Nosocomial Infections in Neonates Supported by Extracorporeal Membrane Oxygenation: First French Retrospective Study

Infectious diseases and infection control prevention strategies in adult and pediatric population on ECMO

As survival after ECMO improves and use of ECMO support increases in both pediatric and adult population, there is a need to focus on both the morbidities and complications associated with ECMO and how to manage and prevent them. Infectious complications during ECMO often have a significant clinical impact, resulting in increased morbidity or mortality irrespective of the underlying etiology necessitating cardiorespiratory support. In this review article, we discuss the prevention, management, challenges, and differences of infectious complications in adult and pediatric patients receiving ECMO support.

Nosocomial infection in paediatric patients undergoing extracorporeal membrane oxygenation: a systematic review and meta-analysis

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.

Metagenomic Next-generation Sequencing for Pathogen Identification in Bronchoalveolar Lavage Fluid From Neonates Receiving Extracorporeal Membrane Oxygenation

BACKGROUND

Neonates on extracorporeal membrane oxygenation (ECMO) are at high risk of infection. Rapid and accurate identification of pathogens is essential to improve the prognosis of children on ECMO. Metagenome next-generation sequencing (mNGS) has been used in recent years to detect pathogenic bacteria, but evidence for its use in neonates on ECMO is lacking.

METHODS

This retrospective study was conducted using an electronic medical record system. We analyzed the results of mNGS and conventional microbiological tests (CMTs) in bronchoalveolar lavage fluid of neonates receiving ECMO support with pulmonary infections in our hospital from July 2021 to January 2023.

RESULTS

We screened 18 ECMO-supported neonates with pneumonia for inclusion in the study. The median age of the included children was 2 (1-4) days, the median gestational age was 38.3 (33-40 +4 ) weeks, and the median weight was 3.3 (2.2-4.8) kg. The detection rate of mNGS was 77.8% (14/18), higher than the 44.4% (8/18) of CMT ( P = 0.04). A total of 20 pathogens were detected in mNGS, with the top 3 most common pathogens being Klebsiella pneumoniae , Acinetobacter baumannii and Escherichia coli . Mixed infections were found in 14 cases (77.8%), including 13 cases (72.2%) with mixed infections detected by mNGS and 7 cases (27.8%) with mixed infections detected by CMT. A total of 9 children underwent treatment changes based on mNGS results and all of them experienced relief of symptoms.

CONCLUSION

Compared with CMT, mNGS can detect pathogens earlier and more sensitively, and may play an important role in ECMO-supported neonatal pneumonia pathogen detection and optimization of antibiotic therapy.