J Perinatol. 2019 Aug 5. doi: 10.1038/s41372-019-0435-5. [Epub ahead of print]
Extracorporeal membrane oxygenation and bloodstream infection in congenital diaphragmatic hernia.
Keene S1, Grover TR2, Murthy K3, Pallotto EK4, Brozanski B5, Gien J2, Zaniletti I6, Johnson YR7, Seabrook RB8, Porta NFM3, Haberman B9, DiGeronimo R10, Rintoul N11; Children’s Hospitals Neonatal Consortium’s (CHNC) Congenital Diaphragmatic HerniaFocus Group.
1Children’s Healthcare of Atlanta at Egleston and Emory University School of Medicine, Atlanta, GA, USA. firstname.lastname@example.orgChildren’s Hospital Colorado and University of Colorado School of Medicine, Aurora, Colorado, USA.3Ann & Robert H. Lurie Children’s Hospital and Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.4Children’s Mercy Hospital and University of Missouri, Kansas City, MO, USA.5Children’s Hospital of Pittsburgh and University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.6Children’s Hospital Association, Overland Park, KS, USA.7Cook Children’s Hospital, Fort Worth, TX, USA.8Nationwide Children’s Hospital and The Ohio State University College of Medicine, Columbus, OH, USA.9Cincinnati Children’s Hospital Medical Center and the University of Cincinnati College of Medicine, Cincinnati, OH, 45267, USA.10Seattle Children’s Hospital and University of Washington School of Medicine, Seattle, WA, 98195, USA.11Children’s Hospital of Philadelphia and University of Pennsylvania School of Medicine, Philadelphia, PA, USA.
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).
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.
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.
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.PMID: 31383944 DOI: 10.1038/s41372-019-0435-5