Infectious Complications in Adults Receiving Extracorporeal Membrane Oxygenation: A Systematic Review and Meta-Analysis of Nosocomial and Bloodstream Infection, Prevalence, Risk Factors, and Clinical Outcomes.
- 1Department of Infectious Diseases, Hamad Medical Corporation, Doha P.O. Box 3050, Qatar.
- 2Department of Medical Intensive Care, Hamad Medical Corporation, Doha P.O. Box 3050, Qatar.
- 3Medical College, Qatar University, Doha P.O. Box 2713, Qatar.
Abstract
Background/objectives
Reported infection rates during extracorporeal membrane oxygenation (ECMO) vary widely, partly because case definitions are applied inconsistently. We synthesized the prevalence and prognostic association of nosocomial and bloodstream infection (BSI) acquired during adult ECMO.Methods
PubMed/MEDLINE, Embase, Scopus and CENTRAL were searched through December 2025 for observational studies of at least 10 adults on ECMO with an explicit infection definition. We classified case definitions by the criteria actually applied. We pooled crude mortality odds ratios (ORs) and patient-level BSI prevalence in studies applying laboratory-confirmed criteria, assessed risk of bias with ROBINS-I and the JBI checklist, and rated certainty with GRADE.Results
Forty-seven reports (46 cohorts; 11,573 patients) were included. Pooled BSI prevalence was 25.8% (95% CI 17.3-36.5%; 7 studies, 1193 patients), 18.2% in pre-pandemic and 39.2% in COVID-19 cohorts (post hoc). Infection was associated with higher crude odds of death (OR 1.65, 1.33-2.04; prediction interval 0.95-2.85; 24 studies), but analyses modeling infection as time-varying were inconsistent, including no association in a multistate model (adjusted hazard ratio 1.00, 0.79-1.26), and small-study effects were suggested. Certainty was very low for both outcomes.Conclusions
Roughly one in four adults on ECMO developed laboratory-confirmed BSI, more often in COVID-19 cohorts. Whether infection acquired on ECMO increases mortality remains uncertain.
Related
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- Clinical Outcomes and Complications of Extracorporeal Membrane Oxygenation (ECMO) in Adult Patients With COVID-19 in Central and Eastern Europe: A Systematic Review and Meta-Analysis
- Risk Factors for Metastatic Infectious Complications in Patients with Catheter-Related Bloodstream Infection
- Mixing point thrombus during veno-arterial extracorporeal membrane oxygenation support
- Early recognition of life-threatening otolaryngologic complications in pediatric epstein-barr virus infectious mononucleosis: a systematic review and meta-analysis.
BibTeX
@article{alzibdeh2026infectious,
title = {{Infectious Complications in Adults Receiving Extracorporeal Membrane Oxygenation: A Systematic Review and Meta-Analysis of Nosocomial and Bloodstream Infection, Prevalence, Risk Factors, and Clinical Outcomes.}},
author = {Aseel Alzibdeh and Ans Alamami and Sabeen Zara and Maha Aljabri and Rabee Tawel and Samar Hashim and Abdurrahmaan Elbuzidi and Hamad Abdelhadi and Ahmed Labib Shehatta and Nadir Kharma and Abdulsalam Saif Ibrahim and Ibrahim Fawzy Hassan and Muna Almaslamani},
journal = {Medical sciences (Basel, Switzerland)},
year = {2026},
month = oct,
doi = {10.3390/medsci14060653},
url = {https://europepmc.org/article/MED/42930572},
note = {CC BY},
}
RIS
TY - JOUR
TI - Infectious Complications in Adults Receiving Extracorporeal Membrane Oxygenation: A Systematic Review and Meta-Analysis of Nosocomial and Bloodstream Infection, Prevalence, Risk Factors, and Clinical Outcomes.
AU - Aseel Alzibdeh
AU - Ans Alamami
AU - Sabeen Zara
AU - Maha Aljabri
AU - Rabee Tawel
AU - Samar Hashim
AU - Abdurrahmaan Elbuzidi
AU - Hamad Abdelhadi
AU - Ahmed Labib Shehatta
AU - Nadir Kharma
AU - Abdulsalam Saif Ibrahim
AU - Ibrahim Fawzy Hassan
AU - Muna Almaslamani
PY - 2026
DA - 2026/10/09
JO - Medical sciences (Basel, Switzerland)
DO - 10.3390/medsci14060653
UR - https://europepmc.org/article/MED/42930572
AB - Background/objectives Reported infection rates during extracorporeal membrane oxygenation (ECMO) vary widely, partly because case definitions are applied inconsistently. We synthesized the prevalence and prognostic association of nosocomial and bloodstream infection (BSI) acquired during adult ECMO.Methods PubMed/MEDLINE, Embase, Scopus and CENTRAL were searched through December 2025 for observational studies of at least 10 adults on ECMO with an explicit infection definition. We classified case definitions by the criteria actually applied. We pooled crude mortality odds ratios (ORs) and patient-level BSI prevalence in studies applying laboratory-confirmed criteria, assessed risk of bias with ROBINS-I and the JBI checklist, and rated certainty with GRADE.Results Forty-seven reports (46 cohorts; 11,573 patients) were included. Pooled BSI prevalence was 25.8% (95% CI 17.3-36.5%; 7 studies, 1193 patients), 18.2% in pre-pandemic and 39.2% in COVID-19 cohorts (post hoc). Infection was associated with higher crude odds of death (OR 1.65, 1.33-2.04; prediction interval 0.95-2.85; 24 studies), but analyses modeling infection as time-varying were inconsistent, including no association in a multistate model (adjusted hazard ratio 1.00, 0.79-1.26), and small-study effects were suggested. Certainty was very low for both outcomes.Conclusions Roughly one in four adults on ECMO developed laboratory-confirmed BSI, more often in COVID-19 cohorts. Whether infection acquired on ECMO increases mortality remains uncertain.
SN - 2076-3271
ER -