PDF(Pubmed)
Abstract：
An increasing number of patients requires extracorporeal membrane oxygenation (ECMO) for life support. This supportive modality is associated with nosocomial infections (NIs). This systematic review and meta-analysis aim to assess the incidence and risk factors of NIs in adult.
We searched PubMed, Scopus, Web of Science, and ProQuest databases up to 2022. The primary endpoint was incidence of NI. Secondary endpoints included time to infection, source of infection, ECMO duration, Intensive care and hospital length of stay (LOS), ECMO survival and overall survival. Incidence of NI was reported as pooled proportions and 95% confidence intervals (CIs), while dichotomous outcomes were presented as risk ratios (RR) as the effective index and 95% CIs using a random-effects model.
Among the 4,733 adult patients who received ECMO support in the 30 included studies, 1,249 ECMO-related NIs per 1000 ECMO-days was observed. The pooled incidence of NIs across 18 studies involving 3424 patients was 26% (95% CI 14-38%).Ventilator-associated pneumonia (VAP) and bloodstream infections (BSI) were the most common NI sources. Infected patients had lower ECMO survival and overall survival rates compared to non-infected patients, with risk ratio values of 0.84 (95% CI 0.74-0.96, P = 0.01) and 0.80 (95% CI 0.71-0.90, P < 0.001), respectively.
Results showed that 16% and 20% lower of ECMO survival and overall survival in patients with NI than patients without NI, respectively. However, NI increased the risk of in-hospital mortality by 37% in infected patients compared with non-infected patients. In addition, this study identified the significant positive correlation between ECMO duration and ECMO-related NI.
We searched PubMed, Scopus, Web of Science, and ProQuest databases up to 2022. The primary endpoint was incidence of NI. Secondary endpoints included time to infection, source of infection, ECMO duration, Intensive care and hospital length of stay (LOS), ECMO survival and overall survival. Incidence of NI was reported as pooled proportions and 95% confidence intervals (CIs), while dichotomous outcomes were presented as risk ratios (RR) as the effective index and 95% CIs using a random-effects model.
Among the 4,733 adult patients who received ECMO support in the 30 included studies, 1,249 ECMO-related NIs per 1000 ECMO-days was observed. The pooled incidence of NIs across 18 studies involving 3424 patients was 26% (95% CI 14-38%).Ventilator-associated pneumonia (VAP) and bloodstream infections (BSI) were the most common NI sources. Infected patients had lower ECMO survival and overall survival rates compared to non-infected patients, with risk ratio values of 0.84 (95% CI 0.74-0.96, P = 0.01) and 0.80 (95% CI 0.71-0.90, P < 0.001), respectively.
Results showed that 16% and 20% lower of ECMO survival and overall survival in patients with NI than patients without NI, respectively. However, NI increased the risk of in-hospital mortality by 37% in infected patients compared with non-infected patients. In addition, this study identified the significant positive correlation between ECMO duration and ECMO-related NI.
摘要：
背景：越来越多的患者需要体外膜氧合（ECMO）来维持生命。这种支持方式与医院感染（NI）有关。本系统评价和荟萃分析旨在评估成人NIs的发生率和危险因素。
方法：我们搜索了PubMed，Scopus,WebofScience,和ProQuest数据库，直到2022年。主要终点是NI的发生率。次要终点包括感染时间，感染源,ECMO持续时间,重症监护和住院时间（LOS），ECMO生存率和总生存率。NI的发生率报告为合并比例和95%置信区间(CI)，而使用随机效应模型将二分法结果表示为作为有效指数的风险比(RR)和95%CI。
结果：在30项纳入研究中接受ECMO支持的4,733名成年患者中，每1000个ECMO天观察到1,249个ECMO相关NI。在涉及3424名患者的18项研究中，NIs的合并发生率为26%(95%CI14-38%)。呼吸机相关性肺炎（VAP）和血流感染（BSI）是最常见的NI来源。与未感染患者相比，感染患者的ECMO生存率和总体生存率较低，风险比为0.84（95％CI0.74-0.96，P=0.01）和0.80（95％CI0.71-0.90，P<0.001），分别。
结论：结果显示，有NI的患者的ECMO生存率和总生存率比没有NI的患者低16%和20%，分别。然而,与未感染患者相比，NI使感染患者的住院死亡率增加了37％。此外,这项研究确定了ECMO持续时间和ECMO相关NI之间的显著正相关。
方法：我们搜索了PubMed，Scopus,WebofScience,和ProQuest数据库，直到2022年。主要终点是NI的发生率。次要终点包括感染时间，感染源,ECMO持续时间,重症监护和住院时间（LOS），ECMO生存率和总生存率。NI的发生率报告为合并比例和95%置信区间(CI)，而使用随机效应模型将二分法结果表示为作为有效指数的风险比(RR)和95%CI。
结果：在30项纳入研究中接受ECMO支持的4,733名成年患者中，每1000个ECMO天观察到1,249个ECMO相关NI。在涉及3424名患者的18项研究中，NIs的合并发生率为26%(95%CI14-38%)。呼吸机相关性肺炎（VAP）和血流感染（BSI）是最常见的NI来源。与未感染患者相比，感染患者的ECMO生存率和总体生存率较低，风险比为0.84（95％CI0.74-0.96，P=0.01）和0.80（95％CI0.71-0.90，P<0.001），分别。
结论：结果显示，有NI的患者的ECMO生存率和总生存率比没有NI的患者低16%和20%，分别。然而,与未感染患者相比，NI使感染患者的住院死亡率增加了37％。此外,这项研究确定了ECMO持续时间和ECMO相关NI之间的显著正相关。
