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

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          Abstract

          Background

          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.

          Methods

          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.

          Results

          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.

          Conclusion

          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.

          Supplementary Information

          The online version contains supplementary material available at 10.1186/s13054-024-04946-8.

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                Author and article information

                Contributors
                Amir Vahedian-Azimi:
                ORCID: http://orcid.org/0000-0002-1678-7608
                amirvahedian63@gmail.com
                Journal
                Journal ID (nlm-ta): Crit Care
                Title: Critical Care
                Publisher: BioMed Central (London )
                ISSN (Print): 1364-8535
                ISSN (Electronic): 1466-609X
                Publication date (Electronic): 10 May 2024
                Publication date PMC-release: 10 May 2024
                Publication date Collection: 2024
                Volume: 28
                Electronic Location Identifier: 158
                Affiliations
                [1 ]Medical Intensive Care Unit, Hamad General Hospital, ( https://ror.org/01bgafn72) Doha, Qatar
                [2 ]GRID grid.416973.e, ISNI 0000 0004 0582 4340, Department of Medicine, , Weill Cornell Medical College, ; Doha, Qatar
                [3 ]College of Health and Life Science, Hamad Bin Khalifa University, ( https://ror.org/03eyq4y97) Doha, Qatar
                [4 ]Trauma Research Center, Nursing Faculty, Baqiyatallah University of Medical Sciences, ( https://ror.org/01ysgtb61) Sheykh Bahayi Street, Vanak Square, P.O. Box 19575-174, Tehran, Iran
                [5 ]GRID grid.508487.6, ISNI 0000 0004 7885 7602, Médecine Intensive et Réanimation, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris, , University of Paris, ; Paris, France
                Author information
                http://orcid.org/0000-0002-7764-5793
                http://orcid.org/0000-0002-1678-7608
                http://orcid.org/0000-0003-1181-909X
                http://orcid.org/0000-0002-0283-125X
                http://orcid.org/0000-0002-8162-1508
                http://orcid.org/0000-0003-4198-8038
                Article
                Publisher ID: 4946
                DOI: 10.1186/s13054-024-04946-8
                PMC ID: 11088079
                PubMed ID: 38730424
                SO-VID: 9c83b755-ae0b-4768-97b1-407e021b52a0
                Copyright © © The Author(s) 2024
                License:

                Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

                History
                Date received : 26 March 2024
                Date accepted : 8 May 2024
                Categories
                Subject: Research
                Custom metadata
                issue-copyright-statement © BioMed Central Ltd., part of Springer Nature 2024

                ScienceOpen disciplines: Emergency medicine & Trauma
                Keywords: extracorporeal membrane oxygenation,incidence,meta-analysis,nosocomial infection,prevalence,risk factors
                Data availability:
                ScienceOpen disciplines: Emergency medicine & Trauma
                Keywords: extracorporeal membrane oxygenation, incidence, meta-analysis, nosocomial infection, prevalence, risk factors

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