Hostname: page-component-848d4c4894-4hhp2 Total loading time: 0 Render date: 2024-06-10T01:37:35.506Z Has data issue: false hasContentIssue false
  • English
  • Français

Infections in Children Receiving Extracorporeal Life Support

Published online by Cambridge University Press:  02 January 2015

Alena Tse-Chang ,
William Midodzi ,
Ari R. Joffe  and
Joan L. Robinson
Alena Tse-Chang
Affiliation:
Department of Pediatrics and Stollery Children's Hospital, Edmonton, Alberta, Canada
William Midodzi
Affiliation:
Epidemiology Coordinating and Research Centre, Edmonton, Alberta, Canada
Ari R. Joffe
Affiliation:
Department of Pediatrics and Stollery Children's Hospital, Edmonton, Alberta, Canada
Joan L. Robinson*
Affiliation:
Department of Pediatrics and Stollery Children's Hospital, Edmonton, Alberta, Canada
*
Room 8213, Aberhart Centre One, 11402 University Avenue, Edmonton, AB CanadaT6G 2J3 (jr3@ualberta.ca)
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective.

To describe risk factors for and the outcome of infections in children receiving extracorporeal life support (ECLS) and to determine the need for removal of foreign bodies with bloodstream infections (BSIs) in children receiving ECLS.

Design.

Retrospective cohort study.

Setting.

Tertiary care children's hospital.

Patients.

Children receiving ECLS from May 1997 through May 2007.

Methods.

For patients with documented infections, medical records were examined for demographic, clinical, and laboratory details. Patients with and without documented infections were compared with regard to demographic characteristics and ECLS course.

Results.

One hundred seventeen patients underwent ECLS for a total of 878 days (median, 5.12 days). Thirty-five patients (29.9%) developed 55 infections, including 21 BSIs (38.2%), 20 urinary tract infections (36.4%), 6 ventilator-associated pneumonia episodes (10.9%), 2 viral infections (3.6%), and 6 miscellaneous infections (10.9%). The rates (in cases per 1,000 ECLS-days) were 23.9 for BSI, 22.8 for urinary tract infection, and 6.8 for ventilator-associated pneumonia. There were no significant differences in the demographic characteristics, indications for ECLS, or ECLS course between infected and uninfected patients, except for the median duration of ECLS (10.1 vs 3.8 days; P < .001). One death was attributed to infection. Resolution of BSI occurred without removal of foreign bodies in 18 (85.7%) of 21 children.

Conclusions.

Longer duration of ECLS was the only identified risk factor for infection. Mortality was not statistically significantly different between infected and uninfected patients. Most BSIs that occurred during ECLS cleared without removal of foreign bodies.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 32 , Issue 2 , February 2011 , pp. 115 - 120
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2011

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. Lequier, L. Extracorporeal life support in pediatric and neonatal critical care: a review. J Intensive Care Med 2004;19:243–258.Google Scholar
2. Coffin, SE, Bell, LM, Manning, M, Polin, R. Nosocomial infections in neonates receiving extracorporeal membrane oxygenation. Infect Control Hosp Epidemiol 1997;18:93–96.CrossRefGoogle ScholarPubMed
3. Douglass, BH, Keenan, AL, Purohit, DM. Bacterial and fungal infection in neonates undergoing venoarterial extracorporeal membrane oxygenation: an analysis of the registry data of the Extracorporeal Life Support Organization. Artif Organs 1996; 20:202–208.Google Scholar
4. Elerian, LF, Sparks, JW, Meyer, TA, et al. Usefulness of surveillance cultures in neonatal extracorporeal membrane oxygenation. ASAIO 2001;47:220–223.Google Scholar
5. Schutze, GE, Heulitt, MJ. Infections during extracorporeal life support. J Pediatr Surg 1995;30:809–812.Google Scholar
6. Horan, TC, Andrus, M, Dudeck, MA. CDC/NHSN surveillance definition of health-care associated infection and criteria for specific types of infections in the acute care setting. Am J Infect Control 2008;36:309–332.Google Scholar
7. O'Neill, JM, Schutze, GE, Heulitt, MJ, Simpson, PM, Taylor, BJ. Nosocomial infections during extracorporeal membrane oxygenation. Intensive Care Med 2001;27:1247–1253.Google Scholar
8. Brown, KL, Ridout, DA, Shaw, M, et al. Healthcare-associated infection in pediatric patients on extracorporeal life support: the role of multidisciplinary surveillance. Pediatr Crit Care Med 2006;7:546–550.Google Scholar
9. Burket, JS, Bartlett, RH, Vander Hyde, K, Chenoweth, CE. Nosocomial infections in adult patients undergoing extracorporeal membrane oxygenation. Clin Infect Dis 1999;28:828–833.Google Scholar
10. Steiner, CK, Stewart, DL, Bond, SJ, Hornung, CA, McKay, VJ. Predictors of acquiring a nosocomial bloodstream infection on extracorporeal membrane oxygenation. J Pediatr Surg 2001;36:487–492.Google Scholar
11. Montgomery, VL, Strotman, JM, Ross, MP. Impact of multiple organ system dysfunction and nosocomial infections on survival of children treated with extracorporeal membrane oxygenation after heart surgery. Critical Care Med 2000;28:526–531.Google Scholar
12. Kaczala, GW, Paulus, SC, Al-Dajani, N, et al. Bloodstream infections in pediatric ECLS: usefulness of daily blood culture monitoring and predictive value of biological makers–the British Columbia experience. Pediatr Surg Int 2009;25:169–173.CrossRefGoogle Scholar
13. Odetola, FO, Moler, FW, Dechert, RE, VanDerElzen, K, Chenoweth, C. Nosocomial catheter-related bloodstream infections in a pediatric intensive care unit: risk and rates associated with various intravascular technologies. Pediatr Crit Care Med 2003;4:432–436.Google Scholar
14. Edwards, JR, Peterson, KD, Andrus, ML, et al. National Healthcare Safety Network (NHSN) report, data summary for 2006, issued June 2007. Am J Infect Control 2007;35:290–301.CrossRefGoogle ScholarPubMed
15. Langley, JM. Defining urinary tract infection in the critically ill child. Pediatr Crit Care Med 20O5;6:S25–S29.Google Scholar