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Nosocomial infection in paediatric patients undergoing extracorporeal membrane oxygenation: a systematic review and
1Intensive Care Unit, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China.
Insights
Nosocomial infections are common in pediatric patients on extracorporeal membrane oxygenation (ECMO), with respiratory infections and Staphylococcus being frequent. However, these infections did not significantly increase mortality risk in this population.
Area of Science:
- Pediatric critical care medicine
- Infectious diseases
- Extracorporeal life support
Background:
- Nosocomial infections are a major complication in pediatric patients undergoing extracorporeal membrane oxygenation (ECMO).
- Understanding these infections is crucial as pediatric patients often benefit significantly from ECMO therapy.
- Previous analyses of nosocomial infections in this specific population are limited.
Purpose of the Study:
- To systematically review the incidence, timing, and sources of nosocomial infections in pediatric ECMO patients.
- To identify primary pathogens, patterns of antibiotic use, and associated risk factors.
- To evaluate the impact of nosocomial infections on mortality in this patient group.
Main Methods:
- A systematic literature search was conducted across seven databases.
- Meta-analysis using Stata 15.0 for combined effects and confidence intervals.
- Descriptive analysis was used for other collected data.
Main Results:
- The overall incidence of nosocomial infections was 0.19 (95% CI: 0.17–0.22).
- Respiratory infections were most common, with Staphylococcus species as the predominant pathogens.
- Prolonged ECMO support (OR = 1.09) increased infection risk, but infection did not significantly raise mortality (OR = 1.44).
Conclusions:
- Nosocomial infections are prevalent in pediatric ECMO patients and influenced by multiple factors.
- Respiratory infections and Staphylococcus are common culprits.
- Despite being frequent, nosocomial infections did not correlate with increased mortality in this cohort.
Abstract:
Nosocomial infection has emerged as a significant complication of extracorporeal membrane oxygenation (ECMO) treatment and is closely associated with poor prognosis. Studies have shown that paediatric patients are more likely to benefit from ECMO. However, nosocomial infection in paediatric patients has not been comprehensively analysed. The aim of this review was to systematically analyse the incidence, timing, locations, primary pathogens, antibiotic use and risk factors associated with nosocomial infection and their effects on mortality among paediatric patients undergoing ECMO. Seven databases were searched for eligible articles; Stata 15.0 was used to calculate the combined effect and 95% confidence interval, and descriptive analysis was employed for other data. A total of 31 articles were included. The incidence of nosocomial infections was 0.19, 95% confidence interval (CI, 0.17-0.22). Respiratory infection was identified as the most common infection type. Staphylococcus species were the predominant pathogens. Antibiotic use was widespread across centres. Prolonged ECMO support was associated with an increased occurrence of nosocomial infections in patients (odds ratio (OR) = 1.09, 95% CI (1.06-1.13)). Nosocomial infection was not associated with an increase in mortality (OR = 1.44, 95% CI (0.98-2.11)). In conclusion, nosocomial infection was common among paediatric ECMO patients and was affected by various factors. However, nosocomial infection did not increase the risk of mortality.
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