Outcome and Clinical Characteristics of Nosocomial Infection in Adult Patients Undergoing Extracorporeal Membrane Oxygenation: A Systematic Review and Meta-Analysis

Overview

Journal Front Public Health

Specialty Public Health

Date 2022 Jul 11

PMID 35812481

Authors

Xiyuan Li

Liangshan Wang

Hong Wang

Xiaotong Hou

Affiliations

Soon will be listed here.

Abstract

Objective: This study conducts a meta-analysis of clinical outcomes of nosocomial infection in adult patients receiving extracorporeal membrane oxygenation (ECMO) and systematically evaluates clinical epidemiological characteristics.

Methods: Document retrieval strategies were determined, and all adult patients treated by ECMO were included. The prevalence, incidence, mortality, ECMO use time, intensive care unit (ICU) stay time, hospital stay time, and risk factors of nosocomial infection were systematically evaluated. Subsequently, a meta-analysis of the impact of nosocomial infection on risk of in-hospital mortality was conducted.

Results: A total of 25 retrospective studies were included, and 19 studies were included in the meta-analysis. The prevalence of nosocomial infection was 8.8-64.0%, incidence was 1.7-85.4‰ (per 1,000 ECMO days), and in-hospital mortality was 31.5-75.4%. The duration of ECMO usage and length of ICU stay were longer for infected patients. Compared with non-infected patients, the meta-analysis revealed that nosocomial infection increased the relative risk of death of adult patients receiving ECMO by 32%. The risk factors included the duration of ECMO usage and disease severity score.

Conclusions: Adult patients treated by ECMO have high prevalence of nosocomial infection. In addition, their ECMO use time and ICU stays are longer. Nosocomial infection significantly increases the relative risk of in-hospital mortality.

Citing Articles

Tough choices: the experience of family members of critically ill patients participating in ECMO treatment decision-making: a descriptive qualitative study.

Yang X, Lin Y, Tang A, Zeng X, Dai W, Zhang Q BMC Med Inform Decis Mak. 2025; 25(1):65.

PMID: 39920721 PMC: 11806576. DOI: 10.1186/s12911-025-02876-1.

Clinical Characteristics of Fever After Extracorporeal Membrane Oxygenation Decannulation: Differentiating Infectious from Non-Infectious Causes of Fever and Their Impact on Outcomes.

Kim S, Kim J, Kim S, Lee J, Kim Y, Hwang J J Clin Med. 2025; 14(1.

PMID: 39797141 PMC: 11721104. DOI: 10.3390/jcm14010059.

Pharmacokinetic Changes and Influencing Factors of Polymyxin B in Different ECMO Modes.

Xu M, Chen N, Yu Y, Pan X, Li T Infect Drug Resist. 2024; 17:5815-5825.

PMID: 39734740 PMC: 11682675. DOI: 10.2147/IDR.S486169.

Risk factors for nosocomial infection in patients undergoing extracorporeal membrane oxygenation support treatment: A systematic review and meta-analysis.

Lv X, Han Y, Liu D, Chen X, Chen L, Huang H PLoS One. 2024; 19(11):e0308078.

PMID: 39585868 PMC: 11588223. DOI: 10.1371/journal.pone.0308078.

Do patients receiving extracorporeal membrane-oxygenation need antibiotic prophylaxis? A systematic review and meta-analysis on 7,996 patients.

Orso D, Fodale C, Fossati S, Venturini S, Fonda F, Cugini F BMC Anesthesiol. 2024; 24(1):410.

PMID: 39533181 PMC: 11556216. DOI: 10.1186/s12871-024-02796-z.

References

ONeill J, Schutze G, Heulitt M, Simpson P, Taylor B . Nosocomial infections during extracorporeal membrane oxygenation. Intensive Care Med. 2001; 27(8):1247-53. DOI: 10.1007/s001340101029. View

Ko R, Huh K, Kim D, Na S, Chung C, Cho Y . Nosocomial infections in in-hospital cardiac arrest patients who undergo extracorporeal cardiopulmonary resuscitation. PLoS One. 2020; 15(12):e0243838. PMC: 7757900. DOI: 10.1371/journal.pone.0243838. View

MacLaren G, Schlapbach L, Aiken A . Nosocomial Infections During Extracorporeal Membrane Oxygenation in Neonatal, Pediatric, and Adult Patients: A Comprehensive Narrative Review. Pediatr Crit Care Med. 2019; 21(3):283-290. DOI: 10.1097/PCC.0000000000002190. View

Brown K, Ridout D, Shaw M, Dodkins I, Smith L, OCallaghan M . Healthcare-associated infection in pediatric patients on extracorporeal life support: The role of multidisciplinary surveillance. Pediatr Crit Care Med. 2006; 7(6):546-50. DOI: 10.1097/01.PCC.0000243748.74264.CE. View

