Melissa Rosas
San Antonio Uniformed Services-BAMC
Fort Sam Houston, Texas
Disclosure information not submitted.
Michal Sobieszczyk, MD
Pulmonary and Critical Care Medicine and Interventional Pulmonary
Brooke Army Medical Center, United States
Disclosure information not submitted.
Robert Walter, MD
Consultant to the Surgeon General for Medical Ethics, Chief of Pulmonary/Critical Care Medicine
Walter Reed Army Medical Center
San Antonio, Texas, United States
Disclosure information not submitted.
Andrew Hersh, MD
Pulmonary and Critical Care Medicine
Montrose Memorial Hospital, United States
Disclosure information not submitted.
Whittney Warren, DO
Pulmonary and Critical Care Medicine and Interventional Pulmonary
SCCM, United States
Disclosure information not submitted.
Phillip Mason, MD
Director, Adult ECMO Program
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: Outcomes of Fungemia in Patients Receiving Extracorporeal Membrane Oxygenation
Introduction: In patients requiring extracorporeal membrane oxygenation (ECMO), 13% of blood stream infections are attributable to fungus, which is associated with >30% mortality in the critically ill (1, 2). There is currently limited published data on fungemia in ECMO patients and best practices for circuit management and antifungals are unknown. We present our experience with 12 cases of fungemia in 11 patients.
Methods: This is a retrospective case series of patients admitted to Brooke Army Medical Center from January 2012 to December 2020 who required ECMO. Patients were included if fungi were recovered from blood cultures. Data regarding hospitalization days, ECMO days, treatment, treatment length, metastatic focus, and outcome were reviewed.
Results: There were 235 patients placed on ECMO during the study period with eleven (5%) patients developing fungemia. The cohort was 82% male and had a median age of 32±8 years with the most common admission for thermal burns (n=3, 27%) and SARS-CoV-2 (n=3, 27%). The most common organism isolated was C. albicans (n=3, 27%) and C. tropicalis(n=3, 27%). Prior to developing fungemia, patients were hospitalized for a median 21±26 days and were cannulated for a median of 14±25 days. Four patients had metastatic foci secondary to fungemia. Echinocandins were used as initial therapy in nine (81%) patients with a median treatment duration of 20±10 days. Four (37%) patients died prior to completing therapy, six (55%) patients survived to discharge, and one (9%) patient was transferred for lung transplant. Of the seven patients who completed therapy, four (57%) patients were decannulated on therapy and three (43%) patients remained on ECMO after treatment. While fungemic, six (72%) patients had circuit changes and two (18%) patients had circuit reconfigurations, with only one of the reconfigurations done due to fungemia. One patient (33%) who remained on ECMO developed recurrence 29 days after completing a 14-day course of micafungin.
Discussion: In our cohort, fungemia appeared late in the ECMO course and was associated with a 36% mortality. All patients who were decannulated during therapy survived without recurrence. Further studies focusing on outcomes of patients who remain on ECMO after completion of antifungal therapy are needed.