INTRODUCTION:
The incidence of bloodstream infection (BSI) in extracorporeal life support (ECLS) is reported between 0.9 and 19.5%. In January 2006, the Extracorporeal Life Support Organization (ELSO) reported an overall incidence of 8.78% distributed as follows: respiratory: 6.5% (neonatal), 20.8% (pediatric); cardiac: 8.2% (neonatal) and 12.6% (pediatric).
METHOD:
At BC Children's Hospital (BCCH) daily surveillance blood cultures (BC) are performed and antibiotic prophylaxis is not routinely recommended.
Positive BC (BC+) were reviewed, including resistance profiles, collection time of BC+, time to positivity and mortality.
White blood cell count, absolute neutrophile count, immature/total ratio, platelet count, fibrinogen and lactate were analyzed 48, 24 and 0 h prior to BSI. A univariate linear regression analysis was performed.
RESULTS:
From 1999 to 2005, 89 patients underwent ECLS. After exclusion, 84 patients were reviewed.
The attack rate was 22.6% (19 BSI) and 13.1% after exclusion of coagulase-negative staphylococci (n = 8). BSI patients were significantly longer on ECLS (157 h) compared to the no-BSI group (127 h, 95% CI: 106-148). Six BSI patients died on ECLS (35%; 4 congenital diaphragmatic hernias, 1 hypoplastic left heart syndrome and 1 after a tetralogy repair). BCCH survival on ECLS was 71 and 58% at discharge, which is comparable to previous reports.
No patient died primarily because of BSI. No BSI predictor was identified, although lactate may show a decreasing trend before BSI (P = 0.102).
CONCLUSION:
Compared with ELSO, the studied BSI incidence was higher with a comparable mortality.
We speculate that our BSI rate is explained by underreporting of "contaminants" in the literature, the use of broad-spectrum antibiotic prophylaxis and a higher yield with daily monitoring BC. We support daily surveillance blood cultures as an alternative to antibiotic prophylaxis in the management of patients on ECLS.
2009-01-23
Eng.
Pediatric Surgery International
Division of Neonatal Intensive Care, Department of Pediatrics, The British Columbia Children's Hospital, 1R47-4480 Oak Street, Vancouver, BC, V6H 3V4, Canada.
Pediatr Surg Int. 2009 Feb;25(2):169-73
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