Pediatric ECMO and infection risk: A retrospective study on surgical site and bloodstream infections.

INTRODUCTION

Extracorporeal membrane oxygenation (ECMO) is associated with severe complications, such as surgical site infections (SSI) and bloodstream infections (BSI). This study investigated the incidence, risk factors, common pathogens, and mortality rates of SSI and BSI in pediatric ECMO patients.

METHODS

This retrospective cohort study included patients aged ≤14 years who received ECMO from (January 2012-December 2022) at King Faisal Specialist Hospital and Research Centre, Riyadh.

RESULTS

The analysis of 163 ECMO episodes revealed that 51.5 % were males with a median age of 4 months [IQR: 0.8-24]. BSI occurred in 8 (4.9 %) cases (incidence: 6.8 cases per 1000 ECMO days), with pathogens including Coagulase-negative staphylococcus (25.0 %), Escherichia coli (25.0 %), and Candida species (25.0 %). SSI occurred in 31 (19.0 %) cases (incidence: 26.5 cases per 1000 ECMO days), with primary pathogens including Coagulase-negative staphylococcus (40.0 %) and Klebsiella pneumoniae (25.0 %). Composite infections (SSI and/or BSI) occurred in 36 (22.1 %) cases with a median of 5 ECMO days [IQR: 4-10]. In univariable analysis, composite infections were significantly associated with longer ICU stays, with a median of 35 days in infected patients compared to 25 days in those without infection (P = 0.032). Yet, prophylactic antimicrobials did not significantly reduce infection risk (P = 0.265). The in-hospital mortality was 49.1 % (80/163).

CONCLUSIONS

The incidence of SSI and BSI in this cohort was influenced by prolonged ICU stay. However, a larger cohort is recommended to support our findings. Clinicians managing ECMO patients should prioritize infection prevention strategies and remain vigilant for early-onset infections to ensure effective clinical management.