• Ait HssainAliA0000-0002-7764-5793Medical Intensive Care Unit, Hamad General Hospital, Doha, Qatar.Department of Medicine, Weill Cornell Medical College, Doha, Qatar.College of Health and Life Science, Hamad Bin Khalifa University, Doha, Qatar., Amir Vahedian-Azimi, Abdulsalam Saif Ibrahim, Ibrahim Fawzy Hassan, Elie Azoulay, and Michael Darmon.
• Medical Intensive Care Unit, Hamad General Hospital, Doha, Qatar.
• Crit Care. 2024 May 10; 28 (1): 158158.

BackgroundAn 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.MethodsWe 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.ResultsAmong 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.ConclusionResults 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.© 2024. The Author(s).

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