Incidence, risk factors and outcomes of nosocomial infection in adult patients supported by extracorporeal membrane oxygenation: a systematic review and meta-analysis

 by Ali Ait Hssain, Amir Vahedian-Azimi, Abdulsalam Saif Ibrahim, Ibrahim Fawzy Hassan, Elie Azoulay and Michael Darmon 

 Critical Care volume 28, Article number: 158, Published: 10 May 2024

Background

An increasing number of patients requires extracorporeal membrane oxygenation (ECMO) for life support. This supportive modality is associated with nosocomial infections (NIs). This systematic review and meta-analysis aim to assess the incidence and risk factors of NIs in adult.

Methods

We searched PubMed, Scopus, Web of Science, and ProQuest databases up to 2022. The primary endpoint was incidence of NI. Secondary endpoints included time to infection, source of infection, ECMO duration, Intensive care and hospital length of stay (LOS), ECMO survival and overall survival. Incidence of NI was reported as pooled proportions and 95% confidence intervals (CIs), while dichotomous outcomes were presented as risk ratios (RR) as the effective index and 95% CIs using a random-effects model.

Results

Among the 4,733 adult patients who received ECMO support in the 30 included studies, 1,249 ECMO-related NIs per 1000 ECMO-days was observed. The pooled incidence of NIs across 18 studies involving 3424 patients was 26% (95% CI 14–38%).Ventilator-associated pneumonia (VAP) and bloodstream infections (BSI) were the most common NI sources. Infected patients had lower ECMO survival and overall survival rates compared to non-infected patients, with risk ratio values of 0.84 (95% CI 0.74–0.96, P = 0.01) and 0.80 (95% CI 0.71–0.90, P < 0.001), respectively.

Conclusion

Results showed that 16% and 20% lower of ECMO survival and overall survival in patients with NI than patients without NI, respectively. However, NI increased the risk of in-hospital mortality by 37% in infected patients compared with non-infected patients. In addition, this study identified the significant positive correlation between ECMO duration and ECMO-related NI.

Practical strategies to reduce nosocomial transmission to healthcare professionals providing respiratory care to patients with COVID-19

 

Practical strategies to reduce nosocomial transmission to healthcare professionals providing respiratory care to patients with COVID-19

 

by Ramandeep Kaur, Tyler T. Weiss, Andrew Perez, James B. Fink, Rongchang Chen, Fengming Luo, Zongan Liang, Sara Mirza and Jie Li

Critical Care volume 24, Article number: 571 (2020) Published: 23 September 2020

 Coronavirus disease (COVID-19) is an emerging viral infection that is rapidly spreading across the globe. SARS-CoV-2 belongs to the same coronavirus class that caused respiratory illnesses such as severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS). During the SARS and MERS outbreaks, many frontline healthcare workers were infected when performing high-risk aerosol-generating medical procedures as well as when providing basic patient care. Similarly, COVID-19 disease has been reported to infect healthcare workers at a rate of ~ 3% of cases treated in the USA. In this review, we conducted an extensive literature search to develop practical strategies that can be implemented when providing respiratory treatments to COVID-19 patients, with the aim to help prevent nosocomial transmission to the frontline workers.

Prevention of Nosocomial Infections in Critically Ill Patients With Lactoferrin: A Randomized, Double-Blind, Placebo-Controlled Study

Prevention of Nosocomial Infections in Critically Ill Patients With Lactoferrin: A Randomized, Double-Blind, Placebo-Controlled Study

by Muscedere, John; Maslove, David M.; Boyd, J. Gordon; O’Callaghan, Nicole; Sibley, Stephanie; Reynolds, Steven; Albert, Martin; Hall, Richard; Jiang, Xuran; Day, Andrew G.; Jones, Gwyneth; Lamontagne, Francois  

Critical Care Medicine: September 2018 - Volume 46 - Issue 9 - p 1450–1456

Objective: To obtain preliminary evidence for the efficacy of lactoferrin as a preventative measure for nosocomial infections and inform the conduct of a definitive study. 

Design: Phase 2, multicenter, randomized, double-blind, placebo-controlled study. Setting: Medical-surgical ICUs. Patients: Adult, critically ill patients receiving invasive mechanical ventilation. Interventions: Randomized, eligible, consenting patients expected to require invasive mechanical ventilation more than 48 hours received lactoferrin both enterally and via an oral swab or a placebo of sterile water for up to 28 days. 

Measurements and Main Results: Of the 214 patients who were randomized, 212 received at least one dose of the intervention and were analyzed (107 lactoferrin and 105 placebo). Protocol adherence was 87.5%. Patients receiving lactoferrin were older (mean [SD], 66.3 [13.5] vs 62.5 [16.2] yr), had a higher Acute Physiology and Chronic Health Evaluation II score (26.8 [7.8] vs 23.5 [7.9]), and need for vasopressors (79% vs 70%). Antibiotic-free days (17.3 [9.0] vs 18.5 [7.1]; p = 0.91) and nosocomial infections (0.3 [0.7] vs 0.4 [0.6] per patient; p = 0.48) did not differ between lactoferrin and placebo groups, respectively. Clinical outcomes for lactoferrin versus placebo were as follows: ICU length of stay (14.5 [18.0] vs 15.0 [37.3] d; p = 0.82), hospital length of stay (25.0 [25.9] vs 28.1 [44.6] d; p = 0.57), hospital mortality (41.1% vs 30.5%; p = 0.11), and 90-day mortality (44.9% vs 32.4%; p = 0.06). Biomarker levels did not differ between the groups. 