Haneke F, Schildhauer T, Schlebes A, Strauch J, Swol J . Infections and Extracorporeal Membrane Oxygenation: Incidence, Therapy, and Outcome. ASAIO J. 2015; 62(1):80-6. DOI: 10.1097/MAT.0000000000000308. View

Hill J, OBrien T, Murray J, Dontigny L, BRAMSON M, OSBORN J . Prolonged extracorporeal oxygenation for acute post-traumatic respiratory failure (shock-lung syndrome). Use of the Bramson membrane lung. N Engl J Med. 1972; 286(12):629-34. DOI: 10.1056/NEJM197203232861204. View

Allou N, Lo Pinto H, Persichini R, Bouchet B, Braunberger E, Lugagne N . Cannula-Related Infection in Patients Supported by Peripheral ECMO: Clinical and Microbiological Characteristics. ASAIO J. 2018; 65(2):180-186. DOI: 10.1097/MAT.0000000000000771. View

Bizzarro M, Conrad S, Kaufman D, Rycus P . Infections acquired during extracorporeal membrane oxygenation in neonates, children, and adults. Pediatr Crit Care Med. 2010; 12(3):277-81. DOI: 10.1097/PCC.0b013e3181e28894. View

Wang J, Huang J, Hu W, Cai X, Hu W, Zhu Y . Risk factors and prognosis of nosocomial pneumonia in patients undergoing extracorporeal membrane oxygenation: a retrospective study. J Int Med Res. 2020; 48(10):300060520964701. PMC: 7585896. DOI: 10.1177/0300060520964701. View

10.

Kim D, Yeo H, Yoon S, Lee S, Lee S, Cho W . Impact of bloodstream infections on catheter colonization during extracorporeal membrane oxygenation. J Artif Organs. 2016; 19(2):128-33. DOI: 10.1007/s10047-015-0882-5. View

11.

Schmidt M, Brechot N, Hariri S, Guiguet M, Luyt C, Makri R . Nosocomial infections in adult cardiogenic shock patients supported by venoarterial extracorporeal membrane oxygenation. Clin Infect Dis. 2012; 55(12):1633-41. PMC: 3888098. DOI: 10.1093/cid/cis783. View

12.

Silvetti S, Ranucci M, Pistuddi V, Isgro G, Ballotta A, Ferraris L . Bloodstream infections during post-cardiotomy extracorporeal membrane oxygenation: Incidence, risk factors, and outcomes. Int J Artif Organs. 2018; 42(6):299-306. DOI: 10.1177/0391398818817325. View

13.

Wang J, Huang J, Hu W, Cai X, Hu W, Zhu Y . Bloodstream infections in patients undergoing extracorporeal membrane oxygenation. Pak J Med Sci. 2020; 36(6):1171-1176. PMC: 7501021. DOI: 10.12669/pjms.36.6.2882. View

14.

Bougle A, Bombled C, Margetis D, Lebreton G, Vidal C, Coroir M . Ventilator-associated pneumonia in patients assisted by veno-arterial extracorporeal membrane oxygenation support: Epidemiology and risk factors of treatment failure. PLoS One. 2018; 13(4):e0194976. PMC: 5898723. DOI: 10.1371/journal.pone.0194976. View

15.

Kim G, Lee K, Park C, Kang S, Kim D, Oh S . Nosocomial Infection in Adult Patients Undergoing Veno-Arterial Extracorporeal Membrane Oxygenation. J Korean Med Sci. 2017; 32(4):593-598. PMC: 5334156. DOI: 10.3346/jkms.2017.32.4.593. View

16.

Menaker J, Galvagno S, Rabinowitz R, Penchev V, Hollis A, Kon Z . Epidemiology of blood stream infection in adult extracorporeal membrane oxygenation patients: A cohort study. Heart Lung. 2019; 48(3):236-239. DOI: 10.1016/j.hrtlng.2019.01.004. View

17.

Juthani B, Macfarlan J, Wu J, Misselbeck T . Incidence of nosocomial infections in adult patients undergoing extracorporeal membrane oxygenation. Heart Lung. 2018; 47(6):626-630. DOI: 10.1016/j.hrtlng.2018.07.004. View

18.

Garner J, Jarvis W, Emori T, Horan T, Hughes J . CDC definitions for nosocomial infections, 1988. Am J Infect Control. 1988; 16(3):128-40. DOI: 10.1016/0196-6553(88)90053-3. View

19.

Fu K, MacLaren G . Infectious Complications of Postcardiotomy Extracorporeal Membrane Oxygenation. Pediatr Crit Care Med. 2020; 21(11):1019-1020. DOI: 10.1097/PCC.0000000000002447. View

20.

Abrams D, Grasselli G, Schmidt M, Mueller T, Brodie D . ECLS-associated infections in adults: what we know and what we don't yet know. Intensive Care Med. 2019; 46(2):182-191. PMC: 7222121. DOI: 10.1007/s00134-019-05847-z. View