Patients receiving extracorporeal membrane oxygenation (ECMO) are at a high risk for infections: 6.1% risk for neonates and 20.5% for adults. A statement from the Extracorporeal Life Support Organization Infectious Disease Task Force concludes that no additional antibiotic coverage is needed for patients receiving ECMO1; however, because patients on ECMO are severely ill, providers tend to prescribe empiric antibiotics.
A retrospective review of 294 patients receiving ECMO was conducted between July 1, 2011, and July 1, 2017, and an ECMO antimicrobial protocol was introduced on July 1, 2014. The study included a cohort of 133 patients before and 161 patients after the implementation of the antimicrobial protocol, and included an evaluation of days of antimicrobial use, antibiotic-free days, and days of individual antimicrobial use, adjusted for Acute Physiology and Chronic Health Evaluation scores and ECMO duration.2
Total days of antimicrobial use after the protocol decreased from 2508 to 2186 (P = .01), with a statistically significant reduction in the use of individual antimicrobials: vancomycin, 407 to 266 (P <.03); and cefepime, 196 to 165 (P = .06); along with reduced days of anidulafungin, caspofungin, fluconazole, meropenem, and daptomycin. When adjusted for mean days receiving ECMO (7 [4-14] before compared with 5 [3-9.5] after [P <.0119]), antimicrobial-free days actually declined after implementation of the protocol. Early trends of improved stewardship were offset when time frame and number of patients were increased. Despite this, no difference was seen in the rate of nosocomial infections, but increased rates were seen for Clostridium difficile (0 vs 4; P <.06).
“Protocolization” and standardization of antimicrobial recommendations for patients treated with ECMO resulted in a reduction in the use of specific antibiotics, yet increased overall antibiotic use.
- The Extracorporeal Life Support Organization Infectious Disease Task Force Recommendation Summary. www.elso.org/Portals/0/Files/ELSO-ID-Task-Force-Recommendations-Summary.pdf. Accessed September 28, 2018.
- Shah A, et al. IDWeek 2018. Abstract 250.