Elsevier

Journal of Pediatric Surgery

Volume 46, Issue 12, December 2011, Pages 2260-2264
Journal of Pediatric Surgery

PAPS Papers
Defining risk for infectious complications on extracorporeal life support☆

https://doi.org/10.1016/j.jpedsurg.2011.09.013Get rights and content

Abstract

Background/Purpose

Little is known about potentially modifiable risk factors associated with infectious complications (IC) acquired during extracorporeal life support (ECLS).

Patients and Methods

The Extracorporeal Life Support Organization registry was accessed, and data on patient demographics, run characteristics, infections, and outcomes were collected. Patients who developed IC while on ECLS were compared to those that did not. Regression analysis was performed. Results are expressed as odds ratios, with P < .05 considered significant.

Results

Infectious complications developed in 10.2% of 38,661 patients and was associated with increased odds of death. Risk factors for IC included increasing age, diagnosis, more remote decade, complications, presence of multiple complications, and ECLS mode. The risk of IC increased with the number of complications (P < .001). Patients with positive cultures before ECLS also had increased odds of IC (OR 2.12, 95% CI 1.92-2.34, P < .001). Those with IC were more likely to have cultures grow aggressive organisms (non-lactose fermenting gram negative rods, methicillin resistant Staphylococcus aureus, and fungi).

Conclusions

Strategies to reduce IC while on ECLS should be aimed at prevention of complications and treatment of pre-existing infections. Future studies should address whether broader spectrum antibiotic prophylaxis and/or empiric coverage for suspected sepsis is indicated in ECLS patients.

Section snippets

Methods

The Extracorporeal Life Support Organization (ELSO) registry represents a collection of data submitted by participating international ECLS centers using a standardized form including demographics, primary diagnosis, pre-ECLS hospital course, and details of the ECLS course. Data from 1987 through 2009 was extracted for gestational age, age at time of ECLS, sex, race, weight, ECLS decade, primary diagnosis, the presence of a positive pre-ECLS culture, ECLS mode, ECLS duration, number and type of

Results

There was a total of 39,622 ECLS runs. 961 were excluded leaving 38,661 ECLS runs for analysis (26,382 neonatal, 9283 pediatric and 2996 adult). Overall mortality was 37.7%. There were 3960 IC. A comparison of the demographics of patients with and without IC as well as duration, complications, and outcomes are presented in detail by age group in Table 1. Univariate analysis showed several significant differences between patients with and without IC including duration of ECLS therapy, a positive

Discussion

This analysis shows that age group, duration of ECLS therapy, a positive pre-ECLS culture, ECLS mode, and number and type of ECLS complications are associated with IC on ECLS. In addition, IC was associated with higher mortality.

Descriptions of IC and their impact on ECLS outcomes have been previously described. The incidence of infection has been reported to range from 7.5% to 46% [2], [3], [4]. Previous reviews of the ELSO registry have shown rates of 3.5% to 11.7% [7], [8], [9], which is

Acknowledgment

Supported by a grant from the ELSO.

References (16)

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Cited by (0)

Presented at the Pacific Association of Pediatric Surgeons 44th Annual Meeting, Cancun, Mexico, April 10-14, 2011.

☆

Funded by a grant from the Extracorporeal Life Support Organization.

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