Characteristics and outcomes of ECMO cannula-related infections: a European multicenter retrospective study

Purpose Only few data regarding epidemiology and management of ECMO cannula-related infections (CRIs) exist. The aim of our study was to describe their epidemiology and prognosis, and to evaluate factors associated with outcome. Methods We performed a multicenter retrospective study in 12 European ICUs, including patients with CRI, defined as a clinical suspicion plus a positive bacterial sample of ECMO-cannulation site. Primary objective was to describe CRI characteristics and outcomes. Secondary objectives were to evaluate the rates of infection recurrence, their risk factors, and to evaluate the impact of antimicrobial treatment duration on outcome. Results During the study period, 124 patients with CRI (78 having concomitant positive blood culture with the same pathogen) were included. Pathogens responsible for infections were predominantly Enterobacteriaceae, coagulase-negative Staphylococcus and Enterococcus spp., and 40% of episodes were polymicrobial. Rates of infection recurrence was 24% and ICU-mortality rate was 50%. Whereas veno-venous ECMO (as compared to veno-arterial ECMO), and therefore ECMO duration was associated with infection recurrence, characteristics of CRI and its management (and in particular duration of antimicrobial treatment) were not associated with recurrence. Patients with antibiotic course ≤8 days had similar infection recurrence rate and outcomes (including mortality) than patients with prolonged (>8 days) antibiotic course. Conclusion CRIs are frequently associated with BSI and frequently polymicrobial. Main risk factor of infection recurrence is ECMO duration. Duration of antimicrobial treatment for CRI ≤8 days is not associated with an increased risk of recurrence or death, as compared to longer treatment.