Infectious Disease Task Force

Committee:

ELSO Task Force on Infectious Disease on ECMO: Diagnosis, Treatment and Prevention

Purpose:

In recognizing the importance and impact of infections on ECMO, the leadership of ELSO created the "Infectious Disease Task Force" in 2008 to address issues of diagnosis, treatment and prevention.  This is summarized in the link below and the entire process, database review, explanation and support of the committee's recommendations are included in the new ELSO "Red Book" 2012.

In order to better disseminate information regarding Infectious Disease and Antibiotic therapy for ECMO patients, ELSO has created a network that will include a discussion board that can be accessed through the new ELSO website.

Goals:

To review the ELSO database, the current literature, and current practices and with the assembled group of experts in both ECMO and infectious disease, make recommendations regarding the diagnosis of infections on ECMO, the treatment of Infections on ECMO, the prevention of infections on ECMO, as well as other related issues such as the safety of pre-primed circuits, prophylactic antibiotics, etc.

Members:

Mike Hines MD, FACS (Chair)
Ivor Berkowitz MD
Matthew Bizzarro MD
Kristina Bryant MD
Steven Conrad MD
Jim Fortenberry MD
Anna Karimova MD
David Kaufman MD
Bill Lynch MD
Preeti Malani MD
Allison Messina MD
Jason Newland MD
Jonathan Smith MD
Stephanie Stoyall MD
Hsin-Yu Sun MD
Enno Wildschut MD
Peter Rycus MPH

Recommendations:

See Task Force summary attached below as well as detailed data in the new ELSO "Red Book" (2012).

Conclusions:

The task force learned many things from the review of the database, including the fact that we need to collect more specific data.  Specifically it is recommended that the ELSO database work to collect data on culture sites and culture dates to help define pre-existing infections from infections occurring on ECMO, particularly when it comes to resistant organisms (MRSA and VRE).  It is currently not possible to distinguish patients colonized with these organisms, even prior to their becoming ill, and those who became colonized in the hospital while on ECMO, and those who were truly infected with these resistant organisms.   Work also needs to be done to clarify the mode of ECMO support (better definitions provided), and to record when patients had open chests and open abdomens, and for how long.  Additional data regarding severity of illness scores would also help with data analysis and outcomes.

The task force also concluded that further studies would be beneficial to define the pharmacokinetics of additional antibiotics. Research to try and define the role of inflammatory markers, including searching for new markers to assist in the identification of infection in this population would also be extremely beneficial. 

Finally, the task force hopes that with implementation of its recommendations, a future study can demonstrate reduction in the rates of nosocomial infections, and perhaps lower mortality in those with sepsis. 

Committee documents: 

References: 

1.Bizzarro MJ, Conrad SA, Kaufman DA, Rycus P. Infections Acquired During Extracorporeal Membrane Oxygenation in Neonates, Children and Adults.  Pediatr Crit Care Med 2011;12(3):277-281.

2. Meyer DM, Jessen ME, Eberhart RC. Neonatal extracorporeal membrane oxygenation complicated by sepsis.  Ann Thorac Surg 1995;59:975-980

3. Brown KL, Ridout DA, Shaw M, Dodkins I, Smith LC, O'Callaghan MA, Goldman AP, Macqueen S, Hartley JC.  Healthcare-associated infection in pediatric patients on extracorporeal life support: The role of multidisciplinary surveillance. Pediatr Crit Care Med 2006 Nov;7(6):546-50

4. Sun HY, Ko WJ, Tsia PR, Sun CC, Chang YY, Lee CW, Chen YC. Infections occurring during extracorporeal membrane oxygenation use in adult patients. J Thorac Cardiovasc Surg 2010;140:1125-1132

5. Douglass BH, Keenan AL, Purohit DM.  Bacterial and fungal infections in neonates undergoing venoarterial extracorporeal membrane oxygenation: an analysis of the registry data of the extracorporeal life support organization.   Artif Organs 1996 Mar;20(3):202-8.

6. O'Neill JM, Schutze GE, Heulitt MJ, Simpson PM, Taylor BJ.  Nosocomial infections during extracorporeal membrane oxygenation.  Intensive Care Med 2001 Aug;27(8):1247-53.

7. Coffin SE, Bell LM, Manning ML, Polin R.  Nosocomial Infections in Neonates Receiving Extracorporeal Membrane Oxygenation. Infect Control Hosp Epidemiol 1997;18:93-96.

8. Kaczala GW, Paulus SC, Al-Dajani N, Jang W, Blondel-Hill E, Dobson S, Cogswell A, Singh AJ.  Bloodstream infection in pediatric ECLS: usefulness of daily blood culture monitoring and predictive value of biologic markers.  The British Columbia experience.   Pediatr Surg Int. 2009 Feb;25(2):169-73.

9. Steiner CK, Stewart DL, Bond SJ, Hornung CA, McKay VJ. Predictors of acquiring a nosocomial bloodstream infection on extracorporeal membrane oxygenation.  J Pediatr Surg 2001 Mar;36(3):487-92.

10. Elerian LF, Sparks JW, Meyer TA, Zwischenberger JB, Doski J, Goretsky MJ, Warner BW, Cheu HW, Lally KP.  Usefulness of surveillance cultures in neonatal extracorporeal membrane oxygenation.  ASAIO Journal 2001;47:220-223.

11. Ahsman MJ, Wildschut ED, Tibboel D, Mathot RA.  Pharmacokinetics of Cefotaxime and Desacetylcefotaxime in Infants during Extracorporeal Membrane Oxygenation.   Antimicrob Agents Chemother 2010 May;54(5) 1734-1741.

12. Wildschut ED, Ahsman MJ, Allegaert K, Mathot RAA, Tibboel D.   Determinants of drug absorption in different ECMO circuits.  Intensive Care Med 2010; 36:2109-2116.

13. Dagan O, Klein J, Gruenwald C, Bohn D, Barker G, Koren G.  Preliminary studies of the effects of extracorporeal membrane oxygenation on the disposition of common pediatric drugs.  Ther Drug Monit 1993 Aug;15(4):263-6.