EPIDEMIOLOGY OF HEALTHCARE-ASSOCIATED INFECTIONS IN PATIENTS RECEIVING EXTRACORPOREAL MEMBRANE OXYGENATION: A CHALLENGE IN ADVANCED LIFE SUPPORT.

BACKGROUND: The growing use of extracorporeal membrane oxygenation (ECMO) has brought attention to therapy-related complications. This study analysed the epidemiological profile and factors associated with healthcare-associated infections (HAI) in adult and paediatric patients on ECMO. METHODS: A retrospective cohort study was conducted including patients who received ECMO therapy. The evaluation included comorbidities, prior antibiotic exposure, and ECMO-related parameters. The outcome was the occurrence of HAI during ECMO therapy, for which the clinical and microbiological profiles were described. Multivariable binomial regression was performed only in adult patients to identify factors independently associated with HAI. RESULTS: 173 patients (124 adults and 49 children) were included. Veno-arterial ECMO was the predominant mode (68.2%), and HAI emerged as the most frequent complication, especially among adults (64.5% vs. 20.4% in children). Among non-infectious complications, haemorrhagic complications (25.0%) were the most frequent in adults, while haemorrhagic complications and arterial thrombosis predominated in paediatric patients (10.2% each). Ventilator-associated pneumonia was the leading type of infection (31.1 cases/1,000 ECMO-days), mainly caused by Klebsiella pneumoniae, Pseudomonas aeruginosa, Serratia spp., and Staphylococcus aureus. Factors independently associated with HAI in adults included antibiotic use before ECMO initiation (RR:1.25; 95%CI:1.13-1.39), increased time on mechanical ventilation (RR:1.31; 95%CI:1.16-1.47), and prolonged ECMO support (RR:1.06; 95%CI:1.02-1.10). CONCLUSION: These findings underscore HAI as a frequent complication of ECMO and a major clinical challenge, highlighting the need for targeted infection control measures and optimized antimicrobial stewardship to improve outcomes in this high-risk population.