Sepsis in pediatric Extra Corporal Life Support (ECLS): the 6 year British Columbia experience

Introduction: Sepsis in patients supported with ECLS is a well known complication. Extracorporeal Life Support Organization (ELSO) reported an overall incidence of 8.7% culture proven infections on 28,545 neonatal and pediatric patients (1). Incidence of infection in neonatal and pediatric patients varied:

I. Respiratory ECLS –6.5% (neonatal), 20.8% (pediatric)

II. Cardiac ECLS –8.2% (neonatal) and 12.6% (pediatric).

Method: At BC Children's Hospital (BCCH), daily surveillance blood cultures are done on all patients during the duration of their ECLS run. All positive blood cultures (+ve BC) reported by the laboratory were reviewed and analyzed for incidence of organism growth(s) with associated sensitivities and timing of first positive culture. Incidence of nosocomial infections in our study population was also determined. Clinical data was retrospectively obtained from a chart review. We compared our results with previously published institution-specific and ELSO data.

Results: At BCCH, from 1999 to 2005, 89 patients were supported on ECLS for a total of 12,977 hrs (541 patient-days) (duration of ECLS: average 145.8 hrs, median 125 hrs). Age distribution of ECLS patients was: neonates (0–30 days) –45, pediatric (>30 days –18 years) –41, adult (>18 years) –1. The single adult (49 years) was excluded from our data analysis.

There were 33 positive blood cultures (in 25 ECLS patients (28.4%)).

Table 1:

Demographic distribution of the positive blood cultures

	Respiratory ECLS(n=49)	Cardiac ECLS(n=39)	+ve BC patients(n=25)
Neonatal ECLS (n=43)	6	7	13
Pediatric ECLS (n=45)	5	7	12
+ve BC patients (n=25)	11	14	25

Table 2:

	BCCH	ELSO
Neonatal Respiratory	24.0%	6.5%
Pediatric Respiratory	38.5%	20.8%
Neonatal Cardiac	38.8%	8.2%
Pediatric Cardiac	21.8%	12.7%
Overall	28.4%	8.7%

Blood cultures were positive between day 1 to 12 on ECLS, with a median of 5.9 days and an average of 5 days.

Table 3:

Distribution of organisms

Gram +ve	Gram -ve	Anaerobics	Fungal
Coag. Neg. Staph (30%) S. aureus (9%) E. faecalis S. viridans Micrococcus	Acetinobacter E. cloacae E. species E. aerogenus Pseudomonas aeruginosa Pseudomonas species Burkholderia Sphingophomonas	B. fragilis	Candida albicans

Conclusion: 25 of our 88 ECLS patients had blood culture proven infections (incidence of 28.4%). Coagulase negative staphylococcus (30%) was the most commonly isolated organism, followed by staphylococcus aureus (9%).

Compared to ELSO data, we noted higher incidence of +ve BC infection in our study population.

Keywords: Sepsis, blood culture, ECLS, ELSO

References: (1) ECLS Registry Report, International summary, January 2005