The Evaluation of Nosocomial Infections in Pediatric Patients with Extracorporeal Membrane Oxygenation Support

Abstract Introduction: Extracorporeal membrane oxygenation (ECMO) has become a standard technique over the past few decades in intensive care unit (ICU). Objective: A review of pediatric patients who received ECMO support in the pediatric cardiac ICU was conducted to determine the incidence, risk factors and causal organisms related to acquired infections and assess the survival rates of ECMO patients with nosocomial infections. Methods: Sixty-six patients who received ECMO support in the pediatric cardiac ICU between January 2011 and June 2014 were included in the study. Demographic, echocardiographic, hemodynamic features and surgical procedures were reviewed. Results: Sixty-six patients received a total of 292.5 days of venoarterial ECMO support. Sixty were postoperative patients. Forty-five patients were weaned from ECMO support with an ECMO survival rate of 68.2%. The rate of infection was 116.2/1000 ECMO days. Prolonged ICU stay, duration of ventilation and ECMO were found associated with development of nosocomial infection and only the duration of ECMO was an independent risk factor for nosocomial infections in ECMO patients. Conclusion: The correction of the underlying process leading to ECMO support and shortening the length of ECMO duration together with stricter application of ECMO indications would improve the infection incidence and hospital surveillance of the patient group.

摘要 引言：过去数十年来，体外膜肺氧合（Extracorporeal membrane oxygenation, ECMO）已成为重症监护病房（intensive care unit, ICU）中的标准救治技术。研究目的：本研究针对儿科心脏重症监护病房（pediatric cardiac ICU）中接受体外膜肺氧合支持的儿科患者展开回顾性分析，旨在明确与获得性感染（acquired infections）相关的发病率、危险因素及致病病原体，并评估合并医院感染（nosocomial infections）的体外膜肺氧合患者的生存率。研究方法：本研究纳入2011年1月至2014年6月期间于儿科心脏重症监护病房接受体外膜肺氧合支持的66例患者，对其人口统计学特征、超声心动图表现、血流动力学特征及手术操作进行回顾性分析。研究结果：66例患者总计接受了292.5天的动静脉体外膜肺氧合支持，其中60例为术后患者。45例患者成功脱离体外膜肺氧合支持，体外膜肺氧合患者生存率为68.2%。感染发生率为116.2/1000体外膜肺氧合日。研究发现，延长重症监护病房停留时间、机械通气时长及体外膜肺氧合支持时长均与医院感染的发生相关，且仅体外膜肺氧合支持时长是体外膜肺氧合患者发生医院感染的独立危险因素。研究结论：纠正导致体外膜肺氧合支持的原发疾病进程、缩短体外膜肺氧合支持时长，并严格把握体外膜肺氧合的应用指征，可降低该患者群体的感染发生率，优化其院内感染监测工作。