Author: de Roux, Quentin; Renaudier, Marie; Bougouin, Wulfran; Boccara, Johanna; Fihman, Vincent; Lepeule, Raphaël; Cherait, Chamsedine; Fiore, Antonio; Hemery, François; Decousser, Jean-Winoc; Langeron, Olivier; Mongardon, Nicolas
Title: Diagnostic yield of routine daily blood culture in patients on veno-arterial extracorporeal membrane oxygenation Cord-id: qcnutxim Document date: 2021_7_8
ID: qcnutxim
Snippet: BACKGROUND: Bloodstream infections (BSIs) are frequent on veno-arterial extracorporeal membrane oxygenation (V-A ECMO). Performing routine blood cultures (BCs) may identify early paucisymptomatic BSIs. We investigated the contribution of systematic daily BCs to detect BSIs on V-A ECMO. METHODS: This was a retrospective study including all adult patients requiring V-A ECMO and surviving more than 24 h. Our protocol included routine daily BCs, from V-A ECMO insertion up to 5 days after withdrawal;
Document: BACKGROUND: Bloodstream infections (BSIs) are frequent on veno-arterial extracorporeal membrane oxygenation (V-A ECMO). Performing routine blood cultures (BCs) may identify early paucisymptomatic BSIs. We investigated the contribution of systematic daily BCs to detect BSIs on V-A ECMO. METHODS: This was a retrospective study including all adult patients requiring V-A ECMO and surviving more than 24 h. Our protocol included routine daily BCs, from V-A ECMO insertion up to 5 days after withdrawal; other BCs were performed on-demand. RESULTS: On the 150 V-A ECMO included, 2146 BCs were performed (1162 routine and 984 on-demand BCs); 190 (9%) were positive, including 68 contaminants. Fifty-one (4%) routine BCs revealed BSIs; meanwhile, 71 (7%) on-demand BCs revealed BSIs (p = 0.005). Performing routine BCs was negatively associated with BSIs diagnosis (OR 0.55, 95% CI [0.38; 0.81], p = 0.002). However, 16 (31%) BSIs diagnosed by routine BCs would have been missed by on-demand BCs. Independent variables for BSIs diagnosis after routine BCs were: V-A ECMO for cardiac graft failure (OR 2.43, 95% CI [1.20; 4.92], p = 0.013) and sampling with on-going antimicrobial therapy (OR 2.15, 95% CI [1.08; 4.27], p = 0.029) or renal replacement therapy (OR 2.05, 95% CI [1.10; 3.81], p = 0.008). Without these three conditions, only two BSIs diagnosed with routine BCs would have been missed by on-demand BCs sampling. CONCLUSIONS: Although routine daily BCs are less effective than on-demand BCs and expose to contamination and inappropriate antimicrobial therapy, a policy restricted to on-demand BCs would omit a significant proportion of BSIs. This argues for a tailored approach to routine daily BCs on V-A ECMO, based on risk factors for positivity.
Search related documents:
Co phrase search for related documents- acute heart failure and low incidence: 1
- acute respiratory distress syndrome and additional cost: 1, 2
- acute respiratory distress syndrome and admission lactate level: 1
- acute respiratory distress syndrome and local protocol: 1, 2, 3, 4, 5
- acute respiratory distress syndrome and logistic modeling: 1, 2
- acute respiratory distress syndrome and logistic regression: 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38, 39, 40, 41, 42, 43, 44, 45, 46, 47, 48, 49, 50, 51, 52, 53, 54, 55, 56, 57, 58, 59, 60, 61, 62, 63, 64, 65, 66, 67, 68, 69, 70, 71, 72
- acute respiratory distress syndrome and low incidence: 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13
- acute respiratory distress syndrome and low interest: 1, 2
- acute respiratory distress syndrome support and logistic regression: 1, 2
- additional cost and logistic modeling: 1
- additional cost and logistic regression: 1, 2, 3
- admission lactate level and logistic regression: 1, 2
- local protocol and logistic regression: 1
- logistic regression and low incidence: 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22
Co phrase search for related documents, hyperlinks ordered by date