ABSTRACT
SESSION TITLE: ECMO and ARDS in COVID-19 Infections SESSION TYPE: Rapid Fire Original Inv PRESENTED ON: 10/17/2022 12:15 pm - 1:15 pm PURPOSE: The purpose of the study is to determine the incidence of bloodstream infections in COVID19 patients treated with ECMO in relation to steroid days and days of ECMO cannulation. METHODS: Retrospective analysis of data for COVID19 patients treated with ECMO in a tertiary academic medical center from January 2020 until July 2021 was performed. Data including baseline patients’ characteristics, type, and duration of ECMO support, type and days of steroids used, blood culture results, and organism type were collected. An institutional review board (IRB) approval was obtained before data collection. A two-tailed T-test was used to calculate the P-value, P-value of <0.05 was considered significant. RESULTS: A Total of 34 patients were analyzed, 3 of them were on (Veno-Arterial) VA ECMO and 31 on (Veno-Venous) VV ECMO, 32 out of 34 (94%) patients received steroids (Dexamethasone alone 16 patients, Methylprednisolone 1 patient and 15 patients received multiple steroid types). Seventeen patients had positive blood cultures (50%), average steroid days for patients with positive blood cultures was 21.6 days compared to 11.8 days for patients with negative blood cultures (P-Value:0.01), Average ECMO days for patients with positive blood cultures was 40.5 days compared to 18.8 days for patients with negative blood cultures ( P-Value:0.01). Staphylococcus epidermidis was found in 47% of the cultures, Enterococcus Faecalis was found in 24% of cultures while MRSA, MSSA, and Candida Albicans were found in 6% of cultures. CONCLUSIONS: Bloodstream Infections during ECMO cannulation are common and carry significant morbidity and mortality in patients. Longer ECMO days and longer duration of steroid use were found to be associated with higher rates of bloodstream infections in our patient’s sample. This could be related to the instrumentation risk or immunosuppression from steroids or other factors not evaluated in this study. CLINICAL IMPLICATIONS: Bloodstream infections are common in patients treated with ECMO, the risk of infections increases with longer ECMO and steroid days. Knowledge of such risks and trying to minimize them such as cautious use of steroids might help in the prevention of infections. Further studies are needed to better assess this risk. DISCLOSURES: No relevant relationships by Varun Halani No relevant relationships Added 03/21/2022 by Ghassan Kamel, value=Honoraria Removed 03/21/2022 by Ghassan Kamel No relevant relationships Added 03/22/2022 by Ghassan Kamel, value=Honoraria Removed 03/22/2022 by Ghassan Kamel No relevant relationships by Ahmad Sharayah
ABSTRACT
SESSION TITLE: Not the Normal Host: Infections Still Matter SESSION TYPE: Rapid Fire Original Inv PRESENTED ON: 10/17/2022 12:15 pm - 1:15 pm PURPOSE: The purpose of this study is to determine the incidence of hospital acquired and ventilator associated pulmonary infections in patients on ECMO for SARS-CoV-2 related ARDS in relation to steroids and ECMO cannulation days. METHODS: A retrospective analysis of COVID19 patients treated with ECMO admitted to a tertiary care academic medical center from January 2020 until July 2021 was conducted. Data including baseline patient characteristics, type, and duration of ECMO support, type and days of steroids use and sputum culture results were collected. An institutional review board (IRB) approval was obtained prior to data collection. A two-tailed T-test was used to calculate the P-value, P-value of <0.05 was considered significant. RESULTS: A total of 34 patients were included in the analysis, of which 3 of them were on (Veno-Arterial) VA-ECMO and 31 were on (Veno-Venous) VV-ECMO. 32 out of 34 (94%) patients received steroids during their hospital course. Total of 20 patients had positive sputum cultures (59%) and average steroid days for patients with positive sputum cultures was 20.75 days as compared to 10.75 days for patients with negative sputum cultures (P-Value: 0.01). Average ECMO days for patients with positive sputum cultures was 26 days as compared to 14.4 days for patients with negative sputum cultures (P Value: 0.0003). Amongst the patients with positive sputum cultures, pseudomonas aeruginosa and methicillin-sensitive staphylococcus aureus (MSSA) were the most isolated organisms (25% of positive cultures), methicillin-resistant staphylococcus aureus (MRSA) and Serratia Marcescens were isolated in 20% of positive cultures, Klebsiella aerogenes was isolated in 15% of positive cultures. CONCLUSIONS: Hospital acquired and ventilator associated pulmonary infections are common in patients on ECMO for SARS-CoV2 related ARDS. Longer ECMO days and a longer duration of steroid use were found to be associated with higher rates of bacterial growth in sputum cultures. Common organisms included Pseudomonas, MSSA, and MRSA. CLINICAL IMPLICATIONS: Our analysis describes the most common bacterial organisms isolated on sputum cultures in this study population. It may also serve as a guide for empiric antibiotics choice when bacterial pneumonia is suspected in similar patients while awaiting sputum culture results. DISCLOSURES: No relevant relationships by Varun Halani No relevant relationships Added 03/21/2022 by Ghassan Kamel, value=Honoraria Removed 03/21/2022 by Ghassan Kamel No relevant relationships Added 03/22/2022 by Ghassan Kamel, value=Honoraria Removed 03/22/2022 by Ghassan Kamel No relevant relationships by Ahmad Sharayah