A systematic review of variability in the reporting of extracorporeal membrane oxygenation-associated infections and recommendations for standardization

• Published in: American journal of infection control Vol. 52; no. 10; pp. 1209 - 1214
• Main Authors: Sweet, Lauren M., Marcus, Joseph E.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-10-2024
• Subjects: Extracorporeal membrane oxygenation; Nosocomial infection; Nosocomial infection; Extracorporeal membrane oxygenation
• ISSN: 0196-6553; 1527-3296; 1527-3296
• DOI: 10.1016/j.ajic.2024.05.005

Extracorporeal membrane oxygenation (ECMO) utilization has surged in recent years, particularly amidst the COVID-19 pandemic, yet standardization of ECMO-associated infection (EAI) reporting remains lacking.
This systematic review assessed 60 studies from 2018 to 2023 in PubMed, which used key words related to EAIs. Adherence to reporting data elements that may bias reporting, including the use of standardized rates of infections per 1,000 patient days, describing the use of antimicrobial prophylaxis, infection control, and culture practices, describing the definitions for infection by site, and listing pathogens by infection site were evaluated by study.
Our review revealed considerable heterogeneity in data elements and infection definitions. While 51 (85%) studies reported definition by site, only 17 (28%) reported infection control practices, and only 5 (8%) studies adhered to all the identified essential reporting elements. Variation in infection rates was also evident across the definitions, with studies using their own definition having the greatest variability in reported infection rates. Microbiological differences by geographic region further underscored the need for standardized reporting and challenges with generalizability in the EAI literature.
Our findings underscore the imperative for consensus on ECMO infection definitions and transparent reporting practices to facilitate meaningful comparisons and advance patient care protocols.
•Only 28% of ECMO-associated infection studies reported infection control practices.•Culture practices and antimicrobial prophylaxis vary significantly by ECMO center.•Rates varied widely by study, including those using similar definitions.•Geographic variability makes universal prevention recommendations difficult.•Future studies need standardized reporting practices to improve generalizability.