持续肾替代治疗和体外膜氧合治疗患者的感染风险。

IF 3.4 3区 医学 Q1 CRITICAL CARE MEDICINE
Current Opinion in Critical Care Pub Date : 2025-10-01 Epub Date: 2025-08-06 DOI:10.1097/MCC.0000000000001315
Antoine Gaillet, Jean-François Timsit
{"title":"持续肾替代治疗和体外膜氧合治疗患者的感染风险。","authors":"Antoine Gaillet, Jean-François Timsit","doi":"10.1097/MCC.0000000000001315","DOIUrl":null,"url":null,"abstract":"<p><strong>Purpose of review: </strong>This review addresses the growing concern over nosocomial infections in patients undergoing extracorporeal membrane oxygenation (ECMO) and/or continuous renal replacement therapy (CRRT). As the use of these modalities increases, particularly in critically ill patients, infection-related complications remain frequent, underdiagnosed, and inadequately addressed in existing guidelines. This review is timely given the urgent need to standardize diagnostic and preventive strategies in this high-risk population.</p><p><strong>Recent findings: </strong>Recent studies highlight the multifactorial origin of infection risk in ECMO/CRRT patients, including device-related immunoparalysis. In patients on ECMO, nosocomial infections - particularly ventilator-associated pneumonia (VAP), bloodstream infections (BSIs), and cannula-related infections (CRIs) - are among the most frequent complications, with incidence rates ranging from 9% to 64%. VAP and BSIs occur at rates up to 61 and 38 per 1000 ECMO-days, respectively. Predominant pathogens include Enterobacterales, nonfermenting Gram-negative bacilli, Enterococcus spp., and fungi. Enterococcus-related BSIs are notably underrecognized and often inadequately treated. Duration of ECMO support is the most consistent infection risk factor, along with illness severity and CRRT co-initiation. Nosocomial infections are associated with a 32% relative increase in mortality.</p><p><strong>Summary: </strong>Nosocomial infections in ECMO/CRRT patients are common, diagnostically challenging, and strongly linked to poor outcomes. Their prevention and management require an integrated, tailored strategy. Standardized definitions, improved surveillance, and targeted antimicrobial stewardship are urgently needed to mitigate risks in this vulnerable population.</p>","PeriodicalId":10851,"journal":{"name":"Current Opinion in Critical Care","volume":" ","pages":"539-546"},"PeriodicalIF":3.4000,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Infection risks in patients treated by continuous renal replacement therapy and extracorporeal membrane oxygenation.\",\"authors\":\"Antoine Gaillet, Jean-François Timsit\",\"doi\":\"10.1097/MCC.0000000000001315\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Purpose of review: </strong>This review addresses the growing concern over nosocomial infections in patients undergoing extracorporeal membrane oxygenation (ECMO) and/or continuous renal replacement therapy (CRRT). As the use of these modalities increases, particularly in critically ill patients, infection-related complications remain frequent, underdiagnosed, and inadequately addressed in existing guidelines. This review is timely given the urgent need to standardize diagnostic and preventive strategies in this high-risk population.</p><p><strong>Recent findings: </strong>Recent studies highlight the multifactorial origin of infection risk in ECMO/CRRT patients, including device-related immunoparalysis. In patients on ECMO, nosocomial infections - particularly ventilator-associated pneumonia (VAP), bloodstream infections (BSIs), and cannula-related infections (CRIs) - are among the most frequent complications, with incidence rates ranging from 9% to 64%. VAP and BSIs occur at rates up to 61 and 38 per 1000 ECMO-days, respectively. Predominant pathogens include Enterobacterales, nonfermenting Gram-negative bacilli, Enterococcus spp., and fungi. Enterococcus-related BSIs are notably underrecognized and often inadequately treated. Duration of ECMO support is the most consistent infection risk factor, along with illness severity and CRRT co-initiation. Nosocomial infections are associated with a 32% relative increase in mortality.</p><p><strong>Summary: </strong>Nosocomial infections in ECMO/CRRT patients are common, diagnostically challenging, and strongly linked to poor outcomes. Their prevention and management require an integrated, tailored strategy. Standardized definitions, improved surveillance, and targeted antimicrobial stewardship are urgently needed to mitigate risks in this vulnerable population.</p>\",\"PeriodicalId\":10851,\"journal\":{\"name\":\"Current Opinion in Critical Care\",\"volume\":\" \",\"pages\":\"539-546\"},\"PeriodicalIF\":3.4000,\"publicationDate\":\"2025-10-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Current Opinion in Critical Care\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1097/MCC.0000000000001315\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2025/8/6 0:00:00\",\"PubModel\":\"Epub\",\"JCR\":\"Q1\",\"JCRName\":\"CRITICAL CARE MEDICINE\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Current Opinion in Critical Care","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1097/MCC.0000000000001315","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2025/8/6 0:00:00","PubModel":"Epub","JCR":"Q1","JCRName":"CRITICAL CARE MEDICINE","Score":null,"Total":0}
引用次数: 0