Conclusions: Lactoferrin did not improve the primary outcome of antibiotic-free days, nor any of the secondary outcomes. Our data do not support the conduct of a larger phase 3 trial.

Daily goals checklist--a goal-directed method to eliminate nosocomial infection in the intensive care unit.

Daily goals checklist--a goal-directed method to eliminate nosocomial infection in the intensive care unit.
Khorfan F.J Healthc Qual. 2008 Nov-Dec;30(6):13-7.PMID: 19160870
[PubMed - indexed for MEDLINE]Related Articles

Nosocomial infection surveillance and control: current situation in Spanish hospitals.

1: J Hosp Infect. 2009 Mar 7. [Epub ahead of print] LinkOut

Sánchez-Payá J, Bischofberger C, Lizan M, Lozano J, Platón EM, Navarro J, Paz J, Vicente JA.

We studied healthcare-associated infection (HCAI) surveillance and control programmes in Spanish hospitals in 2006 and the human resources and materials used. A questionnaire on the structure, organisation and resources for HCAI surveillance and control was sent to all hospitals registered in the 2005 National Catalogue of Hospitals. A total of 237 hospitals (29.8%) responded, representing 55.9% of the beds included in the catalogue. Some 92% of hospitals had a surveillance and control programme, although 29.9% had had it for less than five years. Only 17.4% of hospitals had one infection control nurse per 250 beds, and only 36.2% had one infection control doctor per 500 beds. Surveillance is the main activity of those responsible for surveillance and control, and the most widely used systems are reviews of microbiology laboratory test results and studies of outbreaks, prevalence surveys, the incidence of certain procedures and of infection in critical care areas. Collaboration in multicentre studies is variable. EPINE, the prevalence survey of nosocomial infections in Spain, is performed annually in 80.5% of centres; ENVIN-UCI, a study of the incidence of infection in critically ill patients, is carried out in 24.8%, and the European study of the incidence of surgical infection, HELICS, in 22.7%. Priority should be given to improving specialised human resources and establishing common surveillance and control systems.
PMID: 19272670 [PubMed - as supplied by publisher]
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CRITICAL CARE NURSING QUARTERLY Vol 31 Number 4

CRITICAL CARE NURSING QUARTERLY
VOL 31; NUMB 4; 2008
ISSN 0887-9303

pp. 282-290
Renal Replacement Therapy in the Critical Care Unit.
Chrysochoou, G.; Marcus, R.J.; Sureshkumar, K.K.; McGill, R.L.; Carlin, B.W.
http://zetoc.mimas.ac.uk/wzgw?db=etoc&terms=RN238922183&field=zid

pp. 291-301
Gastrointestinal Prophylaxis in Critically Ill Patients.
Singh, H.; Houy, T.L.; Singh, N.; Sekhon, S.
http://zetoc.mimas.ac.uk/wzgw?db=etoc&terms=RN238922196&field=zid

pp. 302-308
Prevention of Nosocomial Infections in the Intensive Care Unit.
Kanouff, A.J.; DeHaven, K.D.; Kaplan, P.D.
http://zetoc.mimas.ac.uk/wzgw?db=etoc&terms=RN238922208&field=zid

pp. 309-318
Sleep in the Intensive Care Unit Setting.
Patel, M.; Chipman, J.; Carlin, B.W.; Shade, D.
http://zetoc.mimas.ac.uk/wzgw?db=etoc&terms=RN238922213&field=zid

World Wide Web resources on control of nosocomial infections

World Wide Web resources on control of nosocomial infections
Author(s): Ilias I Siempos ; Konstantinos N Fragoulis and Matthew E Falagas
ISSUE: 2008 ; VOL 11 (2008-07-17)
Access: From BioMed Central [PDF] [Abstract]

From Free Medical Journals . com (/1997 - /Embargo: 2 years)

From UK PubMed Central (/1997 - /2008)
Page: 101
Search the Web: [article] [author(s)]

Infection control programs are effective for the limitation of nosocomial, especially intensive care unit-acquired, infections, which are a major worldwide cause of death and disability. The development of World Wide Web has given to health care professionals immediate access to continuously updated information in the field of infection control. We sought to identify Web sites containing information on nosocomial infection control by using popular Internet search engines, such as Google, Yahoo and AltaVista and by reviewing relevant publications identified in the PubMed and Current Contents databases. Only English language, open-access, developed by a government, academic institution, or national or international scientific association, sites were eligible for inclusion. Out of a vast number of Internet sites initially identified, we selected 49 sites providing information on infection control for inclusion in our list of practical and relevant Internet resources. Several sites provide general information on infection control practices, while others focus on one or few specific infection(s). We provide to health care professionals a timely and succinct list of open-access Internet resources containing information regarding the prevention and control of nosocomial infections in order to help in the dissemination of relevant information and thus, contribute to the limitation of such hazards.