Contact Precautions to Prevent Pathogen Transmission

Gastrointestinal colonization with multidrug-resistant Gram-negative bacteria during extracorporeal membrane oxygenation: effect on the risk of subsequent infections and impact on patient outcome

Background

In ICU patients, digestive tract colonization by multidrug-resistant (MDR) Gram-negative (G−) bacteria is a significant risk factor for the development of infections. In patients undergoing extracorporeal membrane oxygenation (ECMO), colonization by MDR bacteria and risk of subsequent nosocomial infections (NIs) have not been studied yet. The aim of this study is to evaluate the incidence, etiology, risk factors, impact on outcome of gastrointestinal colonization by MDR G− bacteria, and risk of subsequent infections in patients undergoing ECMO.

Methods

This is a retrospective analysis of prospectively collected data: 105 consecutive patients, treated with ECMO, were admitted to the ICU of an Italian tertiary referral center (San Gerardo Hospital, Monza, Italy) from January 2010 to November 2015. Rectal swabs for MDR G− bacteria were cultured at admission and twice a week. Only colonization and NIs by MDR G− bacteria were analyzed.

Results

Ninety-one included patients [48.5 (37–56) years old, 63% male, simplified acute physiology score II 37 (32–47)] underwent peripheral ECMO (87% veno-venous) for medical indications (79% ARDS). Nineteen (21%) patients were colonized by MDR G− bacteria. Male gender (OR 4.03, p = 0.029) and duration of mechanical ventilation (MV) before ECMO > 3 days (OR 3.57, p = 0.014) were associated with increased risk of colonization. Colonized patients had increased odds of infections by the colonizing germs (84% vs. 29%, p < 0.001, OR 12.9), longer ICU length of stay (LOS) (43 vs. 24 days, p = 0.002), MV (50 vs. 22 days, p < 0.001) and ECMO (28 vs. 12 days, p < 0.001), but did not have higher risk of death (survival rate 58% vs. 67%, p = 0.480, OR 0.68). Infected patients had almost halved ICU survival (46% vs. 78%, p < 0.001, OR 4.11).

Conclusions

In patients undergoing ECMO for respiratory and/or circulatory failure, colonization by MDR G− bacteria is frequent and associated with more the tenfold odds for subsequent infection. Those infections are associated with an increased risk of death.

Exosomes derived miR-126 attenuates oxidative stress and apoptosis from ischemia and reperfusion injury by targeting ERRFI1

AIMS

Acute myocardial infarction is one of the most threaten disease in the world. In previous studies, exosome derived miR-126 has been verified that exert an pro-angiogenic function through exosomal transfer. However, the function of miR-126 in ischemic reperfusion injury remains unknown. The aim of the study was to investigate the function and mechanism of miR-126 in ischemic reperfusion injury.

METHODS

H₂O₂ and CoCl₂-treated neonatal rat ventricular cardiomyocytes were used to analyze the function of miR-126 in vitro. Tunel, JC-1, ROS, LDH and cell survival rates were detected to evaluate the function of miR-126. Rat acute myocardial infarction was performed to elucidate the function of miR-126 in vivo.

RESULTS

We found that miR-126 could reduce the apoptosis and improved cell survival of H₂O₂-treated and CoCl₂-treated neonatal rat ventricular cardiomyocytes. MiR-126 also attenuates the ROS elevation and mitochondrial membrane potential through JC-1 detection. miR-126 also improved the cardiac function in vivo. Luciferase activity revealed that miR-126 could bind to ERRFI1, suggesting miR-126 functioned through regulating ERRFI1.

CONCLUSION

We verified the function and mechanism of miR-126 and provide evidence that miR-126 may play important role in ischemic reperfusion injury, and understanding the precise role of miR-126 will undoubtedly shed new light on the clinical treatment.