Patients supported with extracorporeal membrane oxygenation (ECMO) are susceptible to healthcare-associated infections (HAIs), which may worsen outcomes. However, epidemiological data from Latin American centres remain scarce.

We conducted a retrospective cohort study including all patients who received ECMO support at Hospital Sírio-Libanês, Brazil (2016–2023). Data were obtained from the institutional ECMO registry and infection control surveillance system. HAIs were defined according to the Centers for Disease Control and Prevention/National Healthcare Safety Network and the Brazilian National Health Surveillance Agency criteria. Incidence rates of bloodstream infection (BSI) and ventilator-associated pneumonia/tracheobronchitis (VAP/VAT) were calculated. Logistic regression identified factors independently associated with in-hospital mortality.

We analysed 115 patients (117 ECMO runs; 82% male; median age = 61 years). Coronavirus disease 2019 (COVID-19) accounted for 77 runs (65.8%). Overall incidence was 5.9/1000 ECMO-days for BSI and 7.0/1000 ECMO-days for VAP/VAT. Compared with non-COVID cases, patients with COVID-19 had longer ECMO duration (median = 13 vs 8.5 days) but similar infection rates. Despite prolonged support, mortality was lower in COVID-19 cases (45.5%). Patients with HAIs had longer ECMO runs (median = 20.5 vs 10.0 days, P < 0.001). In multi-variable analysis, older age (odds ratio [OR] = 1.07; 95% confidence interval [CI] = 1.04–1.11) and HAIs (OR = 4.01; 95% CI = 1.23–15.12) were independently associated with mortality, while COVID-19 diagnosis was protective (OR = 0.22; 95% CI = 0.05–0.75).

In this Brazilian ECMO centre, HAIs occurred less frequently than in most international reports, suggesting effective infection prevention. However, ECMO duration remained the main modifiable risk factor, and HAIs independently increased mortality. Continuous surveillance, preventive bundles, and stewardship are essential to improve ECMO outcomes.