Program-level Infection Prevention Strategies After MDRO Outbreaks in ECMO Patients: Lessons from a Case Series and Development of a Quality-Improvement Initiative

BackgroundPatients on extracorporeal membrane oxygenation (ECMO) are at high risk for multidrug-resistant organism (MDRO) infections due to prolonged vascular access and biofilm formation.These infections complicate management, particularly decisions regarding cannula or circuit exchange.We report a case series of MDRO infections in ECMO patients and describe a quality-improvement initiative (QII) developed to reduce preventable infectious complications. MethodsA retrospective review was conducted of ECMO patients who developed MDRO infections over a 12-month period.Infection patterns and management challenges informed the development of an ECMO-specific infection-prevention QII. ResultsSeven patients developed bloodstream or cannulation-site infections.One patient experienced sequential infections with carbapenem-resistant Klebsiella pneumoniae, Serratia marcescens, vancomycin-resistant Enterococcus, and Candida auris, all resolving without circuit exchange.Another developed post-decannulation cannula-site infections with Candida auris and Candida tropicalis, requiring surgical debridement.Persistent Acinetobacter baumannii bacteremia in one case necessitated replacement of both cannulae and the ECMO circuit.Two patients with Pseudomonas aeruginosa bacteremia responded to polymyxin-based therapy, while two others cleared bacteremia with meropenem alone.Common challenges included frequent gram-negative and fungal 2/4/26, 1:16 PM ABSTRACTS ECMO -IJECMO2026 file:///C:/Users/Prabhat Shukla.DESKTOP-6HO8CNO/Downloads/Page Proof/IJECMO-4(S1)-html/IJECMO-4(S1)-html/IJECMO-4(S1)/4/S(1)/10.5 1/2 infections, high MDRO burden, and lack of clear thresholds for cannula or circuit exchange.:An ECMO-specific infection-prevention bundle was implemented, including sterile cannulation with chlorhexidine, antimicrobial dressings with two-person sterile dressing changes, daily chlorhexidine bathing with focused cannula care, mandatory hub and circuit disinfection, minimised circuit access, structured surveillance, strict hand hygiene, early removal of unnecessary intravascular devices, MDRO isolation or cohorting, and targeted cultures based on clinical indication. LimitationsRetrospective, single-center study. ConclusionsMDRO infections in ECMO patients are predominantly cannula-and line-associated.Implementation of a structured ECMO-specific infection-prevention bundle may reduce infectious complications and improve program-level infection control.