# P-1041. A Comparison of Pre- and Post-Pandemic Infection Epidemiology in Patients with Extracorporeal Membrane Oxygenation (ECMO)

## TL;DR

This study compares infection rates in ECMO patients before and during the pandemic and finds no significant differences in infection rates or outcomes.

## Contribution

The study provides new insights into the consistency of ECMO-related infection epidemiology during and before the pandemic.

## Key findings

- Bloodstream infections (BSIs) were similar in both pre- and post-pandemic groups.
- Gram-positive bacteria were the most common cause of BSIs in both groups.
- There were no significant differences in MDRO colonization, mortality, or ICU length of stay between the groups.

## Abstract

Extracorporeal membrane oxygenation (ECMO) is a mechanical circulatory device that supports patients with pulmonary or cardiac failure. Patients on ECMO have a significant infection risk due to cannula insertion into large vessels with evidence suggesting that 20% of patients develop an infection. The COVID-19 pandemic led to increased ECMO utilization, though it is unclear if ECMO-related infection epidemiology has shifted. We performed a retrospective comparative analysis of infection epidemiology in ECMO patients pre- and post-pandemic.Table 1:Participant characteristicsTable 2:Bloodstream infections during ECMOAbbreviations: ECMO: extracorporeal membrane oxygenation

Participant characteristics

Bloodstream infections during ECMO

Abbreviations: ECMO: extracorporeal membrane oxygenation

After institutional review board (IRB) approval, infection data was collected from the ELSO Registry and our Enterprise Data Warehouse. The pre-pandemic range was defined as 4/1/2018-2/29/2020 and the post-pandemic range was defined as 3/1/2020-2/1/2022.Table 3:Other Non-BSI Infections during ECMOAbbreviations: BSI: bloodstream infection; ECMO: extracorporeal membrane oxygenation

Other Non-BSI Infections during ECMO

Abbreviations: BSI: bloodstream infection; ECMO: extracorporeal membrane oxygenation

We assessed 199 patients pre-pandemic and 228 patients post-pandemic. Most patients in both cohorts were male with a mean Charlson score of 5.2-5.6 and mean BMI of 28-30 (Table 1). There were no significant differences in race, ethnicity, ICU length of stay (LOS), or mortality pre- and post-pandemic; patients post-pandemic were younger overall.

Incidence of bloodstream infections (BSIs) was similar in both groups (Table 2). Gram-positive bacteria comprised 65-75% of BSIs, with E. faecalis the most common organism in both groups. BSIs caused by Gram-negative bacteria comprised 14-24% of cases in both groups. BSIs caused by Candida spp. were observed in 11-12% of cases and most commonly due to C. auris. Multidrug-resistant organisms (MDROs) caused 14-18% of BSIs and typically were vancomycin-resistant Enterococci. Other non-BSI infections occurred in 20-25% of patients, and the frequency of non-BSI infections did not differ between groups (Table 3). MDRO colonization or infection did not differ between groups.

ECMO remains an important life-saving procedure for critically ill patients, and infectious complications occur in up to 20% of patients. This study demonstrated that amongst ECMO recipients at our institution, the post-pandemic state led to no differences regarding infection rate, MDRO colonization or infection, mortality, or ICU LOS.

All Authors: No reported disclosures