Risk factors for healthcare-associated infections in children undergoing ECMO after cardiac surgery for congenital heart disease: A retrospective study

OBJECTIVE: To analyze the influencing factors of ECMO (extracorporeal membrane oxygenation)-related healthcare-associated infections in children after congenital heart disease (CHD) surgery. METHODS: A retrospective analysis was conducted on the healthcare-associated infections (HAI) and related factors of 54 pediatric patients who received ECMO support after CHD surgery at Fuwai Central China Cardiovascular Hospital between 1 January 2019 and 1 April 2024. All children were divided into the infection group (n = 14) and the non-infection group (n = 40) based on whether they developed ECMO-related HAIs. Multivariate logistic regression analysis was used to identify the risk factors for ECMO-related HAI in children after congenital heart disease surgery. RESULTS: Among the 54 ECMO-supported children, 14 developed HAIs during ECMO support, with a total of 17 pathogenic microorganisms isolated. Gram-negative bacteria predominated (3 strains of Klebsiella pneumoniae, 3 strains of Stenotrophomonas maltophilia, 2 strains of Pseudomonas aeruginosa, and 2 strains of Burkholderia cepacia), accounting for 64.7% of the cases. Statistically significant differences were observed between the infected and non-infected groups in terms of preoperative endotracheal intubation for congenital heart disease and ICU stay duration (p < 0.05), but there was no significant difference in mortality between the two groups (p > 0.05). Multivariate logistic regression analysis revealed that preoperative endotracheal intubation for congenital heart disease (OR = 4.852, 95% CI: 1.174-20.059; p = 0.029) was significantly associated with the occurence of ECMO-related HAI. CONCLUSION: ECMO-related HAI in children after congenital heart surgery are primarily Gram-negative bacterial respiratory infections. Preoperative endotracheal intubation for congenital heart disease was significantly associated with the occurence of ECMO-related HAI in children after CHD surgery. Avoiding preoperative endotracheal intubation whenever possible may reduce the incidence of HAI. However, given the observational design and potential for confounding by severity, these findings should be interpreted as hypothesis-generating rather than definitive. Future studies are needed to determine whether strategies to minimize preoperative intubation or optimize infection prevention in intubated patients can reduce HAI rates in this high-risk population.