Healthcare-associated infections in patients with severe COVID-19 supported with extracorporeal membrane oxygenation: a nationwide cohort study

Crit Care. 2024 Feb 20;28(1):54. doi: 10.1186/s13054-024-04832-3.

Abstract

Background: Both critically ill patients with coronavirus disease 2019 (COVID-19) and patients receiving extracorporeal membrane oxygenation (ECMO) support exhibit a high incidence of healthcare-associated infections (HAI). However, data on incidence, microbiology, resistance patterns, and the impact of HAI on outcomes in patients receiving ECMO for severe COVID-19 remain limited. We aimed to report HAI incidence and microbiology in patients receiving ECMO for severe COVID-19 and to evaluate the impact of ECMO-associated infections (ECMO-AI) on in-hospital mortality.

Methods: For this study, we analyzed data from 701 patients included in the ECMOSARS registry which included COVID-19 patients supported by ECMO in France.

Results: Among 602 analyzed patients for whom HAI and hospital mortality data were available, 214 (36%) had ECMO-AI, resulting in an incidence rate of 27 ECMO-AI per 1000 ECMO days at risk. Of these, 154 patients had bloodstream infection (BSI) and 117 patients had ventilator-associated pneumonia (VAP). The responsible microorganisms were Enterobacteriaceae (34% for BSI and 48% for VAP), Enterococcus species (25% and 6%, respectively) and non-fermenting Gram-negative bacilli (13% and 20%, respectively). Fungal infections were also observed (10% for BSI and 3% for VAP), as were multidrug-resistant organisms (21% and 15%, respectively). Using a Cox multistate model, ECMO-AI were not found associated with hospital death (HR = 1.00 95% CI [0.79-1.26], p = 0.986).

Conclusions: In a nationwide cohort of COVID-19 patients receiving ECMO support, we observed a high incidence of ECMO-AI. ECMO-AI were not found associated with hospital death. Trial registration number NCT04397588 (May 21, 2020).

Keywords: Bloodstream infections; ECLS; Nosocomial infections; SARS-CoV 2; Ventilator-associated pneumonia.

MeSH terms

  • COVID-19* / complications
  • COVID-19* / epidemiology
  • COVID-19* / therapy
  • Cohort Studies
  • Cross Infection* / epidemiology
  • Delivery of Health Care
  • Extracorporeal Membrane Oxygenation* / adverse effects
  • Extracorporeal Membrane Oxygenation* / methods
  • Humans
  • Pneumonia, Ventilator-Associated* / etiology
  • Retrospective Studies
  • Sepsis* / complications

Associated data

  • ClinicalTrials.gov/NCT04397588