Healthcare-associated infections in patients with severe COVID-19 supported with extracorporeal membrane oxygenation: a nationwide cohort study
Authors: Nesseler Nicolas , Mansour Alexandre , Schmidt Matthieu , Para Marylou , Porto Alizée , Falcoz Pierre-Emmanuel , Mongardon Nicolas , Fougerou Claire , Ross James T. , Beurton Antoine , Gaide-Chevronnay Lucie , Guinot Pierre-Grégoire , Lebreton Guillaume , Flecher Erwan , Vincentelli André , Massart Nicolas ,   ECMOSARS Investigators, Fouquet Olivier , Pierrot Marc , Chocron Sidney , Flicoteaux Guillaume , Mauriat Philippe , Ouattara Alexandre , Roze Hadrien , Huet Olivier , Fischer Marc-Olivier , Bellaïche Raphel , Constant Ophélie , De Roux Quentin , André L. Y. , Meffert Arnaud , Merle Jean-Claude , Picard Lucile , Skripkina Elena , Folliguet Thierry , Fiore Antonio , D’ostrevy Nicolas , Morgan Marie-Catherine , Nguyen Maxime , Terzi Nicolas , Colin Gwenhaël , Fabre Olivier , Astaneh Arash , Issard Justin , Fadel Elie , Fabre Dominique , Guihaire Julien , Ion Iolande , Menager Jean Baptiste , Mitilian Delphine , Mercier Olaf , Stephan François , Thes Jacques , Jouan Jerôme , Duburcq Thibault , Loobuyck Valentin , Moussa Mouhammed , Manganiello Sabrina , Mugnier Agnes , Rousse Natacha , Desebbe Olivier , Fellahi Jean-Luc , Henaine Roland , Pozzi Matteo , Riad Zakaria , Guervilly Christophe , Hraiech Sami , Papazian Laurent , Castanier Matthias , Chanavaz Charles , Cadoz Cyril , Gette Sebastien , Louis Guillaume , Portocarrero Erick , Gaudard Philippe , Brini Kais , Bischoff Nicolas , Kimmoun Antoine , Levy Bruno , Perez Pierre , Bourdiol Alexandre , Hourmant Yannick , Mahé Pierre-Joachim , Rozec Bertrand , Vourc’h Mickaël , Aubert Stéphane , Bazalgette Florian , Roger Claire , Jaquet Pierre , Lortat-Jacob Brice , Mordant Pierre , Nataf Patrick , Patrier Juliette , Provenchere Sophie , Roué Morgan , Sonneville Romain , Tran-Dinh Alexy , Wicky Paul-Henri , Al Zreibi Charles , Cholley Bernard , Guyonvarch Yannis , Hamada Sophie , Barbanti Claudio , Bertier Astrid , Harrois Anatole , Matiello Jordi , Kerforne Thomas , Lacroix Corentin , Brechot Nicolas , Combes Alain , Chommeloux Juliette , D’alessandro Cosimo , Demondion Pierre , Demoule Alexandre , Dres Martin , Fadel Guillaume , Fartoukh Muriel , Hekimian Guillaume , Juvin Charles , Leprince Pascal , Levy David , Luyt Charles Edouard , Schoell Thibaut , Fillâtre Pierre , Massart Nicolas , Jonas Maud , Allou Nicolas , Muccio Salvatore , Di Perna Dario , Ruggieri Vito-Giovanni , Mourvillier Bruno , Anselmi Amedeo , Bounader Karl , Launey Yoann , Lebouvier Thomas , Parasido Alessandro , Reizine Florian , Esvan Maxime , Seguin Philippe , Besnier Emmanuel , Carpentier Dorothée , Clavier Thomas , Olland Anne , Villard Marion , Bounes Fanny , Labaste François , Minville Vincent , Guillon Antoine , Fedun Yannick ,   SFAR Research Network
Published: February 2024

Abstract
Background
Both critically ill patients with coronavirus disease 2019 (COVID-19) and patients receiving extracorporeal membrane oxygenation (ECMO) support exhibit a high incidence of healthcare-associated infections (HAI). However, data on incidence, microbiology, resistance patterns, and the impact of HAI on outcomes in patients receiving ECMO for severe COVID-19 remain limited. We aimed to report HAI incidence and microbiology in patients receiving ECMO for severe COVID-19 and to evaluate the impact of ECMO-associated infections (ECMO-AI) on in-hospital mortality.

Methods
For this study, we analyzed data from 701 patients included in the ECMOSARS registry which included COVID-19 patients supported by ECMO in France.

Results
Among 602 analyzed patients for whom HAI and hospital mortality data were available, 214 (36%) had ECMO-AI, resulting in an incidence rate of 27 ECMO-AI per 1000 ECMO days at risk. Of these, 154 patients had bloodstream infection (BSI) and 117 patients had ventilator-associated pneumonia (VAP). The responsible microorganisms were Enterobacteriaceae (34% for BSI and 48% for VAP), Enterococcus species (25% and 6%, respectively) and non-fermenting Gram-negative bacilli (13% and 20%, respectively). Fungal infections were also observed (10% for BSI and 3% for VAP), as were multidrug-resistant organisms (21% and 15%, respectively). Using a Cox multistate model, ECMO-AI were not found associated with hospital death (HR = 1.00 95% CI [0.79–1.26], p = 0.986).

Conclusions
In a nationwide cohort of COVID-19 patients receiving ECMO support, we observed a high incidence of ECMO-AI. ECMO-AI were not found associated with hospital death.
Trial registration number NCT04397588 (May 21, 2020).