Journal Article

Retrospective ANalysis of multi-drug resistant Gram-nEgative bacteRia on veno-venous extracorporeal membrane oxygenation. The multicenter RANGER STUDY

Boscolo, Annalisa, Biamonte, Eugenio, Bruni, Andrea, Pozzi, Matteo, Navalesi, Paolo, Foti, Giuseppe, Gori, Mercedes, Rezoagli, Emanuele, Grasso, Salvatore, Garofalo, Eugenio, Gottin, Leonardo, Longhini, Federico, Pistollato, Elisa, D’Arrigo, Graziella, Palcani, Matteo, Sella, Nicolò, Tripepi, Giovanni Luigi, Bombino, Michela, Pettenuzzo, Tommaso, Falcioni, Elena, Giani, Marco, Murgolo, Francesco

2024

Overview

Background Veno-venous extracorporeal membrane oxygenation (V-V ECMO) is a rapidly expanding life-support technique worldwide. The most common indications are severe hypoxemia and/or hypercapnia, unresponsive to conventional treatments, primarily in cases of acute respiratory distress syndrome. Concerning potential contraindications, there is no mention of microbiological history, especially related to multi-drug resistant (MDR) bacteria isolated before V-V ECMO placement. Our study aims to investigate: (i) the prevalence and incidence of MDR Gram-negative (GN) bacteria in a cohort of V-V ECMOs; (ii) the risk of 1-year mortality, especially in the case of predetected MDR GN bacteria; and (iii) the impact of annual hospital V-V ECMO volume on the probability of acquiring MDR GN bacteria. Methods All consecutive adults admitted to the Intensive Care Units of 5 Italian university-affiliated hospitals and requiring V-V ECMO were screened. Exclusion criteria were age < 18 years, pregnancy, veno-arterial or mixed ECMO-configuration, incomplete records, survival < 24 h after V-V ECMO. A standard protocol of microbiological surveillance was applied and MDR profiles were identified using in vitro susceptibility tests. Cox-proportional hazards models were applied for investigating mortality. Results Two hundred and seventy-nine V-V ECMO patients (72% male) were enrolled. The overall MDR GN bacteria percentage was 50%: 21% (n.59) detected before and 29% (n.80) after V-V ECMO placement. The overall 1-year mortality was 42%, with a higher risk observed in predetected patients (aHR 2.14 [1.33–3.47], p value 0.002), while not in ‘V-V ECMO-acquired MDR GN bacteria’ group (aHR 1.51 [0.94–2.42], p value 0.090), as compared to ‘non-MDR GN bacteria’ group ( reference ). Same findings were found considering only infections. A larger annual hospital V-V ECMO volume was associated with a lower probability of acquiring MDR GN bacteria during V-V ECMO course (aOR 0.91 [0.86–0.97], p value 0.002). Conclusions 21% of MDR GN bacteria were detected before; while 29% after V-V ECMO connection. A history of MDR GN bacteria, isolated before V-V ECMO, was an independent risk factor for mortality. The annual hospital V-V ECMO volume affected the probability of acquiring MDR GN bacteria. Trial Registration ClinicalTrial.gov Registration Number NCTNCT06199141, date 12.26.2023.

• Publisher: BioMed Central,BioMed Central Ltd,Springer Nature B.V
• Subject: Acute respiratory distress syndrome / Adult / Aged / Analysis / Antibiotics / Bacteria / Beta lactamases / Contraindications / Critical Care Medicine / Disease control / Drug resistance / Drug Resistance, Multiple, Bacterial / Emergency Medicine / Extracorporeal membrane oxygenation / Extracorporeal Membrane Oxygenation - methods / Extracorporeal Membrane Oxygenation - statistics & numerical data / Extubation / Female / Gram-Negative Bacteria - drug effects / Gram-Negative Bacterial Infections - drug therapy / Gram-Negative Bacterial Infections - mortality / Health aspects / Hospital patients / Hospitals / Humans / Hypoxemia / Infectious diseases / Intensive / Intensive care / Italy - epidemiology / Laboratories / Male / Medical research / Medicine / Medicine & Public Health / Medicine, Experimental / Microbiology / Middle Aged / Mortality / Nosocomial infections / Pathogens / Patients / Respiratory agents / Retrospective Studies / Risk factors / Sepsis / Variables / Ventilators / Weaning