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.