Infections occurring in adult patients receiving mechanical circulatory support: The two-year experience of an italian national referral tertiary care center

M. Pieri, N. Agracheva, L. Fumagalli, T. Greco, M. De Bonis, M. C. Calabrese, A. Rossodivita, A. Zangrillo, F. Pappalardo

Research output: Contribution to journalArticle

13 Citations (Scopus)

Abstract

Objective: Infection during mechanical circulatory support is a frequent adverse complication. We analyzed infections occurring in this population in a national tertiary care center, and assessed the differences existing between the setting of extracorporeal membrane oxygenation (ECMO) and ventricular assist devices (VADs). Design, setting, and participants: An observational study was made of patients treated with ECMO or VAD in the San Raffaele Scientific Institute (Italy) between 2009 and 2011. Interventions: None. Results: Thirty-nine percent of the 46 patients with ECMO and 69% of the 15 patients with VAD developed infection. We observed a mortality rate of 36.1% during mechanical circulatory support and of 55.7% during the global hospitalization period. Although Gram-negative infections were predominant overall, patients with ECMO were more prone to develop Candida infection (29%), and patients with VAD tended to suffer Staphylococcus infection (18%). Patients with infection had longer ECMO support ( p= 0.03), VAD support ( p= 0.01), stay in the intensive care unit ( p= 0.002), and hospital admission ( p= 0.03) than patients without infection.Infection (regression coefficient. = 3.99, 95% CI 0.93-7.05, p= 0.02), body mass index (regression coefficient. = 0.46, 95% CI 0.09-0.83, p= 0.02), fungal infection (regression coefficient. = 4.96, 95% CI 1.42-8.44, p= 0.009) and obesity (regression coefficient. = 10.47, 95% CI 1.77-19.17, p= 0.02) were predictors of the duration of ECMO support. Stepwise logistic regression analysis showed the SOFA score at the time of implant (OR. = 12.33, 95% CI 1.15-132.36, p= 0.04) and VAD (OR. = 1.27, 95% CI 1.04-1.56, p= 0.02) to be associated with infection. Conclusions: Infection is a major challenge during ECMO and VAD support. Each mechanical circulatory support configuration is associated with specific pathogens; fungal infections play a major role.

Original languageEnglish
Pages (from-to)468-475
Number of pages8
JournalMedicina Intensiva
Volume37
Issue number7
DOIs
Publication statusPublished - Oct 2013

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Tertiary Care Centers
Referral and Consultation
Extracorporeal Membrane Oxygenation
Heart-Assist Devices
Infection
Mycoses
Staphylococcus
Candida
Italy
Observational Studies
Intensive Care Units
Hospitalization
Body Mass Index
Obesity
Logistic Models
Regression Analysis
Mortality

Keywords

  • Extracorporeal membrane oxygenation
  • Infection
  • Ventricular assist devices

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine

Cite this

Infections occurring in adult patients receiving mechanical circulatory support : The two-year experience of an italian national referral tertiary care center. / Pieri, M.; Agracheva, N.; Fumagalli, L.; Greco, T.; De Bonis, M.; Calabrese, M. C.; Rossodivita, A.; Zangrillo, A.; Pappalardo, F.

In: Medicina Intensiva, Vol. 37, No. 7, 10.2013, p. 468-475.

Research output: Contribution to journalArticle

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abstract = "Objective: Infection during mechanical circulatory support is a frequent adverse complication. We analyzed infections occurring in this population in a national tertiary care center, and assessed the differences existing between the setting of extracorporeal membrane oxygenation (ECMO) and ventricular assist devices (VADs). Design, setting, and participants: An observational study was made of patients treated with ECMO or VAD in the San Raffaele Scientific Institute (Italy) between 2009 and 2011. Interventions: None. Results: Thirty-nine percent of the 46 patients with ECMO and 69{\%} of the 15 patients with VAD developed infection. We observed a mortality rate of 36.1{\%} during mechanical circulatory support and of 55.7{\%} during the global hospitalization period. Although Gram-negative infections were predominant overall, patients with ECMO were more prone to develop Candida infection (29{\%}), and patients with VAD tended to suffer Staphylococcus infection (18{\%}). Patients with infection had longer ECMO support ( p= 0.03), VAD support ( p= 0.01), stay in the intensive care unit ( p= 0.002), and hospital admission ( p= 0.03) than patients without infection.Infection (regression coefficient. = 3.99, 95{\%} CI 0.93-7.05, p= 0.02), body mass index (regression coefficient. = 0.46, 95{\%} CI 0.09-0.83, p= 0.02), fungal infection (regression coefficient. = 4.96, 95{\%} CI 1.42-8.44, p= 0.009) and obesity (regression coefficient. = 10.47, 95{\%} CI 1.77-19.17, p= 0.02) were predictors of the duration of ECMO support. Stepwise logistic regression analysis showed the SOFA score at the time of implant (OR. = 12.33, 95{\%} CI 1.15-132.36, p= 0.04) and VAD (OR. = 1.27, 95{\%} CI 1.04-1.56, p= 0.02) to be associated with infection. Conclusions: Infection is a major challenge during ECMO and VAD support. Each mechanical circulatory support configuration is associated with specific pathogens; fungal infections play a major role.",
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T2 - The two-year experience of an italian national referral tertiary care center

AU - Pieri, M.

AU - Agracheva, N.

AU - Fumagalli, L.

AU - Greco, T.

AU - De Bonis, M.

AU - Calabrese, M. C.

AU - Rossodivita, A.

AU - Zangrillo, A.

AU - Pappalardo, F.

PY - 2013/10

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N2 - Objective: Infection during mechanical circulatory support is a frequent adverse complication. We analyzed infections occurring in this population in a national tertiary care center, and assessed the differences existing between the setting of extracorporeal membrane oxygenation (ECMO) and ventricular assist devices (VADs). Design, setting, and participants: An observational study was made of patients treated with ECMO or VAD in the San Raffaele Scientific Institute (Italy) between 2009 and 2011. Interventions: None. Results: Thirty-nine percent of the 46 patients with ECMO and 69% of the 15 patients with VAD developed infection. We observed a mortality rate of 36.1% during mechanical circulatory support and of 55.7% during the global hospitalization period. Although Gram-negative infections were predominant overall, patients with ECMO were more prone to develop Candida infection (29%), and patients with VAD tended to suffer Staphylococcus infection (18%). Patients with infection had longer ECMO support ( p= 0.03), VAD support ( p= 0.01), stay in the intensive care unit ( p= 0.002), and hospital admission ( p= 0.03) than patients without infection.Infection (regression coefficient. = 3.99, 95% CI 0.93-7.05, p= 0.02), body mass index (regression coefficient. = 0.46, 95% CI 0.09-0.83, p= 0.02), fungal infection (regression coefficient. = 4.96, 95% CI 1.42-8.44, p= 0.009) and obesity (regression coefficient. = 10.47, 95% CI 1.77-19.17, p= 0.02) were predictors of the duration of ECMO support. Stepwise logistic regression analysis showed the SOFA score at the time of implant (OR. = 12.33, 95% CI 1.15-132.36, p= 0.04) and VAD (OR. = 1.27, 95% CI 1.04-1.56, p= 0.02) to be associated with infection. Conclusions: Infection is a major challenge during ECMO and VAD support. Each mechanical circulatory support configuration is associated with specific pathogens; fungal infections play a major role.

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