Michal Sobieszczyk, MD
Pulmonary and Critical Care Medicine and Interventional Pulmonary
Brooke Army Medical Center, United States
Disclosure information not submitted.
Alice Barsoumian, MD (ID)
Physician
Brooke Army Medical Center, United States
Disclosure information not submitted.
Joseph Marcus, MD (ID)
Physician
Brooke Army Medical Center, United States
Disclosure information not submitted.
Title: The Performance of Sepsis Criteria in Predicting Bacteremia in Extracorporeal Membrane Oxygenation
Introduction: Extracorporeal membrane oxygenation (ECMO) is an increasingly used modality of life support with high risk for nosocomial infections. The accuracy of sepsis prediction tools in patients on ECMO is unknown, and rely on measurement of multiple variables which are altered by the circuit. We examine the performance of commonly used sepsis scores in identifying blood stream infections in these patients.
Methods: This is a retrospective review identified all blood stream infections for patients receiving ECMO between January 2012 and December 2020. The Sequential Organ Failure Assessment (SOFA), Logistic Organ Dysfunction Score (LODS), American Burn Association Sepsis Criteria (ABA), Systemic Inflammatory Response Syndrome (SIRS) were calculated for patients during an episodes of blood stream infections. These scores were compared to a time when patients were not bacteremic, which was defined as the first negative blood culture that was at least 72 hours post cannulation or after last positive blood culture.
Results: Of the 220 patients who received ECMO during the study period, 31 (14%) had 51 blood stream infections. Patients with blood stream infections were predominantly male (n=23, 74%) and had a median age of 39 (IQR: 29-47). 30 (97%) patients were on veno-venous modality and 1(3%) patient was on a venoarterial modality. Gram positive infections made up 57% (n=29) of infections with E. faecalis (n=12, 24%) being the most common organism isolated. Gram negative infections (n=13, 26%) and candidemia (n=9, 18%) were less common. There were no significant differences comparing sepsis prediction scores at the time of infection compared to infection-free time points for SOFA (median (IQR) 7 (5-9) vs. 6 (5-8), p=0.22), LODS (median (IQR) 12 (10-12) vs. 11 (10-13), p=0.57), ABA (median (IQR) 2 (1-3) vs. 2 (1-3) p=0.46), or SIRS (median (IQR) 3 (2-3) vs. 3 (2-3), p=0.19).
Conclusions: Our data shows that previously published sepsis scores are elevated throughout a patient’s ECMO course, and do not correlate with bacteremia. As these scores have low predictive value, they should not be used to predict blood stream infections in patients receiving ECMO. Future considerations can include larger cohort for review or a new criterion specific for ECMO population.