Ventilator-associated pneumonia in patients assisted by veno-arterial extracorporeal membrane oxygenation support: Epidemiology and risk factors of treatment failure

<div><p>Introduction</p><p>Ventilator-associated pneumonia (VAP) is frequent in Intensive Care Unit (ICU) patients. In the specific case of patients treated with Veno-Arterial Extracorporeal Membrane Oxygenation Support (VA-ECMO), VAP treatment failures (VAP-TF) have been incompletely investigated.</p><p>Methods</p><p>To investigate the risk factors of treatment failure (VAP-TF) in a large cohort of ICU patients treated with VA-ECMO, we conducted a retrospective study in a Surgical ICU about patients assisted with VA-ECMO between January 1, 2013, and December 31, 2014. Diagnosis of VAP was confirmed by a positive quantitative culture of a respiratory sample. VAP-TF was defined as composite of death attributable to pneumonia and relapse within 28 days of the first episode.</p><p>Results</p><p>In total, 152 patients underwent ECMO support for > 48h. During the VA-ECMO support, 85 (55.9%) patients developed a VAP, for a rate of 60.6 per 1000 ECMO days. The main pathogens identified were <i>Pseudomonas aeruginosa</i> and Enterobacteriaceae. VAP-TF occurred in 37.2% of patients and was associated with an increased 28-day mortality (Hazard Ratio 3.05 [1.66; 5.63], P<0.001), and VA-ECMO assistance duration (HR 1.47 [1.05–2.05], P = 0.025).</p><p>Risk factors for VAP-TF were renal replacement therapy (HR 13.05 [1.73; 98.56], P = 0.013) and documentation of <i>Pseudomonas aeruginosa</i> (HR 2.36 [1.04; 5.35], P = 0.04).</p><p>Conclusions</p><p>VAP in patients treated with VA-ECMO is associated with an increased morbidity and mortality. RRT and infection by <i>Pseudomonas aeruginosa</i> appear as strong risks factors of treatment failure. Further studies seem necessary to precise the best antibiotic management in these patients.</p></div

Risk factors for VAP treatment failure in patients assisted with ECMO.

<p>Risk factors for VAP treatment failure in patients assisted with ECMO.</p

Baseline characteristics.

<p>Baseline characteristics.</p

Pathogens isolated from respiratory samplings.

<p>Pathogens isolated from respiratory samplings.</p

Additional file 1: of Extended-spectrum beta-lactamase − producing enterobacteriaceae in the intensive care unit: acquisition does not mean cross-transmission

Characterization of ESBL-E. (DOCX 92 kb