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| Name | Class |
|---|---|
| Azienda Ospedaliera Mater Domini di Catanzaro | UNKNOWN |
| Policlinico di Bari Giovanni XXIII | UNKNOWN |
| Azienda Ospedaliera Universitaria Integrata Verona | OTHER |
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Veno-venous extracorporeal membrane oxygenation (VV-ECMO) is a life-support technique used in patients with most severe acute respiratory distress syndrome (ARDS). ARDS is a life-threatening form of respiratory failure associated with a mortality rate of approximately 40-45%.Despite several studies confirming a real benefit of the use of ECMO in patients with ARDS who are unresponsive to conventional management, ECMO is still a complex and costly treatment that can be exposed to potential complications, such as nosocomial infections (NI).
Noteworthy, the most frequent NIs occurring during VV-ECMO are pneumonia (>40%) and, secondly, blood-stream infections (3-18%). The situation is more challenging for Gram-negative bacilli: more than one-half of the Escherichia coli and more than one-third of the Klebsiella pneumoniae isolates were resistant to at least one antimicrobial group. Of note, an alarming increase in carbapenem resistance has been reported in several species, including K. pneumoniae (7.9% of isolates), P.aeruginosa (16.5% of isolates) and A. baumannii (>30% of isolates).
In fact, the isolation of MDROs has been shown to be an independent risk of death and of subsequent infections not only in critically ill patients but also in those patients requiring VV-ECMO (mortality rate between 56-68%). However, data are still conflicting about the exact incidence of multidrug resistant organisms (MDRO) during VV-ECMO and the impact on short- and mid-term outcomes.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| VV-ECMO patients | Patients requiring VV-ECMO for acute respiratory distress syndrome (ARDS) |
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| Measure | Description | Time Frame |
|---|---|---|
| Overall incidence of MDR Gram negative bacteria isolations | Overall incidence of MDR Gram negative bacteria isolations during ECMO (n° events/1.000 person-days of ECMO) | From ECMO connection up to 48 hours after ECMO de-connection |
| Incidence of MDR Gram negative bacteria acquired | Incidence of MDR Gram negative bacteria acquired after ECMO connection (n° events/1.000 person-days of ECMO) | From ECMO connection up to 48 hours after ECMO de-connection |
| Incidence of MDR Gram negative bacteria isolated prior to ECMO connection | Incidence of patients requiring VV-ECMO with a previous MDR Gram negative bacteria | At study enrollment |
| Measure | Description | Time Frame |
|---|---|---|
| Incidence of MDR-related infections (plus descriptive analysis) | Incidence of patients acquiring MDR-related infections | From ECMO connection up to 48 hours after ECMO de-connection |
| Incidence of MDR-related colonizations (plus descriptive analysis) |
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Inclusion Criteria:
Exclusion Criteria:
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Patients affected by ARDS (according to Berlon criteria) undergoing VV-ECMO.
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| Name | Affiliation | Role |
|---|---|---|
| Andrea Bruni, Prof | Azienda Ospedaliera Mater Domini di Catanzaro | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Azienda Ospedaliera Università Padova | Padova | 35126 | Italy |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 39192287 | Derived | Boscolo A, Bruni A, Giani M, Garofalo E, Sella N, Pettenuzzo T, Bombino M, Palcani M, Rezoagli E, Pozzi M, Falcioni E, Pistollato E, Biamonte E, Murgolo F, D'Arrigo G, Gori M, Tripepi GL, Gottin L, Longhini F, Grasso S, Navalesi P, Foti G. Retrospective ANalysis of multi-drug resistant Gram-nEgative bacteRia on veno-venous extracorporeal membrane oxygenation. The multicenter RANGER STUDY. Crit Care. 2024 Aug 27;28(1):279. doi: 10.1186/s13054-024-05068-x. |
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| ID | Term |
|---|---|
| D012128 | Respiratory Distress Syndrome |
| ID | Term |
|---|---|
| D008171 | Lung Diseases |
| D012140 | Respiratory Tract Diseases |
| D012120 | Respiration Disorders |
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| Fondazione IRCCS San Gerardo di Monza |
| UNKNOWN |
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Incidence of patients acquiring MDR-related colonizations
| From ECMO connection up to 48 hours after ECMO de-connection |
| Risk factors-mortality | Risk factors for mortality | At ECMO connection (baseline) |