Risk of nosocomial infections in patients with acute respiratory distress syndrome (ARDS) on pumpless extracorporeal lung assist (PECLA)

Background: Systemic infections remain a frequent cause of morbidity and mortality in hospitalised patients with ARDS. We prospectively analysed the incidence of bacteraemia in patients with ARDS and PECLA support, as long-term exposure of blood to foreign material is supposed to promote infection during ICU treatment.

Methods: We compared blood culture positive bacteraemia between two groups of ARDS patients. PECLA-Group: 170 prospectively collected patients with PECLA support for a total of 1237 days, non-PECLA group: retrospective cohort of 87 ARDS patients treated without PECLA.

Results: Mortality was significantly higher in patients with PECLA support (64% vs. 46%, p=0.005). The rate of bloodstream infections were not significantly different between PECLA patients (n=27; 5.7 cases per 1000 PECLA days) and non-PECLA patients (n=13). The microorganisms most often associated with bacteraemia in all ARDS patients were coagulase-negative staphylococci (n=10) followed by staphylococcus aureus (n=7). Multi-resistant microorganisms were found in four cases.

Conclusion: Patients with ARDS are at high risk for nosocomial infections. In this study patients on PECLA support show no increased risk for nosocomial bloodstream infections in comparison to patients conventionally treated for ARDS.