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Published on: December 5, 2025
Risk factors for nosocomial infections in ECMO patients: a systematic review and meta-analysis
Jia Duan1, Lei Yang2, YanFang Huang3
1Department of Intensive Care Medicine, Neijiang Hospital of Traditional Chinese Medicine, Neijiang, Sichuan, China.
Background:
Nosocomial infection (NSI) is a serious complication in extracorporeal membrane oxygenation (ECMO) patients, yet reported risk factors remain inconsistent. A systematic synthesis is needed to identify key predictors.
Methods:
Following PRISMA guidelines, this meta-analysis (PROSPERO: CRD420251161290) searched five databases for studies reporting multivariate risk factors for NSI in adult ECMO patients. Study selection, data extraction, and quality assessment (Newcastle-Ottawa Scale) were performed independently by two reviewers. Pooled odds ratios (ORs) were calculated with random-effects models; heterogeneity (I2 ≥ 50%) was explored via meta-regression and subgroup analyses.
Results:
Thirty-four observational studies (≈8,901 patients) were included. Significant risk factors were: immunosuppression (OR 2.21, 95% CI 1.27-3.85), inter-hospital transport (2.24, 1.04-4.80), pre-ECMO infection (2.54, 2.03-3.18), higher SOFA score (per point: 1.13, 1.03-1.24), prolonged ECMO duration (per day: 1.10, 1.07-1.14), continuous renal replacement therapy (2.18, 1.57-3.02), and catheter intubation (1.24, 1.02-1.51). ECMO duration showed high heterogeneity (I2 = 89.9%), largely driven by small-study effects. Age, body mass index, diabetes mellitus, and hypertension were not significantly associated.
Conclusion:
NSI in ECMO patients arises from an interplay of baseline characteristics, illness severity, and invasive support duration/intensity. A stratified, risk-factor-based prevention strategy is warranted. Given the predominantly retrospective evidence, prospective studies are required for validation.
Systematic Review Registration:
https://www.crd.york.ac.uk/PROSPERO/view/CRD420251161290, Identifier: CRD420251161290.
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