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Acquired infection during neonatal and pediatric extracorporeal membrane oxygenation.

Publication ,  Journal Article
Cashen, K; Reeder, R; Dalton, HJ; Berg, RA; Shanley, TP; Newth, CJL; Pollack, MM; Wessel, D; Carcillo, J; Harrison, R; Dean, JM; Tamburro, R ...
Published in: Perfusion
September 2018

INTRODUCTION: Our objectives are to (1) describe the pathogens, site, timing and risk factors for acquired infection during neonatal and pediatric ECMO and (2) explore the association between acquired infection and mortality. METHODS: Secondary analysis of prospective data collected by the Collaborative Pediatric Critical Care Research Network between December 2012 and September 2014. Clinical factors associated with acquired infection were assessed with multivariable Cox regression. Factors associated with mortality were assessed with logistic regression. RESULTS: Of 481 patients, 247 (51.3%) were neonates and 400 (83.2%) received venoarterial ECMO. Eighty (16.6%) patients acquired one or more infections during ECMO; 60 (12.5%) patients had bacterial, 21 (4.4%) had fungal and 11 (2.3%) had viral infections. The site of infection included respiratory for 53 (11.0%) patients, bloodstream for 21 (4.4%), urine for 20 (4.2%) and other for 7 (1.5%). Candida species were most common. Median time to infection was 5.2 days (IQR 2.3, 9.6). On multivariable analysis, a greater number of procedures for ECMO cannula placement was independently associated with increased risk of acquired infection during ECMO (Hazard Ratio 2.13 (95% CI 1.22, 3.72), p<0.01) and receiving ECMO in a neonatal ICU compared to a pediatric or cardiac ICU was associated with decreased risk (Hazard Ratio pediatric ICU 4.25 (95% CI 2.20, 8.20), cardiac ICU 2.91 (95% CI 1.48, 5.71), neonatal ICU as reference, p<0.001). Acquired infection was not independently associated with mortality. CONCLUSION: ECMO procedures and location may contribute to acquired infection risk; however, acquired infection did not predict mortality in this study.

Duke Scholars

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Published In

Perfusion

DOI

EISSN

1477-111X

Publication Date

September 2018

Volume

33

Issue

6

Start / End Page

472 / 482

Location

England

Related Subject Headings

  • Virus Diseases
  • Risk Factors
  • Prospective Studies
  • Mycoses
  • Male
  • Infant, Newborn
  • Infant
  • Humans
  • Hospital Mortality
  • Female
 

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Chicago
ICMJE
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Cashen, K., Reeder, R., Dalton, H. J., Berg, R. A., Shanley, T. P., Newth, C. J. L., … Meert, K. L. (2018). Acquired infection during neonatal and pediatric extracorporeal membrane oxygenation. Perfusion, 33(6), 472–482. https://doi.org/10.1177/0267659118766436
Cashen, Katherine, Ron Reeder, Heidi J. Dalton, Robert A. Berg, Thomas P. Shanley, Christopher J. L. Newth, Murray M. Pollack, et al. “Acquired infection during neonatal and pediatric extracorporeal membrane oxygenation.Perfusion 33, no. 6 (September 2018): 472–82. https://doi.org/10.1177/0267659118766436.
Cashen K, Reeder R, Dalton HJ, Berg RA, Shanley TP, Newth CJL, et al. Acquired infection during neonatal and pediatric extracorporeal membrane oxygenation. Perfusion. 2018 Sep;33(6):472–82.
Cashen, Katherine, et al. “Acquired infection during neonatal and pediatric extracorporeal membrane oxygenation.Perfusion, vol. 33, no. 6, Sept. 2018, pp. 472–82. Pubmed, doi:10.1177/0267659118766436.
Cashen K, Reeder R, Dalton HJ, Berg RA, Shanley TP, Newth CJL, Pollack MM, Wessel D, Carcillo J, Harrison R, Dean JM, Tamburro R, Meert KL. Acquired infection during neonatal and pediatric extracorporeal membrane oxygenation. Perfusion. 2018 Sep;33(6):472–482.
Journal cover image

Published In

Perfusion

DOI

EISSN

1477-111X

Publication Date

September 2018

Volume

33

Issue

6

Start / End Page

472 / 482

Location

England

Related Subject Headings

  • Virus Diseases
  • Risk Factors
  • Prospective Studies
  • Mycoses
  • Male
  • Infant, Newborn
  • Infant
  • Humans
  • Hospital Mortality
  • Female