Nosocomial bloodstream infection in critically ill patients: is extracorporeal membrane oxygenation a relevant factor?

Autores de IIS La Fe

• María Martín Cerezuela

  Autor

• Juan Salvador Frasquet Artes

  Autor

• José Ricardo Gimeno Costa

  Autor

• Francisca Pérez Esteban

  Autor

• Faustino Álvarez Cebrián

  Autor

• Javier Pemán García

  Autor

• Álvaro Castellanos Ortega

  Autor

• Paula Ramírez Galleymore

  Autor

Participantes ajenos a IIS La Fe

• Martínez, A
• Carrasco, C

Grupos

• Grupo de Investigación de Farmacia

• Infección Grave

• Medicina Intensiva

Abstract

Background: Nosocomial bloodstream infection (BSI) in critically ill patients can cause clinical deterioration, prolong intensive care unit (ICU) stays, and increase mortality risk. Extracorporeal membrane oxygenation support (ECMO) is a known risk factor for BSI, and infections in these patients are assumed to have a worse prognosis. Aim: To compare risk factors for BSI between ECMO and non-ECMO patients. Methods: A three-year prospective observational study was conducted in a 24-bed medical ICU. Consecutive nosocomial BSI episodes were recorded, and BSIs in mechanically ventilated patients were analysed based on ECMO treatment status. Findings: A total of 98 BSI episodes were included: 30 (30.6%) in ECMO and 68 (69.3%) in non-ECMO patients. The total number of ECMO patients during the study period was 110, with a bacteraemia rate of 27.7% (20.26 episodes per 1000 treatment-days). In non-ECMO patients, the BSI rate was 7.9% (P < 0.001). ECMO patients were younger and had fewer comorbidities. BSI type and aetiology were similar between groups, but severity was higher in ECMO patients. Although multidrug-resistant micro-organisms were more frequent in ECMO patients, the appropriate treatment rate was similar. ICU mortality was 66.6% in ECMO patients and 30.8% in non-ECMO patients (P < 0.001). However, continuous renal replacement therapy (odds ratio (OR): 3.67), Sepsis Organ Failure Assessment score (OR: 1.54), and COVID-19 diagnosis (OR: 1.54) were the only independent risk factors associated with mortality in BSI patients. Conclusion: Although BSI was more frequent and severe in ECMO patients, ECMO support was not independently related to mortality in patients with healthcare-associated BSI. (c) 2025 The Healthcare Infection Society. Published by Elsevier Ltd. All rights are reserved, including those for text and data mining, AI training, and similar technologies.

Copyright © 2025 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.

Keywords

• Bloodstream infection; Extracorporeal circulation membrane oxygenation; Critical care; Healthcare-associated infection; Mortality