Standardizing Antimicrobial Prophylaxis in Pediatric Patients Requiring Extracorporeal Membrane Oxygenation.
Document Type
Article
Publication Date
3-1-2026
Identifier
DOI: 10.1097/INF.0000000000005008
Abstract
BACKGROUND: Prophylactic antimicrobials for pediatric patients requiring extracorporeal membrane oxygenation (ECMO) support are not well delineated; there are no consistent guidelines nationally or internationally. We analyzed antimicrobial use before and after implementing a narrow-spectra ECMO antimicrobial prophylaxis protocol intended to standardize prophylaxis by risk related to ECMO type and configuration.
METHODS: This retrospective, single-center study included children under 18 years old requiring ECMO between May 2018 and December 2021. Medical and cardiac surgical patients requiring open-chested (central) or peripheral veno-venous or veno-arterial ECMO were included. We evaluated the impact of an ECMO antimicrobial prophylaxis protocol by comparing the appropriateness of antimicrobial use as well as nosocomial infections in the pre versus post protocol.
RESULTS: Our study included 55 children with 58 individual ECMO episodes. More than 50% of the patients were open-chested during ECMO support, and the majority of ECMO support was veno-arterial. In the post protocol period, patients were 4 times as likely to have appropriate antimicrobial prescribing (Odds ratio 4.4; 95% confidence interval: 1.1-19; P = 0.036), including both prophylactic (per protocol) and therapeutic (chart documentation of an infection with appropriate therapeutic antimicrobials, including drug and duration). There was no difference in the odds of nosocomial infection occurring during ECMO pre protocol versus post protocol (pre vs. post protocol, P = 0.71 for invasive infections, P = 0.73 for all infections including potential colonization).
CONCLUSIONS: After implementation of a standardized narrow-spectra ECMO antimicrobial prophylaxis protocol, we observed an increase in appropriate and standardized antimicrobial prescribing without concomitant increase in nosocomial infections.
Journal Title
The Pediatric infectious disease journal
Volume
45
Issue
3
First Page
245
Last Page
250
MeSH Keywords
Humans; Extracorporeal Membrane Oxygenation; Retrospective Studies; Child; Antibiotic Prophylaxis; Female; Male; Child, Preschool; Infant; Adolescent; Cross Infection; Infant, Newborn; Anti-Bacterial Agents
PubMed ID
40966758
Keywords
antimicrobial prophylaxis; cardiac surgery; extracorporeal membrane oxygenation; nosocomial infection
Recommended Citation
Mitzelfelt JC, Hentz RC, Ristagno EH, et al. Standardizing Antimicrobial Prophylaxis in Pediatric Patients Requiring Extracorporeal Membrane Oxygenation. Pediatr Infect Dis J. 2026;45(3):245-250. doi:10.1097/INF.0000000000005008
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