Pathogen patterns in viral ARDS on V-V ECMO: a single-center experience
8 affiliations
- 1Department of Internal Medicine II/Cardiology and Pulmonology, University Hospital Regensburg, Regensburg, Germany
- 2Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charité (DHZC), Campus Benjamin Franklin, Hindenburgdamm 30, 12203 Berlin, Germany
- 3Department of Pulmonology and Conservative Intensive Care Medicine, Barmherzige Brueder Hospital Regensburg, Regensburg, Germany
- 4Department of Cardiothoracic Surgery, University Hospital Regensburg, Regensburg, Germany
- 5Department of Pulmonology, Caritas Hospital St. Maria, Donaustauf, Germany
- 6Department of Infectiology, University Hospital Regensburg, Regensburg, Germany
- 7Institute for Microbiology and Hygiene, University Hospital Regensburg, Regensburg, Germany
- 8Department of Anesthesiology and Intensive Care, University Hospital Regensburg, Regensburg, Germany
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.
Methods: 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).
Results: 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.
Conclusion: 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.
Supplementary Information: The online version contains supplementary material available at https://doi.org/10.1007/s15010-026-02879-8.
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BibTeX
@article{krais2026pathogen,
title = {{Pathogen patterns in viral ARDS on V-V ECMO: a single-center experience}},
author = {Jannis Krais and Matthias Lubnow and Alois Philipp and Maik Foltan and Florian Geismann and Christoph Fisser and Florian Hitzenbichler and Bernd Salzberger and Stilla Bauernfeind and Barbara Schmid and Dirk Lunz and Johannes Steinmann and Christoph Eissnert and Martin Kieninger and Walter Petermichl and Roland Schneckenpointner and Alexander Dietl and Lars S. Maier and Bernhard Graf and Thomas Müller and Clemens Wiest},
journal = {Infection},
year = {2026},
month = jul,
doi = {10.1007/s15010-026-02879-8},
url = {https://doi.org/10.1007/s15010-026-02879-8},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Pathogen patterns in viral ARDS on V-V ECMO: a single-center experience
AU - Jannis Krais
AU - Matthias Lubnow
AU - Alois Philipp
AU - Maik Foltan
AU - Florian Geismann
AU - Christoph Fisser
AU - Florian Hitzenbichler
AU - Bernd Salzberger
AU - Stilla Bauernfeind
AU - Barbara Schmid
AU - Dirk Lunz
AU - Johannes Steinmann
AU - Christoph Eissnert
AU - Martin Kieninger
AU - Walter Petermichl
AU - Roland Schneckenpointner
AU - Alexander Dietl
AU - Lars S. Maier
AU - Bernhard Graf
AU - Thomas Müller
AU - Clemens Wiest
PY - 2026
DA - 2026/07/15
JO - Infection
DO - 10.1007/s15010-026-02879-8
UR - https://doi.org/10.1007/s15010-026-02879-8
AB - 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. Methods: 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). Results: 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. Conclusion: 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. Supplementary Information: The online version contains supplementary material available at https://doi.org/10.1007/s15010-026-02879-8.
SN - 0300-8126
SN - 1439-0973
ER -