Background
An increasing number of patients requires extracorporeal
membrane oxygenation (ECMO) for life support. This supportive modality is
associated with nosocomial infections (NIs). This systematic review and
meta-analysis aim to assess the incidence and risk factors of NIs in adult.
Methods
We searched PubMed, Scopus, Web of Science, and ProQuest
databases up to 2022. The primary endpoint was incidence of NI. Secondary
endpoints included time to infection, source of infection, ECMO duration,
Intensive care and hospital length of stay (LOS), ECMO survival and overall
survival. Incidence of NI was reported as pooled proportions and 95% confidence
intervals (CIs), while dichotomous outcomes were presented as risk ratios (RR)
as the effective index and 95% CIs using a random-effects model.
Results
Among the 4,733 adult patients who received ECMO support in
the 30 included studies, 1,249 ECMO-related NIs per 1000 ECMO-days was
observed. The pooled incidence of NIs across 18 studies involving 3424 patients
was 26% (95% CI 14–38%).Ventilator-associated pneumonia (VAP) and bloodstream
infections (BSI) were the most common NI sources. Infected patients had lower
ECMO survival and overall survival rates compared to non-infected patients,
with risk ratio values of 0.84 (95% CI 0.74–0.96, P = 0.01) and 0.80 (95%
CI 0.71–0.90, P < 0.001), respectively.
Conclusion
Results showed that 16% and 20% lower of ECMO survival and
overall survival in patients with NI than patients without NI, respectively.
However, NI increased the risk of in-hospital mortality by 37% in infected
patients compared with non-infected patients. In addition, this study
identified the significant positive correlation between ECMO duration and
ECMO-related NI.
No comments:
Post a Comment