Reducing Broad-Spectrum Antimicrobial Use in Extracorporeal Membrane Oxygenation: Reduce AMMO Study

Aditya Shah; Priya Sampathkumar; Ryan W Stevens; John K Bohman; Brian D Lahr; Prabij Dhungana; Kirtivardhan Vashistha; John C O'Horo

doi:10.1093/cid/ciab118

Reducing Broad-Spectrum Antimicrobial Use in Extracorporeal Membrane Oxygenation: Reduce AMMO Study

Clin Infect Dis. 2021 Aug 16;73(4):e988-e996. doi: 10.1093/cid/ciab118.

Authors

Aditya Shah¹, Priya Sampathkumar¹, Ryan W Stevens², John K Bohman³, Brian D Lahr⁴, Prabij Dhungana⁵, Kirtivardhan Vashistha⁶, John C O'Horo^{1

7}

Affiliations

¹ Division of Infectious Diseases, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA.
² Department of Pharmacy Services, Mayo Clinic, Rochester, Minnesota, USA.
³ Division of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, USA.
⁴ Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota, USA.
⁵ Division of Internal Medicine, Medstar Hospital, Baltimore, Maryland, USA.
⁶ Division of Internal Medicine, Allegheny Medical Center, Pittsburgh, Pennsylvania, USA.
⁷ Division of Pulmonary and Critical Care Medicine, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA.

PMID: 33575744
DOI: 10.1093/cid/ciab118

Abstract

Background: The use of extracorporeal membrane oxygenation (ECMO) in critically ill adults is increasing. There are currently no guidelines for antimicrobial prophylaxis. We analyzed 7 years of prophylactic antimicrobial use across 3 time series for patients on ECMO at our institution in the development, improvement, and streamlining of our ECMO antimicrobial prophylaxis protocol.

Methods: In this quasi-experimental interrupted time series analysis, we evaluated the impact of an initial ECMO antimicrobial prophylaxis protocol, implemented in 2014, on antimicrobial use and National Healthcare Safety Network-reportable infection rates. Then, following a revision and streamlining of the protocol in November 2018, we reevaluated the same metrics.

Results: Our study population included 338 intensive care unit patients who received ECMO between July 2011 and November 2019. After implementation of the first version of the protocol, we did not observe significant changes in antimicrobial use or infection rates in these patients; however, following revision and streamlining of the protocol, we demonstrated a significant reduction in broad-spectrum antimicrobial use for prophylaxis in patients on ECMO without any evidence of a compensatory increase in infection rates.

Conclusions: Our final protocol significantly reduces broad-spectrum antimicrobial use for prophylaxis in patients on ECMO. We propose a standard antimicrobial prophylaxis regimen for patients on ECMO based on current evidence and our experience.Summary: There are no guidelines for antimicrobial prophylaxis in patients on extracorporeal membrane oxygenation (ECMO). A rational approach employing concepts of antimicrobial stewardship can drive logical antimicrobial selection for prophylaxis in patients on ECMO without adversely impacting outcomes.

Keywords: antimicrobial prophylaxis; antimicrobial stewardship; extracorporeal membrane oxygenation; nosocomial infections.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adult
Anti-Infective Agents* / therapeutic use
Critical Care
Critical Illness
Extracorporeal Membrane Oxygenation*
Humans
Interrupted Time Series Analysis

Substances

Anti-Infective Agents