2095. Infections in Burn Patients Receiving Extracorporeal Membrane Oxygenation (ECMO) at a Tertiary Military Medical Center
Session: Poster Abstract Session: Healthcare Epidemiology: Device-associated HAIs
Saturday, October 6, 2018
Room: S Poster Hall

Background: Patients on ECMO are at higher risk for nosocomial infections. While several studies report on infections in ECMO patients, the epidemiology of infections in burn patients on ECMO has not been previously described.

Methods: A retrospective chart review was performed on all patients on ECMO for >48 hours at Brooke Army Medical Center and the US Army Institute of Surgical Research Burn Center between 2012-2017. Patient demographics, burn status, ECMO characteristics, and infection incidence during ECMO were captured. Statistical analyses comparing burn versus non-burn patients were performed using Chi-squared, Fisher’s exact and Mann-Whitney U tests.

Results:  In comparison with those without diagnosed infections, infected patients had more days on ECMO (median [IQR] 16 [12-20] vs. 6.5 [5-10], p<0.01) and longer hospitalization (median [IQR] 35 [24-54] vs. 23.5 days [8-45], p=0.06), however survival to hospital discharge was no different (64% vs. 58%, p=0.77). Burn patients trended towards more infections in their ECMO course (Table).

Burn (n=14)

Non-Burn (n=38)

p-value

 

Median age (yrs)

29.5 (25-39)

39 (29.5-55.5)

0.05

 

Gender, male

9 (64%)

25 (74%)

1

 

Median days on ECMO

14 (8-18)

9 (5-14)

0.26

 

Survival to discharge

9 (64%)

23 (72%)

1

 

Median length of stay (days)

34 (25-47)

24 (11-50)

0.23

 

Median burn % total body surface area (%TBSA)

25 (21-40)

n/a

n/a

 

Infections on ECMO

 

Any Infection

10 (71%)

18 (47%)

0.21 

 

Multiple infections

7 (50%)

9 (24%)

0.07

 

Respiratory infection (RI)

9 (64%)

13 (34%)

0.07

 

Blood stream infection (BSI)

4 (28.6%)

7 (18.4%)

0.46

 

Other infection

5 (35.7%)

9 (24%)

0.49

 

Median time to RI diagnosis (days)

3 (1-9)

2 (1-6.5)

0.79

 

Median time to BSI diagnosis (days)

2.5 (2-5)

5 (1-2)

0.74

 

Total infections per 1000 ECMO days

99.7

50.6

0.02

 

RI per 1000 ECMO days

49.9

22.7

0.12

 

BSI per 1000 ECMO days

22.1

12.2

0.52

 

All data expressed as number N, % or median, interquartile range (IQR) unless otherwise stated

 

Conclusion:
Infection is a common complication of ECMO and is associated with longer duration on ECMO and longer hospitalizations. Burn patients in this cohort were observed to have higher rates of infection compared to non-burn patients.

Joseph Marcus, MD, Internal Medicine, San Antonio Military Medical Center, San Antonio, TX, Lydia Piper, MD, Surgery, San Antonio Military Medical Center, San Antonio, TX, Craig Ainsworth, MD, US Army Institute of Surgical Research, San Antonio, TX, Valerie Sams, DO, SAMMC, San Antonio, TX, Jason Okulicz, MD, Infectious Disease, San Antonio Military Medical Center, Fort Sam Houston, TX and Alice Barsoumian, MD, Infectious Disease Service, Department of Medicine, San Antonio Military Medical Center, JBSA Fort Sam Houston, TX

Disclosures:

J. Marcus, None

L. Piper, None

C. Ainsworth, None

V. Sams, None

J. Okulicz, None

A. Barsoumian, None

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