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Ojective: We aim to describe a large, multicenter cohort of patients with bloodstream infection (BSI) acquired during extracorporeal membrane oxygenation (ECMO) support., Methods: We conducted a retrospective observational study in 12 Europeans ICUs. Only patients who developed a BSI of unknown source during ECMO support were included in the present analysis. Primary aim was to describe BSI epidemiology in patients with ECMO support. Secondary objectives were to describe antimicrobial susceptibility of incriminated micro-organisms., Results: One hundred and eighty-two patients were included. Main reason for ECMO support was ARDS, followed by cardiogenic shock and post-cardiotomy. Half of the patients (51.9%) received early antimicrobial therapy. Main incriminated microorganisms were Enterococcus sp. (37.4%), Enterobacterales (26.9%), coagulase negative Staphylococci (15.9%) and Gram negative bacilli (11.5%). Multi drug resistant organisms (MDRO) were incriminated in 26 (14.3%) BSI and were mainly extended spectrum producing-Enterobacterales (17/26). Antimicrobial therapy was considered as appropriate in 130 patients (71.4%). Patients who received inappropriate antimicrobial therapy were more frequently infected with MDRO. Only 59 (32.4%) of cases were susceptible to 3rd generation cephalosporin while association of piperacillin/tazobactam with vancomycin was considered appropriate in 155 cases (85.2%) as compared with 168 cases (92.3%) for carbapenems combined with vancomycin., Conclusion: Enterococcus sp. was incriminated in about a third of BSI among patients with ECMO support. High appropriateness would only be obtained with piperacilline/tazobactam or carbapenems in association with vancomycin while 3rd generation cephalosporin would have failed in the majority of BSI cases., Clinical Trial Number: Not applicable., Competing Interests: Declarations. Ethics approval: In accordance with the declaration of Helsinki, the protocol was submitted and then approved by the ethics committee of the Société de Réanimation de Langue Française (registration no. CE-SRLF-22–074) and the database is registered by the Commission Nationale de l’Informatique et des Libertés (CNIL, registration no 2228484v 0). Consent to participate: In accordance with current French law, informed written consent for demographic, physiologic and hospital-outcome data analyses was waived because this observational study did not modify existing diagnostic or therapeutic strategies. Nonetheless, patients and/or relatives were informed about the anonymous data collection and told that they could decline inclusion. Competing interests: The authors declare no competing interests. Contributors: Groupe Hospitalier Pitié-Salpêtrière, Paris, France: Juliette Chommeloux, Guillaume Hékimian, Alain Combes, Nima Djavidi, Aymeric Lancelot, Pauline Dureau, Guillaume Lebreton. CH de Saint-Brieuc, France: Pierre Fillâtre. Centre Hospitalier Universitaire de La Réunion, Saint Denis, France: Laura Rivoire, Nicolas Allou, Radj Cally. Hôpital Bichat-Claude Bernard, Paris, France: Hermann Do Rego, Mariem Dlela, Marc Doman. Centre Hospitalier universitaire de Rennes: Christophe Camus, Erwan Flecher, Alexandre Mansour. Hôpital Louis Pradel, Lyon, France: Jean-Luc Fellahi, Matteo Pozzi, Matthias Jacquet-Lagreze. Hôpitaux Universitaires de Genève, Genève, Switzerland: Raphaël Giraud, Karim Bendjelid. Hôpital Henri Mondor, Créteil, France: Keyvan Razazi, Armand Mekontso-Dessap. Hôpital universitaire de Lille, Lille, France: Anahita Rouzé, Saad Nseir, Thibault Duburcq. Hôpital Nord, Marseille, France: Christophe Guervilly, Jean-Marie Forel. Hôpital Haut Leveque, Pessac, France: Eline Bonnardel. Hôpital Universitaire de Bruxelles, Brussels, Belgium: Fabio S Taccone. Central message: Among ECMO patients with bloodstream infection, incriminated microorganisms were dominated by Enterococcus sp., Enterobacterales and coagulase negative Staphylococci. Mortality was high (50%). Perspective statement: Base on observed microbiology, high appropriateness would only be obtained with piperacilline/tazobactam or carbapenems in association with vancomycin. Future trial evaluating empirical therapy in this setting are needed., (© 2025. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Purpose: Fever is frequent after extracorporeal membrane oxygenation (ECMO) decannulation. We aimed to evaluate the incidence of post-decannulation fever and describe its causes., Methods: Adult ECMO patients who were successfully weaned from ECMO were retrospectively included. Minimal and maximal core temperatures were collected daily for each patient from 48 h before decannulation up to 5 days after. Patients were grouped according to the cause of fever (infection, thrombosis, or no evident cause) and compared. Plasma cytokine profile was obtained, each day from decannulation to 5 days after for 20 patients., Results: Between January 2021 and December 2022, 123 patients successfully weaned from ECMO were included. Post-decannulation fever occurred in 54 patients (44 %). It was associated with an infection in 39 patients (72 %) and with a thrombosis in 6 patients (11 %), and no cause was identified in the remaining 9 (17 %). Prolonged ECMO duration, extended ICU length-of-stay, diabetes and vascular comorbidities were significantly associated with a higher risk of infection. Finally, the pro-inflammatory cytokine profiles did not differ between febrile and afebrile patients., Conclusion: Post-decannulation fever was common, and was mainly due to infections or thrombosis. Fever should therefore not be considered as a benign inflammatory reaction until proven otherwise., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

