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.