{
  "abstract": "Background: Viral acute respiratory distress syndrome (ARDS) is a common cause of respiratory failure requiring veno-venous extracorporeal membrane oxygenation (V-V ECMO). Pulmonary bacterial superinfections, pulmonary aspergillosis, and viral infections or reactivations frequently occur, but data on their incidence, timing, and microbiological spectrum remain limited. We analyzed infectious complications in a large cohort of V-V ECMO-treated patients with viral ARDS.\n\nMethods: We retrospectively evaluated all patients treated at University Hospital Regensburg (UKR) requiring V-V ECMO for COVID-19 (March 2020–May 2022) or influenza (May 2012–December 2022).\n\nResults: We included 147 COVID-19 patients (median age 55.3 years; 77% male; SOFA score 9; V-V ECMO duration 23 days) and 72 influenza patients (median age 55.3 years; 53% male; SOFA score 13; V-V ECMO duration 16 days). COVID-19 patients showed higher cumulative incidences of pulmonary bacterial superinfection (61% vs 35%), aspergillosis (33% vs. 22%), CMV reactivation (18%vs. 4%) and HSV reactivation (49% vs. 26%), however incidence-density rates were comparable between groups with incidence rate ratios (IRR) of 1.10, 0.93, 1.36 and 1.12, respectively. First bacterial pulmonary infection occurred a median of 2 days after V-V ECMO initiation in COVID-19 and 1 day before initiation in influenza patients. Predominant bacterial pathogens were Klebsiella spp. (28%), Staphylococcus aureus (27%) and Escherichia coli (11%) in COVID-19, and Staphylococcus aureus (25%) and Streptococcus pneumoniae (25%) in influenza.\n\nConclusion: Patients with COVID-19 requiring V-V ECMO showed a distinct trajectory of infectious complications compared to Influenza, particularly bacterial, HSV, CMV, and fungal infections, highlighting their infectious burden.\n\nSupplementary Information: The online version contains supplementary material available at https://doi.org/10.1007/s15010-026-02879-8.",
  "abstract_shown": true,
  "affiliations": [
    "Department of Internal Medicine II/Cardiology and Pulmonology, University Hospital Regensburg, Regensburg, Germany",
    "Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charité (DHZC), Campus Benjamin Franklin, Hindenburgdamm 30, 12203 Berlin, Germany",
    "Department of Pulmonology and Conservative Intensive Care Medicine, Barmherzige Brueder Hospital Regensburg, Regensburg, Germany",
    "Department of Cardiothoracic Surgery, University Hospital Regensburg, Regensburg, Germany",
    "Department of Pulmonology, Caritas Hospital St. Maria, Donaustauf, Germany",
    "Department of Infectiology, University Hospital Regensburg, Regensburg, Germany",
    "Institute for Microbiology and Hygiene, University Hospital Regensburg, Regensburg, Germany",
    "Department of Anesthesiology and Intensive Care, University Hospital Regensburg, Regensburg, Germany"
  ],
  "article_type": "research article",
  "arxiv": null,
  "author_total": 21,
  "authors": [
    {
      "affs": [
        0,
        1
      ],
      "name": "Jannis Krais",
      "orcid": "0009-0003-4871-5953"
    },
    {
      "affs": [
        0,
        2
      ],
      "name": "Matthias Lubnow"
    },
    {
      "affs": [
        3
      ],
      "name": "Alois Philipp"
    },
    {
      "affs": [
        3
      ],
      "name": "Maik Foltan"
    },
    {
      "affs": [
        4
      ],
      "name": "Florian Geismann"
    },
    {
      "affs": [
        4
      ],
      "name": "Christoph Fisser"
    },
    {
      "affs": [
        5
      ],
      "name": "Florian Hitzenbichler"
    },
    {
      "affs": [
        5
      ],
      "name": "Bernd Salzberger"
    },
    {
      "affs": [
        5
      ],
      "name": "Stilla Bauernfeind"
    },
    {
      "affs": [
        6
      ],
      "name": "Barbara Schmid"
    },
    {
      "affs": [
        7
      ],
      "name": "Dirk Lunz"
    },
    {
      "affs": [
        7
      ],
      "name": "Johannes Steinmann"
    },
    {
      "affs": [
        7
      ],
      "name": "Christoph Eissnert"
    },
    {
      "affs": [
        7
      ],
      "name": "Martin Kieninger"
    },
    {
      "affs": [
        7
      ],
      "name": "Walter Petermichl"
    },
    {
      "affs": [
        0
      ],
      "name": "Roland Schneckenpointner"
    },
    {
      "affs": [
        0
      ],
      "name": "Alexander Dietl"
    },
    {
      "affs": [
        0
      ],
      "name": "Lars S. Maier"
    },
    {
      "affs": [
        7
      ],
      "name": "Bernhard Graf"
    },
    {
      "affs": [
        0
      ],
      "name": "Thomas Müller"
    },
    {
      "affs": [
        0
      ],
      "name": "Clemens Wiest"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/51mm7e6drh7a0.bib",
  "cited_by": 0,
  "doi": "10.1007/s15010-026-02879-8",
  "fulltext_url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC13727879/",
  "id": "51mm7e6drh7a0",
  "issns": [
    "0300-8126",
    "1439-0973"
  ],
  "landing_url": "https://doi.org/10.1007/s15010-026-02879-8",
  "language": "en",
  "licence": "CC-BY-4.0",
  "licence_label": "CC BY 4.0",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "heading",
      "Research"
    ],
    [
      "openalex",
      "2204|Mechanical Circulatory Support Devices"
    ]
  ],
  "openalex": "W7168338785",
  "pdf_url": null,
  "pmcid": "PMC13727879",
  "pmid": "42455266",
  "published": "2026-07-15",
  "publisher": null,
  "ris": "https://research.draconitic.com/paper/51mm7e6drh7a0.ris",
  "sources": [
    {
      "first_seen": "2026-11-06T12:23:40Z",
      "native_id": "PMC13727879",
      "source": "pmc",
      "url": "https://doi.org/10.1007/s15010-026-02879-8"
    }
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  "subjects": [
    {
      "field": "medicine",
      "origin": "journal-openalex:F27",
      "subfield": "general"
    }
  ],
  "title": "Pathogen patterns in viral ARDS on V-V ECMO: a single-center experience",
  "title_text": "Pathogen patterns in viral ARDS on V-V ECMO: a single-center experience",
  "type": "peer-reviewed",
  "updated_at": "2026-11-07T12:20:59Z",
  "url": "https://research.draconitic.com/paper/51mm7e6drh7a0",
  "venue": "Infection",
  "versions": []
}