P-1041. A Comparison of Pre- and Post-Pandemic Infection Epidemiology in Patients with Extracorporeal Membrane Oxygenation (ECMO)

TL;DR

This study compares infection rates in ECMO patients before and during the pandemic and finds no significant differences in infection rates or outcomes.

Contribution

The study provides new insights into the consistency of ECMO-related infection epidemiology during and before the pandemic.

Findings

Bloodstream infections (BSIs) were similar in both pre- and post-pandemic groups.

Gram-positive bacteria were the most common cause of BSIs in both groups.

There were no significant differences in MDRO colonization, mortality, or ICU length of stay between the groups.

Abstract

Extracorporeal membrane oxygenation (ECMO) is a mechanical circulatory device that supports patients with pulmonary or cardiac failure. Patients on ECMO have a significant infection risk due to cannula insertion into large vessels with evidence suggesting that 20% of patients develop an infection. The COVID-19 pandemic led to increased ECMO utilization, though it is unclear if ECMO-related infection epidemiology has shifted. We performed a retrospective comparative analysis of infection epidemiology in ECMO patients pre- and post-pandemic.Table 1:Participant characteristicsTable 2:Bloodstream infections during ECMOAbbreviations: ECMO: extracorporeal membrane oxygenation

Participant characteristics

Bloodstream infections during ECMO

Abbreviations: ECMO: extracorporeal membrane oxygenation

After institutional review board (IRB) approval, infection data was collected from the ELSO Registry and our Enterprise Data Warehouse. The pre-pandemic range was defined as 4/1/2018-2/29/2020 and the post-pandemic range was defined as 3/1/2020-2/1/2022.Table 3:Other Non-BSI Infections during ECMOAbbreviations: BSI: bloodstream infection; ECMO: extracorporeal membrane oxygenation

Other Non-BSI Infections during ECMO

Abbreviations: BSI: bloodstream infection; ECMO: extracorporeal membrane oxygenation

We assessed 199 patients pre-pandemic and 228 patients post-pandemic. Most patients in both cohorts were male with a mean Charlson score of 5.2-5.6 and mean BMI of 28-30 (Table 1). There were no significant differences in race, ethnicity, ICU length of stay (LOS), or mortality pre- and post-pandemic; patients post-pandemic were younger overall.

Incidence of bloodstream infections (BSIs) was similar in both groups (Table 2). Gram-positive bacteria comprised 65-75% of BSIs, with E. faecalis the most common organism in both groups. BSIs caused by Gram-negative bacteria comprised 14-24% of cases in both groups. BSIs caused by Candida spp. were observed in 11-12% of cases and most commonly due to C. auris. Multidrug-resistant organisms (MDROs) caused 14-18% of BSIs and typically were vancomycin-resistant Enterococci. Other non-BSI infections occurred in 20-25% of patients, and the frequency of non-BSI infections did not differ between groups (Table 3). MDRO colonization or infection did not differ between groups.

ECMO remains an important life-saving procedure for critically ill patients, and infectious complications occur in up to 20% of patients. This study demonstrated that amongst ECMO recipients at our institution, the post-pandemic state led to no differences regarding infection rate, MDRO colonization or infection, mortality, or ICU LOS.

All Authors: No reported disclosures

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