Prophylactic Antibiotic Use on ECMO

Prophylactic antibiotic use on ECMO has historically been a very common practice.  Many institutions are still practicing prophylactic antibiotic use on ECMO but is it justified?

A review of the ELSO database published in PEDIATRIC CRITICAL CARE MEDICINE in May of 2011 highlighted an overall rate of 11.7% incidence of acquired infections on ECMO from 1998 to 2008.  It’s clear that infections acquired on ECMO are associated with longer ECMO runs, increased ICU stays, and decreased survival rates.  But how do we mitigate the risks of ECMO related to infections?

A recent abstract in ASAIO looked at the use of prophylactic antibiotic use on ECMO and found no evidence of benefit over treating on a case by case basis.  It was suggested that one reason there was no benefit may be because the causative organisms were so diverse that it would be difficult to determine a clear prophylactic strategy.

So as ECMOlogists, what do we do to mitigate the risk of infections acquired on ECMO?  ELSO set out to answer this very complex question in 2008.  The ELSO Task Force on Infectious Disease on ECMO: Diagnosis, Treatment and Prevention, submitted a SUMMARY report on their findings.  In that report they also state lack of evidence for routine prophylactic antibiotic use on ECMO. The summary report provides 8 pages of recommendations related to infection control on ECMO and is well worth a few minutes to review.

 

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