(332) Utility of Routine Blood Cultures in Diagnosing Bloodstream Infections in Pediatric ECMO

Introduction: Six to 18 % of patients supported with extracorporeal membrane oxygenation (ECMO) develop bloodstream Infections (BSI). This high prevalence of BSI on ECMO has multifactorial causes. In a survey of the Extracorporeal Life Support Organization (ELSO), only one-third of the United States centers performed routine blood cultures. There remains a paucity of data regarding effective methods for screening for BSI in such patients. Thus, our study aims to investigate the utility of surveillance blood cultures to diagnose BSI in pediatric patients supported with ECMO.

Methods: We conducted a retrospective cohort study investigating the utility of routine blood cultures in patients supported with ECMO under the age of 21 years who were admitted to an academic pediatric intensive care unit (PICU) over a four-year period. Our primary outcome was positivity of blood culture, and secondary outcome was ECMO duration. Groups were compared using Fisher Exact test and Welch’s t-test with a significance value < 0.05.

Results: Twenty-four patients supported with ECMO between 2019 and 2022 were included in the study. The mean age of the cohort was 29.5 months. Seventy-five percent of patients were male, and 95% were supported by VA ECMO. Fifty percent were cannulated for respiratory indications, 46% for E-CPR, and 4% for cardiac indications. Two hundred sixty-three blood cultures were collected. Of these, nine blood cultures were positive, but three were determined to be contaminants. The overall true positive rate was 2.28%. The median duration of ECMO for non-BSI patients was five days, and for BSI-patients, eleven days. The median number of days when the blood cultures detected infection was 8.5. When comparing the group with BSI to that without BSI, absence of daily chlorhexidine gluconate (CHG) bathing (p < 0.04), non-use of contact precautions (p < 0.04), and positivity of non-blood culture (p < 0.01) were considered statistically significant risk factors.

Conclusions: Potential life-threatening consequences of missing infections makes clinicians consider the use of obtaining routine daily blood cultures. There is, however, significant burden from contamination that must be considered.