Nosocomial Infection in Patients Treated with Venoarterial Extracorporeal Membrane Oxygenation: Incidence, Risk factors, and Outcomes

Background The success rate of venoarterial extracorporeal membrane oxygenation (VA-ECMO) is related to complications such as nosocomial infection (NI), with multidrug-resistant organisms (MDROs) infection posing the toughest challenge, however, the incidence, risk factors, and prognosis of NI during VA-ECMO are unclear. Methods We performed a single-center, retrospective analysis of 152 patients receiving VA-ECMO. Patients were categorized into NI and non-NI groups, depending on whether pathogenic microorganisms were isolated between 48h after VA-ECMO initiation and within 24h weaning from VA-ECMO. Multivariate logistic regression analysis was performed to identify the independent risk factors of NI. Results The incidence of NI during VA-ECMO was 38.82% (59/152), and 71 microbial strains were isolated from the cultures, with Gram-negative bacteria accounting for 73.24% (52/71) and MDROs for 63.38% (45/71). The chi-square test showed that the probability of percutaneous dilatational tracheotomy (PDT) was elevated in the NI group (25.42% vs 8.6%). The rank sum test found that the NI group had longer hospitalization (18 vs 12 days), intensive care unit (ICU) stay (16 vs 9 days), and duration of VA-ECMO (6.63 vs 5.01 days), and invasive mechanical ventilation (IMV, 11 vs 6 days). Multivariate logistic regression analysis revealed that the occurrence of NI was independently associated with ICU stay (OR 1.128; 95%CI 1.004 ~ 1.268; P = 0.043) and the need for PDT (OR 3.459; 95%CI 1.051 ~ 11.389; P = 0.041). Conclusions The Gram-negative bacilli was the most common pathogens for NI during ECMO, with MDROs being the predominant species. The occurrence of NI in patients caused a prolonged ICU stay and increased probability of PDT. Trial registration ChiCTR1900026105 (Registration Date 20190921).