Incidence, risk factors and outcomes of nosocomial infection in adult patients supported by extracorporeal membrane oxygenation: a systematic review and meta-analysis

• Published in: Critical care (London, England) Vol. 28; no. 1; p. 158
• Main Authors: Ait Hssain, Ali, Vahedian-Azimi, Amir, Ibrahim, Abdulsalam Saif, Hassan, Ibrahim Fawzy, Azoulay, Elie, Darmon, Michael
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 10-05-2024; BioMed Central
• Subjects: Adult; Bacterial pneumonia; Bias; Blood oxygenation, Extracorporeal; Care and treatment; Cohort analysis; Complications and side effects; Cross infection; Cross Infection - epidemiology; Cross Infection - mortality; Extracorporeal membrane oxygenation; Extracorporeal Membrane Oxygenation - adverse effects; Extracorporeal Membrane Oxygenation - methods; Extracorporeal Membrane Oxygenation - statistics & numerical data; Health aspects; Humans; Incidence; Length of stay; Medical research; Medicine, Experimental; Meta-analysis; Nosocomial infections; Patient outcomes; Pneumonia; Respiratory failure; Risk Factors; Systematic review; Urogenital system; Ventilators; France; Serbia; Nosocomial infection; Extracorporeal membrane oxygenation; Prevalence; Risk factors; Incidence; Meta-analysis
• ISSN: 1364-8535; 1466-609X; 1466-609X; 1364-8535; 1366-609X
• DOI: 10.1186/s13054-024-04946-8

An increasing number of patients requires extracorporeal membrane oxygenation (ECMO) for life support. This supportive modality is associated with nosocomial infections (NIs). This systematic review and meta-analysis aim to assess the incidence and risk factors of NIs in adult.
We searched PubMed, Scopus, Web of Science, and ProQuest databases up to 2022. The primary endpoint was incidence of NI. Secondary endpoints included time to infection, source of infection, ECMO duration, Intensive care and hospital length of stay (LOS), ECMO survival and overall survival. Incidence of NI was reported as pooled proportions and 95% confidence intervals (CIs), while dichotomous outcomes were presented as risk ratios (RR) as the effective index and 95% CIs using a random-effects model.
Among the 4,733 adult patients who received ECMO support in the 30 included studies, 1,249 ECMO-related NIs per 1000 ECMO-days was observed. The pooled incidence of NIs across 18 studies involving 3424 patients was 26% (95% CI 14-38%).Ventilator-associated pneumonia (VAP) and bloodstream infections (BSI) were the most common NI sources. Infected patients had lower ECMO survival and overall survival rates compared to non-infected patients, with risk ratio values of 0.84 (95% CI 0.74-0.96, P = 0.01) and 0.80 (95% CI 0.71-0.90, P < 0.001), respectively.
Results showed that 16% and 20% lower of ECMO survival and overall survival in patients with NI than patients without NI, respectively. However, NI increased the risk of in-hospital mortality by 37% in infected patients compared with non-infected patients. In addition, this study identified the significant positive correlation between ECMO duration and ECMO-related NI.