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A5117 - Pneumonia Before, On and After ECMO
Author Block: E. Gupta1, M. Baram2, H. Hitoshi3, N. Cavarocchi3; 1Pulmonary Critical care, Thomas Jefferson University Hospital, Philadelphia, PA, United States, 2Pulmonary Critical Care, Thomas Jefferson University Hospital, Philadelphia, PA, United States, 3Cardiothoracic surgery, Thomas Jefferson University Hospital, Philadelphia, PA, United States.
Normal 0 false false false EN-US JA X-NONE /* Style Definitions */ table.MsoNormalTable {mso-style-name:""Table Normal""; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-priority:99; mso-style-parent:""""; mso-padding-alt:0in 5.4pt 0in 5.4pt; mso-para-margin:0in; mso-para-margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:12.0pt; font-family:Cambria; mso-ascii-font-family:Cambria; mso-ascii-theme-font:minor-latin; mso-hansi-font-family:Cambria; mso-hansi-theme-font:minor-latin;} INTRODUCTION ECMO patients have a higher risk of infections than other critically ill patients. However effect of positive cultures before ECMO has not been effectively distinguished from new infections on or after ECMO. METHODS All patients placed on ECMO between August 2010 and February 2017 were enrolled in this study. Information on baseline characteristics, laboratory data, vital signs, culture data before, on and after ECMO was collected via chart review. Primary outcome was 30-day survival after de-cannulation from ECMO. Multivariable logistic regression was performed to assess the effect of sputum culture positive infections on mortality. RESULTS There were 192 patients with an average age of 48 years (age range 17-77years). There were 65% males. Thirty four (17.7%) were found to have positive fungal or bacterial sputum culture before initiation of ECMO. Additionally 25 patients (13.2%) were found to have viral pneumonia. Whereas 28 patients developed new sputum culture positive infection after ECMO In multivariate regression, bacterial pneumonia before ECMO was associated with improved mortality after adjusting for age, sex, race, VA or VV ECMO, cardiac or respiratory indication for ECMO and PF ratio at baseline (OR 0.23, 95% CI 0.08-0.67 p value 0.007). However fungal pneumonia had a significantly higher mortality at 30 days (OR 14.8, 95% CI 1.62- 15.2, p value 0.017) after adjusting for the above variables. No effect of viral pneumonia on mortality. No effect of new infection while on ECMO or post ECMO on 30 day mortality. Patients with pre-ECMO pneumonia had a longer stay in the hospital after ECMO than patients with post-ECMO pneumonia or no pneumonia (mean 46.2 days, 32.3 days and 35.5 days respectively) although not statistically significant CONCLUSION In this study, 18 % of patients had a positive sputum culture before ECMO and 21% developed a new infection after ECMO. Bacterial pneumonia before ECMO was associated with a decreased mortality however fungal pneumonia pre-ECMO had a significantly higher mortality in multivariate analysis. Its is important to recognize and treat appropriately treat infections before ECMO.