摘要

综述目的:本综述探讨了接受体外膜氧合(ECMO)和/或持续肾替代治疗(CRRT)的患者对院内感染的日益关注。随着这些模式的使用增加,特别是在危重患者中,感染相关并发症仍然频繁,诊断不足,并且在现有指南中没有得到充分解决。鉴于迫切需要规范这一高危人群的诊断和预防策略,本综述是及时的。最近的发现:最近的研究强调了ECMO/CRRT患者感染风险的多因素起源,包括器械相关的免疫麻痹。在ECMO患者中,院内感染——特别是呼吸机相关性肺炎(VAP)、血流感染(bsi)和插管相关感染(CRIs)——是最常见的并发症,发病率从9%到64%不等。VAP和bsi的发生率分别高达61和38 / 1000 ECMO-days。主要病原体包括肠杆菌、非发酵革兰氏阴性杆菌、肠球菌和真菌。与肠球菌相关的脑损伤明显未被充分认识,而且往往治疗不充分。ECMO支持的持续时间是最一致的感染风险因素,以及疾病严重程度和CRRT共同启动。医院感染与死亡率相对增加32%相关。总结:ECMO/CRRT患者的院内感染很常见,诊断上具有挑战性,并且与不良预后密切相关。它们的预防和管理需要一个综合的、有针对性的战略。迫切需要标准化的定义、改进的监测和有针对性的抗微生物药物管理,以减轻这一弱势群体的风险。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Infection risks in patients treated by continuous renal replacement therapy and extracorporeal membrane oxygenation.

Purpose of review: This review addresses the growing concern over nosocomial infections in patients undergoing extracorporeal membrane oxygenation (ECMO) and/or continuous renal replacement therapy (CRRT). As the use of these modalities increases, particularly in critically ill patients, infection-related complications remain frequent, underdiagnosed, and inadequately addressed in existing guidelines. This review is timely given the urgent need to standardize diagnostic and preventive strategies in this high-risk population.

Recent findings: Recent studies highlight the multifactorial origin of infection risk in ECMO/CRRT patients, including device-related immunoparalysis. In patients on ECMO, nosocomial infections - particularly ventilator-associated pneumonia (VAP), bloodstream infections (BSIs), and cannula-related infections (CRIs) - are among the most frequent complications, with incidence rates ranging from 9% to 64%. VAP and BSIs occur at rates up to 61 and 38 per 1000 ECMO-days, respectively. Predominant pathogens include Enterobacterales, nonfermenting Gram-negative bacilli, Enterococcus spp., and fungi. Enterococcus-related BSIs are notably underrecognized and often inadequately treated. Duration of ECMO support is the most consistent infection risk factor, along with illness severity and CRRT co-initiation. Nosocomial infections are associated with a 32% relative increase in mortality.

Summary: Nosocomial infections in ECMO/CRRT patients are common, diagnostically challenging, and strongly linked to poor outcomes. Their prevention and management require an integrated, tailored strategy. Standardized definitions, improved surveillance, and targeted antimicrobial stewardship are urgently needed to mitigate risks in this vulnerable population.

求助全文
通过发布文献求助,成功后即可免费获取论文全文。 去求助
来源期刊
Current Opinion in Critical Care
Current Opinion in Critical Care 医学-危重病医学
CiteScore
5.90
自引率
3.00%
发文量
172
审稿时长
6-12 weeks
期刊介绍: ​​​​​​​​​Current Opinion in Critical Care delivers a broad-based perspective on the most recent and most exciting developments in critical care from across the world. Published bimonthly and featuring thirteen key topics – including the respiratory system, neuroscience, trauma and infectious diseases – the journal’s renowned team of guest editors ensure a balanced, expert assessment of the recently published literature in each respective field with insightful editorials and on-the-mark invited reviews.
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
确定
请完成安全验证×
copy
已复制链接
快去分享给好友吧!
我知道了
右上角分享
点击右上角分享
0
联系我们:info@booksci.cn Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。 Copyright © 2023 布克学术 All rights reserved.
京ICP备2023020795号-1
ghs 京公网安备 11010802042870号
Book学术文献互助
Book学术文献互助群
群 号:604180095
Book学术官方微信