Epidemiology of nosocomial infections in ECMO patients in Qatar: the CLEAN-Q seven-year retrospective cohort study
Year: 2026
Type: article
Study design: Observational Study
Abstract: BACKGROUND: Extracorporeal Membrane Oxygenation (ECMO) is a critical rescue therapy complicated by high rates of nosocomial infections (NIs). While Western data abound, evidence from the Middle East remains limited. This study examined the epidemiological patterns, predictors, and outcomes of NIs among ECMO patients in Qatar. METHODS: This retrospective cohort study analyzed adult patients supported with ECMO at Hamad General Hospital (2014-2021). Clinical and microbiological data were retrieved according to ELSO definitions. Primary outcomes included mortality at ECMO weaning, ICU, and hospital discharge. Multivariable logistic regression and competing-risks models were employed to identify predictors of infection and survival. RESULTS: Among 172 patients (mean age 41.2 ± 13.3 years), 55.2% developed NIs (65.5 episodes/1,000 ECMO days), predominantly respiratory (51.2%) and bloodstream infections (30.2%). The microbial landscape was characterized by multidrug-resistant Pseudomonas aeruginosa, Klebsiella pneumoniae (18%), and Candida auris (7.4%). Multivariable analyses identified obesity and tracheostomy as independent factors associated with improved survival across all discharge tiers. Competing-risks regression further supported these findings, indicating that tracheostomy was associated with reduced infection-related mortality hazards, while obesity correlated with lower non-infection mortality risks. CONCLUSIONS: This inaugural Middle Eastern cohort highlights a substantial burden of nosocomial infections driven by a resistant Gram-negative and fungal pathogen profile. The observed survival advantages associated with obesity and tracheostomy suggest potential favorable phenotypes that warrant further prospective investigation to guide regional risk stratification and management strategies.
Source: BMC Infectious Diseases
Authors: Ali Ait Hssain, Fatemeh Bahramnezhad, Amir vahedian-azimi, Mahmood Salesi, Hicham Raïq, Abrar Abdelrahman, Asma’a AlMulla, Walid Kouidri, Alaa Al-Qadhi, Nassima Zerouali, Latifa Alkhayyat, Abderrezzaq Soltani, Ibrahim Abdelsalam, Muna Alshammari, Morteza Izadi, Abbas Ali Imani Fooladi, Abdelali Agouni, Elie Azoulay, Michael Darmon
Institutions: Hamad General Hospital, Hamad Medical Corporation, Tehran University of Medical Sciences, Baqiyatallah University of Medical Sciences, Qatar University, Public Authority for Applied Education and Training, Université Paris Cité, Assistance Publique – Hôpitaux de Paris, Hôpital Saint-Louis
Language: English
Topic: Nosocomial Infections in ICU
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $3,090
OpenAlex ID: W7140602288