• Daniele Orso, Caterina Maria Fodale, Sara Fossati, Sergio Venturini, Federico Fonda, Francesco Cugini, Irene Comisso, Massimo Crapis, Luisa Cacciavillani, and Tiziana Bove.
• Department of Emergency, University Hospital of Udine, Azienda Sanitaria Universitaria Friuli Centrale, "Santa Maria della Misericordia", Piazzale Santa Maria della Misericordia 15, Udine, 33100, Italy. sd7782.do@gmail.com.
• BMC Anesthesiol. 2024 Nov 12; 24 (1): 410410.

BackgroundPatients undergoing Extracorporeal Membrane Oxygenation (ECMO) are particularly susceptible to infections: 42% experience sepsis and 26% develop a nosocomial infection (NI). Whether antibiotic prophylaxis is effective in reducing mortality and its effects on the rate of NIs is currently unclear.Research QuestionCan antibiotic prophylaxis decrease 30-day mortality for patients on ECMO? Can antibiotic prophylaxis prevent the occurrence of NIs in these patients?Study Design And MethodsA systematic review and meta-analysis was conducted. We searched PubMed, Scopus, and CINAHL libraries from inception to June 12, 2024. Two researchers were involved in abstract screening and three researchers were involved in full text selection.ResultsA pooled population of 7,996 patients is represented by 5 retrospective studies. Reported mortality ranges between 46 and 58% and the NIs rate is between 14 and 62%. Regarding 30-day mortality, the random-effects model (I2 = 65%) indicates a non-statistically significant difference between the antibiotic prophylaxis group and the non-prophylaxis group (OR 0.76; 95%CI 0.37-1.59). For the NIs rate, a fixed-effect model (I2 = 36%) shows an OR of 0.81 (95%CI 0.71-0.92) in favor of the antibiotic prophylaxis group, with a number-needed-to-treat (NNT) of 39.7 patients.ConclusionAccording to a very low degree of certainty, antibiotic prophylaxis appears to have no impact on the 30-day mortality rate of ECMO recipients. The risk of NIs seems to decrease with antibiotic prophylaxis, even though the NNT is high. Prospective high-quality studies that address these specific clinical questions are necessary.Clinical Trial RegistrationPROSPERO: International prospective register of systematic reviews, 2024, CRD42024567037.© 2024. The Author(s).

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