Etiological characteristics and appropriate empiric antibiotic strategies of multidrug-resistant pathogens in patients requiring extracorporeal membrane oxygenation: a retrospective cohort study

Abstract Background : Delayed treatments of MDR infections in patients receiving extracorporeal membrane oxygenation (ECMO) supports associated with increased mortality. But, there was currently no relevant references available to guide early anti-infective treatments for them. The purpose of our study was to clarify etiological characteristics and empiric antibiotic strategies of MDR pathogens in ECMO patients. Methods : The clinical data of 104 ECMO patients in Tianjin third central hospital were retrospectively collected from January 2014 to December 2022. There were 61 and 29 adult patients supported by veno-arterial (VA)-ECMO or veno-venous (VV)-ECMO for > 24 hours enrolled. Patients were divided into “group R” and “group N” by with or without MDR infections. Clinical characteristics of enrolled patients were collected. The data of MDR pathogens and anti-infection treatments against them were summarized. Results : The rates of MDRinfections were 50.8% and 79.3% in VA-ECMO and VV-ECMO patients respectively. ECMO patients in group R presented poor prognostic indicators as expected. MDR pathogens detected were mainly MDR Gram-negative bacteria (MDR-GNB) (91.6% in VA-ECMO patients and 92.5% in VV-ECMO patients, respectively). Sputum was the main source of MDR. There were 72.9% and 80% of MDR pathogens deprived from sputum in VA-ECMO and VV-ECMO patients respectively. MDR pathogens generally showed high drug-resistant prevalence to routine antibiotics, and anti-infection treatments against them were not optimistic. Cephalosporins, meropenem, linezolid and tigecycline were most selected antibiotics according to antimicrobial susceptibility tests in our study. Conclusion : ECMO patients had high incidence of MDR infection, which mostly induced by MDR-GNB from sputum. Cephalosporins, meropenem, linezolid and tigecycline were appropriate empiric antibiotics against MDR pathogens in ECMO patients according to our study.