Incidence of candidaemia in prolonged venovenous extracorporeal membrane oxygenation.

This single-centre retrospective study reports the dynamics of the incidence of candida bloodstream infection (CBSI) in 145 patients receiving venovenous extracorporeal membrane oxygenation (ECMO) for respiratory support between January 2014 and December 2018. The incidence rate and odds ratio (OR) of CBSI were calculated, stratified by week of ECMO exposure. Weekly incidence increased throughout the ECMO run, with an increasing trend in OR (P=0.005), and a window of continued risk after decannulation was observed. Of the 13 patients who developed CBSI, five (38%) received empirical micafungin treatment before positive culture due to clinical suspicion. There is a need for prospective studies aiming to improve ECMO diagnostic stewardship practices and discourage unnecessary antifungal prophylaxis or empiric management.

Bloodstream infections in patients receiving extracorporeal membrane oxygenation for COVID-19 pneumonitis

Objective: A significant challenge in the care of patients receiving ECMO is the management of bloodstream infections (BSI). Several factors may increase the risk of BSI in patients with COVID-19, including use of high dose steroids and the immunopathologic effects of COVID-19 itself. We aimed to assess the incidence of BSI in patients who received ECMO for severe COVID- 19 pneumonitis and compare these with non-COVID-19 ECMO admissions. Methods: We performed a retrospective review of medical records and laboratory data for patients receiving ECMO between January 2019 and July 2020. We reviewed all blood cultures taken during ECMO until the date of decannulation. COVID-19 and non- COVID-19 groups were compared. Results: Seventy-four (37 COVID-19, 37 non- COVID-19) patients were identified. Demographics and BSI incidence are summarised in table 1. The commonest bacteria isolated were (COVID-19, non- COVID-19);coagulase negative Staphylococci (17, 3), Enterococcus faecium (19, 4), Klebsiella pneumoniae (4, 0), Klebsiella aerogenes (4, 0). Yeasts isolated included Candida parapsilosis complex (3, 2) and Candida albicans (2,1). Conclusions: COVID-19 ECMO admissions were associated with longer ECMO duration and higher BSI incidence compared with non-COVID-19 ECMO patients. Antimicrobial stewardship and robust IPC measures are recommended to reduce incidence. Further research into effective infection prevention in ECMO patients is needed.