Work

Association of vancomycin or teicoplanin gram-positive prophylaxis with infection profile and mortality in ECMO patients: A real-world cohort study

Year: 2026

Type: article

Abstract: OBJECTIVES: ECMO patients are highly susceptible to Gram-positive infections, yet the benefit of prophylactic antibiotics remains unclear. This study examines associations between prophylactic Gram-positive antibiotic use, infection patterns, and in-hospital mortality, and compares vancomycin and teicoplanin in this context. METHODS: We retrospectively reviewed 1424 patients who received ECMO at our institution between 2007 and 2022. Patients were excluded if they did not receive veno-venous or veno-arterial ECMO, died within 7 days of initiation, or had documented infections prior to ECMO. Patients were grouped based on prophylactic antibiotic use, and clinical and infection-related data were collected, including comorbidities, ECMO duration, severity scores, and outcomes. Primary outcomes were the occurrence of gram-positive and gram-negative infections and in-hospital mortality. Multivariable logistic regression adjusted for baseline differences. RESULTS: A total of 387 patients were included in the final analysis, 47.5% received prophylactic antibiotics, most commonly teicoplanin (59.8%) or vancomycin (29.4%); 10.9% experienced sequential exposure to both agents, with treatment switching occurring in either direction. Prophylactic Gram-positive antibiotic use was associated with a nonsignificant reduction in overall infection rates and an association with lower in-hospital mortality, particularly with vancomycin (OR: 0.43, 95% CI: 0.21-0.87). Patients receiving prophylaxis had higher illness severity, reflected by higher APACHE II and APS scores, and were more likely to require subsequent Gram-negative antibiotics (25.0% vs 8.37%, P < 0.0001), which may reflect differences in illness severity or overall antimicrobial management rather than a direct effect of prophylaxis. CONCLUSION: Prophylactic use of vancomycin or teicoplanin in ECMO patients was associated with lower in-hospital mortality without a statistically significant reduction in overall infection rates. These findings represent associations among patients surviving beyond the early ECMO period and should not be interpreted as causal. The higher use of subsequent Gram-negative antibiotics underscores the need to balance potential benefits against antimicrobial resistance. Further prospective studies are warranted to clarify the role of prophylactic antibiotic strategies in this population.

Source: International Journal of Infectious Diseases

DOI: 10.1016/j.ijid.2026.108492

Authors: You-Cian Lin, Pei-Chun Lai, Chih-Hsin Muo, Shih-Chi Wu

Institutions: China Medical University, China Medical University Hospital

Language: English

Topic: Nosocomial Infections in ICU

Subfield: Critical Care and Intensive Care Medicine

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: gold

Estimated APC paid: $2,900