Background : Nosocomial lower respiratory tract infections (nLRTIs) are associated with unfavorable clinical outcomes and significant healthcare costs. nLRTIs include hospital-acquired pneumonia (HAP), ventilator-associated pneumonia (VAP), and other ICU-acquired pneumonia phenotypes. While risk factors for mortality in these infections are critical to guide preventive strategies, it remains unclear whether they vary based on their requirement of invasive mechanical ventilation (IMV) at any point during the hospitalization. Objectives: This study aims to identify risk factors associated with short- and long-term mortality in patients with nLRTIs, considering differences between those requiring IMV and those who do not. Methods : This multinational prospective cohort study included ICU-admitted patients diagnosed with nLRTI from 28 hospitals across 13 countries in Europe and South America between May 2016 and August 2019. Patients were selected based on predefined inclusion and exclusion criteria, and clinical data were collected from medical records. A random forest classifier determined the most optimal clustering strategy when comparing pneumonia site acquisition [ward or intensive care unit (ICU)] versus intensive mechanical ventilation (IMV) necessity at any point during hospitalization to enhance the accuracy and generalizability of the regression models. Results : A total of 1060 patients were included. The random forest classifier identified that the most efficient clustering strategy was based on ventilation necessity. In total, 76.4% of patients [810/1060] received IMV at some point during the hospitalization. Diabetes mellitus was identified to be associated with 28-day mortality in the non-IMV group (OR [IQR]: 2.96 [1.28-6.80], p = 0.01). The 90-day mortality-associated factor was MDRP infection (1.98 [1.13-3.44], p = 0.01). For ventilated patients, chronic liver disease was associated with 28-day mortality (2.38 [1.06-5.31] p = 0.03), with no variable showing statistical and clinical significance at 90 days. Conclusions : The risk factors associated with 28-day mortality differ from those linked to 90-day mortality. Additionally, these factors vary between patients receiving invasive mechanical ventilation and those in the non-invasive ventilation group. This underscores the necessity of tailoring therapeutic objectives and preventive strategies with a personalized approach.

Objectives: Vascular complications after venoarterial extracorporeal membrane oxygenation (ECMO) remains poorly studied, although they may highly impact patient management after ECMO removal. Our aim was to assess their frequency, predictors, and management., Design: Retrospective, observational cohort study., Setting: Two ICUs from a tertiary referral academic hospital., Patients: Adult patients who were successfully weaned from venoarterial ECMO between January 2021 and January 2022., Interventions: None., Primary Outcome: Vascular complications frequency related to ECMO cannula., Measurements and Main Results: A total of 288 patients were implanted with venoarterial ECMO during the inclusion period. One hundred ninety-four patients were successfully weaned, and 109 underwent a CT examination to assess for vascular complications until 4 days after the weaning procedure. The median age of the cohort was 58 years (interquartile range [IQR], 46-64 yr), with a median duration of ECMO support of 7 days (IQR, 5-12 d). Vascular complications were observed in 88 patients (81%). The most frequent complication was thrombosis, either cannula-associated deep vein thrombosis (CaDVT) ( n = 63, 58%) or arterial thrombosis ( n = 36, 33%). Nonthrombotic arterial complications were observed in 48 patients (44%), with 35 (31%) presenting with bleeding. The most common site of CaDVT was the inferior vena cava, occurring in 33 (50%) of cases, with 20% of patients presenting with pulmonary embolism. There was no association between thrombotic complications and ECMO duration, anticoagulation level, or ECMO rotation flow. CT scans influenced management in 83% of patients. In-hospital mortality was 17% regardless of vascular complications., Conclusions: Vascular complications related to venoarterial ECMO cannula are common after ECMO implantation. CT allows early detection of complications after weaning and impacts patient management. Patients should be routinely screened for vascular complications by CT after decannulation., Competing Interests: Dr. Luyt received funding from Advanz Pharma and Merck; he received funding from Merck. The remaining authors have disclosed that they do not have any potential conflicts of interest., (Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the Society of Critical Care Medicine and Wolters Kluwer Health, Inc.)