio pediatric ICU 4.25 (95{\%} CI 2.20, 8.20), cardiac ICU 2.91 (95{\%} CI 1.48, 5.71), neonatal ICU as reference, p<0.001). Acquired infection was not independently associated with mortality. Conclusion: ECMO procedures and location may contribute to acquired infection risk; however, acquired infection did not predict mortality in this study.",
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Cashen, K, Reeder, R, Dalton, HJ, Berg, RA, Shanley, TP, Newth, CJL, Pollack, MM, Wessel, D, Carcillo, J, Harrison, R, Dean, JM, Tamburro, R & Meert, KL 2018, 'Acquired infection during neonatal and pediatric extracorporeal membrane oxygenation', Perfusion (United Kingdom), vol. 33, no. 6, pp. 472-482. https://doi.org/10.1177/0267659118766436

Acquired infection during neonatal and pediatric extracorporeal membrane oxygenation. / Cashen, Katherine; Reeder, Ron; Dalton, Heidi J.; Berg, Robert A.; Shanley, Thomas Patrick; Newth, Christopher J.L.; Pollack, Murray M.; Wessel, David; Carcillo, Joseph; Harrison, Rick; Dean, J. Michael; Tamburro, Robert; Meert, Kathleen L.

In: Perfusion (United Kingdom), Vol. 33, No. 6, 01.09.2018, p. 472-482.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Acquired infection during neonatal and pediatric extracorporeal membrane oxygenation

AU - Cashen, Katherine

AU - Reeder, Ron

AU - Dalton, Heidi J.

AU - Berg, Robert A.

AU - Shanley, Thomas Patrick

AU - Newth, Christopher J.L.

AU - Pollack, Murray M.

AU - Wessel, David

AU - Carcillo, Joseph

AU - Harrison, Rick

AU - Dean, J. Michael

AU - Tamburro, Robert

AU - Meert, Kathleen L.

PY - 2018/9/1

Y1 - 2018/9/1

N2 - Introduction: Our objectives are to (1) describe the pathogens, site, timing and risk factors for acquired infection during neonatal and pediatric ECMO and (2) explore the association between acquired infection and mortality. Methods: Secondary analysis of prospective data collected by the Collaborative Pediatric Critical Care Research Network between December 2012 and September 2014. Clinical factors associated with acquired infection were assessed with multivariable Cox regression. Factors associated with mortality were assessed with logistic regression. Results: Of 481 patients, 247 (51.3%) were neonates and 400 (83.2%) received venoarterial ECMO. Eighty (16.6%) patients acquired one or more infections during ECMO; 60 (12.5%) patients had bacterial, 21 (4.4%) had fungal and 11 (2.3%) had viral infections. The site of infection included respiratory for 53 (11.0%) patients, bloodstream for 21 (4.4%), urine for 20 (4.2%) and other for 7 (1.5%). Candida species were most common. Median time to infection was 5.2 days (IQR 2.3, 9.6). On multivariable analysis, a greater number of procedures for ECMO cannula placement was independently associated with increased risk of acquired infection during ECMO (Hazard Ratio 2.13 (95% CI 1.22, 3.72), p<0.01) and receiving ECMO in a neonatal ICU compared to a pediatric or cardiac ICU was associated with decreased risk (Hazard Ratio pediatric ICU 4.25 (95% CI 2.20, 8.20), cardiac ICU 2.91 (95% CI 1.48, 5.71), neonatal ICU as reference, p<0.001). Acquired infection was not independently associated with mortality. Conclusion: ECMO procedures and location may contribute to acquired infection risk; however, acquired infection did not predict mortality in this study.

AB - Introduction: Our objectives are to (1) describe the pathogens, site, timing and risk factors for acquired infection during neonatal and pediatric ECMO and (2) explore the association between acquired infection and mortality. Methods: Secondary analysis of prospective data collected by the Collaborative Pediatric Critical Care Research Network between December 2012 and September 2014. Clinical factors associated with acquired infection were assessed with multivariable Cox regression. Factors associated with mortality were assessed with logistic regression. Results: Of 481 patients, 247 (51.3%) were neonates and 400 (83.2%) received venoarterial ECMO. Eighty (16.6%) patients acquired one or more infections during ECMO; 60 (12.5%) patients had bacterial, 21 (4.4%) had fungal and 11 (2.3%) had viral infections. The site of infection included respiratory for 53 (11.0%) patients, bloodstream for 21 (4.4%), urine for 20 (4.2%) and other for 7 (1.5%). Candida species were most common. Median time to infection was 5.2 days (IQR 2.3, 9.6). On multivariable analysis, a greater number of procedures for ECMO cannula placement was independently associated with increased risk of acquired infection during ECMO (Hazard Ratio 2.13 (95% CI 1.22, 3.72), p<0.01) and receiving ECMO in a neonatal ICU compared to a pediatric or cardiac ICU was associated with decreased risk (Hazard Ratio pediatric ICU 4.25 (95% CI 2.20, 8.20), cardiac ICU 2.91 (95% CI 1.48, 5.71), neonatal ICU as reference, p<0.001). Acquired infection was not independently associated with mortality. Conclusion: ECMO procedures and location may contribute to acquired infection risk; however, acquired infection did not predict mortality in this study.

KW - extracorporeal membrane oxygenation

KW - infection

KW - mortality

KW - neonatal

KW - pediatrics

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