Sepsis in pediatric Extra Corporal Life Support (ECLS): the 6 year British Columbia experience
Bibliographic record
Abstract
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.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.002 |
| Science and technology studies | 0.002 | 0.001 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".