Healthcare-associated infections in patients with severe COVID-19 supported with extracorporeal membrane oxygenation: a nationwide cohort study
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Nesseler, Nicolas | Mansour, Alexandre | Schmidt, Matthieu | Para, Marylou | Porto, Alizée | Falcoz, Pierre-Emmanuel | Mongardon, Nicolas | Fougerou, Claire | Ross, James | Beurton, Antoine | Gaide-Chevronnay, Lucie | Guinot, Pierre-Grégoire | Lebreton, Guillaume | Flecher, Erwan | Vincentelli, André | Massart, Nicolas | Fouquet, Olivier | Pierrot, Marc | Chocron, Sidney | Flicoteaux, Guillaume | Mauriat, Philippe | Ouattara, Alexandre | Roze, Hadrien | Huet, Olivier | Fischer, Marc-Olivier | Bellaïche, Raphel | Constant, Ophélie | de Roux, Quentin | André, L. | Meffert, Arnaud | Merle, Jean-Claude | Picard, Lucile | Skripkina, Elena | Folliguet, Thierry | Fiore, Antonio | D’ostrevy, Nicolas | Morgan, Marie-Catherine | Nguyen, Maxime | Terzi, Nicolas | Colin, Gwenhaël | Fabre, Olivier | Astaneh, Arash | Issard, Justin | Fadel, Elie | Fabre, Dominique | Guihaire, Julien | Ion, Iolande | Menager, Jean Baptiste | Mitilian, Delphine | Mercier, Olaf | Stephan, François | Thes, Jacques | Jouan, Jerôme | Duburcq, Thibault | Loobuyck, Valentin | Moussa, Mouhammed | Manganiello, Sabrina | Mugnier, Agnes | Rousse, Natacha | Desebbe, Olivier | Fellahi, Jean-Luc | Henaine, Roland | Pozzi, Matteo | Riad, Zakaria | Guervilly, Christophe | Hraiech, Sami | Papazian, Laurent | Castanier, Matthias | Chanavaz, Charles | Cadoz, Cyril | Gette, Sebastien | Louis, Guillaume | Portocarrero, Erick | Gaudard, Philippe | Brini, Kais | Bischoff, Nicolas | Kimmoun, Antoine | Levy, Bruno | Perez, Pierre | Bourdiol, Alexandre | Hourmant, Yannick | Mahé, Pierre-Joachim | Rozec, Bertrand | Vourc’h, Mickaël | Aubert, Stéphane | Bazalgette, Florian | Roger, Claire | Jaquet, Pierre | Lortat-Jacob, Brice | Mordant, Pierre | Nataf, Patrick | Patrier, Juliette | Provenchere, Sophie | Roué, Morgan | Sonneville, Romain | Tran-Dinh, Alexy | Wicky, Paul-Henri | Al Zreibi, Charles | Cholley, Bernard | Guyonvarch, Yannis | Hamada, Sophie | Barbanti, Claudio | Bertier, Astrid | Harrois, Anatole | Matiello, Jordi | Kerforne, Thomas | Lacroix, Corentin | Brechot, Nicolas | Combes, Alain | Chommeloux, Juliette | D’alessandro, Cosimo | Demondion, Pierre | Demoule, Alexandre | Dres, Martin | Fadel, Guillaume | Fartoukh, Muriel | Hekimian, Guillaume | Juvin, Charles | Leprince, Pascal | Levy, David | Luyt, Charles Edouard | Schoell, Thibaut | Fillâtre, Pierre | Jonas, Maud | Allou, Nicolas | Muccio, Salvatore | Di Perna, Dario | Ruggieri, Vito-Giovanni | Mourvillier, Bruno | Anselmi, Amedeo | Bounader, Karl | Launey, Yoann | Lebouvier, Thomas | Parasido, Alessandro | Reizine, Florian | Esvan, Maxime | Seguin, Philippe | Besnier, Emmanuel | Carpentier, Dorothée | Clavier, Thomas | Olland, Anne | Villard, Marion | Bounes, Fanny | Labaste, François | Minville, Vincent | Guillon, Antoine | Fedun, Yannick
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International audience.
Background Both critically ill patients with coronavirus disease 2019 (COVID-19) and patients receiving extracorporeal membrane oxygenation (ECMO) support exhibit a high incidence of healthcare-associated infections (HAI). However, data on incidence, microbiology, resistance patterns, and the impact of HAI on outcomes in patients receiving ECMO for severe COVID-19 remain limited. We aimed to report HAI incidence and microbiology in patients receiving ECMO for severe COVID-19 and to evaluate the impact of ECMO-associated infections (ECMO-AI) on in-hospital mortality. Methods For this study, we analyzed data from 701 patients included in the ECMOSARS registry which included COVID-19 patients supported by ECMO in France. Results Among 602 analyzed patients for whom HAI and hospital mortality data were available, 214 (36%) had ECMO-AI, resulting in an incidence rate of 27 ECMO-AI per 1000 ECMO days at risk. Of these, 154 patients had bloodstream infection (BSI) and 117 patients had ventilator-associated pneumonia (VAP). The responsible microorganisms were Enterobacteriaceae (34% for BSI and 48% for VAP), Enterococcus species (25% and 6%, respectively) and non-fermenting Gram-negative bacilli (13% and 20%, respectively). Fungal infections were also observed (10% for BSI and 3% for VAP), as were multidrug-resistant organisms (21% and 15%, respectively). Using a Cox multistate model, ECMO-AI were not found associated with hospital death (HR = 1.00 95% CI [0.79–1.26], p = 0.986). Conclusions In a nationwide cohort of COVID-19 patients receiving ECMO support, we observed a high incidence of ECMO-AI. ECMO-AI were not found associated with hospital death. Trial registration number NCT04397588 (May 21, 2020).
