• Giacomo Grasselli, Vittorio Scaravilli, Stefano Di Bella, Stefano Biffi, Michela Bombino, Nicolò Patroniti, Luca Bisi, Anna Maria Peri, Antonio Pesenti, Andrea Gori, and Laura Alagna.
• 1Department of Anesthesia, Critical Care and Emergency, Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico, Milan (MI), Italy. 2Infectious Disease Unit, University Hospital of Trieste, Trieste (TS), Italy. 3School of Medicine and Surgery, University of Milan-Bicocca, Milan (MI), Italy. 4Department of Anesthesia, Critical Care and Emergency, ASST Monza San Gerardo Hospital, Monza (MB), Italy. 5Infectious Disease Clinics, ASST Monza San Gerardo Hospital, Monza (MB), Italy. 6Department of Pathophysiology and Transplantation, University of Milan, Milan (MI), Italy.
• Crit. Care Med. 2017 Oct 1; 45 (10): 1726-1733.

ObjectiveTo study incidence, type, etiology, risk factors, and impact on outcome of nosocomial infections during extracorporeal membrane oxygenation.DesignRetrospective analysis of prospectively collected data.SettingItalian tertiary referral center medical-surgical ICU.PatientsOne hundred five consecutive patients who were treated with extracorporeal membrane oxygenation from January 2010 to November 2015.InterventionsNone.Measurements And Main ResultsNinety-two patients were included in the analysis (48.5 [37-56] years old, simplified acute physiology score II 37 [32-47]) who underwent peripheral extracorporeal membrane oxygenation (87% veno-venous) for medical indications (78% acute respiratory distress syndrome). Fifty-two patients (55%) were infected (50.4 infections/1,000 person-days of extracorporeal membrane oxygenation). We identified 32 ventilator-associated pneumonia, eight urinary tract infections, five blood stream infections, three catheter-related blood stream infections, two colitis, one extracorporeal membrane oxygenation cannula infection, and one pulmonary-catheter infection. G+ infections (35%) occurred earlier compared with G- (48%) (4 [2-10] vs. 13 [7-23] days from extracorporeal membrane oxygenation initiation; p < 0.001). Multidrug-resistant organisms caused 56% of bacterial infections. Younger age (2-35 years old) was independently associated with higher risk for nosocomial infections. Twenty-nine patients (31.5%) died (13.0 deaths/1,000 person-days of extracorporeal membrane oxygenation). Infected patients had higher risk for death (18 vs. 8 deaths/1,000 person-days of extracorporeal membrane oxygenation; p = 0.037) and longer ICU stay (32.5 [19.5-78] vs. 19 [10.5-27.5] days; p = 0.003), mechanical ventilation (36.5 [20-80.5] vs. 16.5 [9-25.5] days; p < 0.001), and extracorporeal membrane oxygenation (25.5 [10.75-54] vs. 10 [5-13] days; p < 0.001). Older age (> 50 years old), reason for connection different from acute respiratory distress syndrome, higher simplified acute physiology score II, diagnosis of ventilator-associated pneumonia, and infection by multidrug-resistant bacteria were independently associated to increased death rate.ConclusionsInfections (especially ventilator-associated pneumonia) during extracorporeal membrane oxygenation therapy are common and frequently involve multidrug-resistant organisms. In addition, they have a negative impact on patients' outcomes.

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