Extracorporeal membrane oxygenation and bloodstream infection in congenital diaphragmatic hernia

• Published in: Journal of perinatology 2019-10, Vol.39 (10), p.1384-1391
• Main Authors: Keene, Sarah, Grover, Theresa R., Murthy, Karna, Pallotto, Eugenia K., Brozanski, Beverly, Gien, Jason, Zaniletti, Isabella, Johnson, Yvette R., Seabrook, Ruth B., Porta, Nicolas F. M., Haberman, Beth, DiGeronimo, Robert, Rintoul, Natalie
• Format: Article
• Language: English
• Subjects: 692/308/409; 692/499; 692/699/1785; Anti-Bacterial Agents - therapeutic use; Antibiotics; Bacteremia - drug therapy; Bacteremia - etiology; Bacteremia - microbiology; Birth defects; Blood oxygenation, Extracorporeal; Care and treatment; Complications and side effects; Diaphragm; Dosage and administration; Enterobacter - isolation & purification; Escherichia coli - isolation & purification; Extracorporeal membrane oxygenation; Extracorporeal Membrane Oxygenation - adverse effects; Female; Health aspects; Hernia; Hernias; Hernias, Diaphragmatic, Congenital - complications; Hernias, Diaphragmatic, Congenital - therapy; Humans; Infant, Newborn; Infants; Infections; Male; Medicine; Medicine & Public Health; Neonates; Oxygenation; Patients; Pediatric research; Pediatric Surgery; Pediatrics; Proteus - isolation & purification; Respiratory therapy; Risk Factors; Septicemia; Staphylococcus aureus - isolation & purification; Urinary tract; Urinary tract infections; Urinary Tract Infections - drug therapy; Urinary Tract Infections - etiology; Urinary Tract Infections - microbiology
• ISSN: 0743-8346; 1476-5543
• DOI: 10.1038/s41372-019-0435-5

Objective To characterize the risk of bloodstream (BSI) and urinary tract infection (UTI) and describe antibiotic use in infants with congenital diaphragmatic hernia (CDH) requiring extracorporeal membrane oxygenation (ECMO). Study design The Children’s Hospitals Neonatal Database was queried for infants with CDH and ECMO treatment from 2010 to 2016. The outcomes included BSI, UTI, and antimicrobial medication. Member institutions completed a survey on infection practices. Result Eighteen of the 338 patients identified (5.3%) had ≥1 BSI during their ECMO course. The likelihood of BSI increased with time: 1.2/1000 ECMO days; 0.6% (2/315) in the first week and rising to 14.6/1000; 8.6% (5/58) after 21 days ( p  = 0.002). More than 95% of patients received antibiotics each week on ECMO. Conclusions Confirmed BSI is rare in infants with CDH treated with ECMO in the first week, but increases with the duration of ECMO. Use of antibiotics was extensive and did not correspond to infection frequency.