Antimicrobial stewardship challenges in extracorporeal membrane oxygenation

Nosocomial infections represent a major complication during extracorporeal membrane oxygenation (ECMO), and their detrimental impact on outcomes is unquestionable ( 1 Li X. Wang L. Wang H. et al. Outcome and Clinical Characteristics of nosocomial infection in adult patients undergoing Extracorporeal Membrane Oxygenation: A Systematic Review and Meta-Analysis. Infect Drug Resist. 2023; 16: 4189-4200 Crossref Google Scholar ). With respect to other intensive care unit patients, ECMO patients present three key differences: the presence of the indwelling ECMO cannulas, the oxygenator-circuit, and the higher severity-of-illness. Other challenges are the differences in the identification signs of infection and the presence of an inflammatory syndrome in response to the oxygenator membrane or after decannulation from ECMO ( 2 Esposito E.C. Jones K.M. Galvagno S.M. et al. Incidence of healthcare-associated infections in patients with fever during the first 48 hours after decannulation from veno-venous extracorporeal membrane oxygenation. Perfusion. 2021; 36: 421-428 Crossref Scopus (2) Google Scholar ). As a result, over-prescription of antibiotics is common. Therefore, the development of adapted definitions for this subpopulation in specific clinical practice guidelines is an unmet clinical need.