19: Epidemiology of Nosocomial Bloodstream Infections in COVID-19 Patients Receiving ECMO: A Retrospective Study from Qatar

Background: The COVID-19 pandemic markedly heightened the demand for extracorporeal membrane oxygenation (ECMO) therapy in critically ill patients experiencing severe respiratory failure. Although ECMO can be life-saving, its application is associated with extended ICU stays, increasing the likelihood of nosocomial infections and adverse clinical outcomes [1]. This study is the first investigation in Qatar and the Middle East on the epidemiology of nosocomial bloodstream infections (BSIs) in COVID-19 patients undergoing ECMO in Qatar. Methods: Data from 54 COVID-19 patients on ECMO (admitted April 2020-November 2021) were analyzed to calculate infection rates and infection density. Pathogen identification was conducted, and baseline parameters were compared between individuals with and without BSIs. Results: The patient cohort primarily comprised males (85.2%) aged 29 to 65 years, with notable comorbidities including diabetes (66.7%) and hypertension (68.5%). Out of 54 patients, 25 (46.3%) experienced BSIs, yielding an infection density of 22.7 BSIs per 1000 ECMO days throughout a cumulative total of 2022 ECMO days. The primary BSI pathogens comprised Klebsiella pneumoniae (15.22%), Escherichia coli (13.04%), and notable fungal agents such as Candida auris (10.87%). Patients with BSIs demonstrated a markedly extended hospital stay (116.12 days vs. 61.17 days, p=0.0116) and ICU stay (87 days vs. 39.31 days, p=0.0132). Nonetheless, total death rates were comparable in the two groups (48% with BSIs versus 37.9% without BSIs), suggesting that additional factors, such as initial disease severity (APACHE2 mean of 26.3 among deceased patients), may substantially affect outcomes. Comorbidities, including diabetes (48%) and obesity (72%), were more frequent in individuals with BSIs, indicating increased vulnerability to infections. Conclusions: These results underscore the considerable burden of nosocomial bloodstream infections in COVID-19 ECMO patients, highlighting the necessity for improved infection control protocols and customized antimicrobial stewardship initiatives in Qatar and the wider Middle East.