• Nicolas Nesseler, Alexandre Mansour, Matthieu Schmidt, Marylou Para, Alizée Porto, Pierre-Emmanuel Falcoz, Nicolas Mongardon, Claire Fougerou, James T Ross, Antoine Beurton, Lucie Gaide-Chevronnay, Pierre-Grégoire Guinot, Guillaume Lebreton, Erwan Flecher, André Vincentelli, Nicolas Massart, ECMOSARS Investigators, and SFAR Research Network.
• Department of Anesthesia and Critical Care, Pontchaillou, University Hospital of Rennes, Rennes, France. nicolas.nesseler@chu-rennes.fr.
• Crit Care. 2024 Feb 20; 28 (1): 5454.

BackgroundBoth 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.MethodsFor this study, we analyzed data from 701 patients included in the ECMOSARS registry which included COVID-19 patients supported by ECMO in France.ResultsAmong 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).ConclusionsIn 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).© 2024. The Author(s).

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