Extracorporeal membrane oxygenation increases recurrent bacteremia risk

There is a risk of recurrent Enterococcus bacteremia or Staphylococcus aureus bacteremia (SAB) in patients who stay on extracorporeal membrane oxygenation (ECMO) after antibiotics have been completed, says an article published in Heart & Lung: The Journal of Cardiopulmonary and Acute Care.

While there is guidance for managing blood stream infections with different invasive devices, there is presently little evidence to advise antibiotic selection and duration in patients getting extracorporeal membrane oxygenation. As a result, Joseph E. Marcus and colleagues undertook this study to assess the management and outcomes of thirty-six patients on ECMO with Staphylococcus aureus and Enterococcus bacteremia.

Blood culture data from patients with Staphylococcus aureus or Enterococcus bacteremia who received ECMO assistance at Brooke Army Medical Centre between March 2012 and September 2021 were analyzed retrospectively.

The key findings of this study were:

During the research period, 25 (9%) of the 282 patients who had ECMO acquired Enterococcus bacteremia, and 16 (6%) developed SAB. 

SAB occurred more frequently in ECMO than in Enterococcus (median day 2 IQR (1-5) vs. 22 (12-51), p = 0.01). 

The most prevalent antibiotic duration was 28 days following SAB clearance and 14 days after Enterococcus clearance. 

With initial bacteremia, 2 (5%) patients received cannula exchange, while 7 (17%) underwent circuit exchange. 1/3 (33%) of SAB patients and 3/10 (30%) of Enterococcus bacteremia patients who remained cannulated after antibiotics were diagnosed with a second episode of SAB or Enterococcus bacteremia.

This small retrospective research of patients undergoing extracorporeal membrane oxygenation (ECMO) discovered that 6% had Staphylococcus aureus bacteremia and 9% had Enterococcus bacteremia, necessitating a lengthy course of antibiotics for clearance. Recurrent bacteremia was prevalent in individuals who continued on ECMO after finishing antibiotics. This study shows how long-term ECMO usage can predispose individuals to recurrent bacteremia.

Reference: 

Marcus, J. E., Ford, M. B., Sattler, L. A., Iqbal, S., Garner, C. L., Sobieszczyk, M. J., & Barsoumian, A. E. (2023). Treatment and outcome of gram-positive bacteremia in patients receiving extracorporeal membrane oxygenation. In Heart & Lung (Vol. 60, pp. 15–19). Elsevier BV. https://doi.org/10.1016/j.hrtlng.2023.02.020