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Do patients receiving extracorporeal membrane-oxygenation need antibiotic prophylaxis? A systematic review and meta-analysis on 7,996 patients

Authors :
Daniele Orso
Caterina Maria Fodale
Sara Fossati
Sergio Venturini
Federico Fonda
Francesco Cugini
Irene Comisso
Massimo Crapis
Luisa Cacciavillani
Tiziana Bove
Source :
BMC Anesthesiology, Vol 24, Iss 1, Pp 1-13 (2024)
Publication Year :
2024
Publisher :
BMC, 2024.

Abstract

Abstract Background Patients undergoing Extracorporeal Membrane Oxygenation (ECMO) are particularly susceptible to infections: 42% experience sepsis and 26% develop a nosocomial infection (NI). Whether antibiotic prophylaxis is effective in reducing mortality and its effects on the rate of NIs is currently unclear. Research question Can antibiotic prophylaxis decrease 30-day mortality for patients on ECMO? Can antibiotic prophylaxis prevent the occurrence of NIs in these patients? Study design and methods A systematic review and meta-analysis was conducted. We searched PubMed, Scopus, and CINAHL libraries from inception to June 12, 2024. Two researchers were involved in abstract screening and three researchers were involved in full text selection. Results A pooled population of 7,996 patients is represented by 5 retrospective studies. Reported mortality ranges between 46 and 58% and the NIs rate is between 14 and 62%. Regarding 30-day mortality, the random-effects model (I2 = 65%) indicates a non-statistically significant difference between the antibiotic prophylaxis group and the non-prophylaxis group (OR 0.76; 95%CI 0.37–1.59). For the NIs rate, a fixed-effect model (I2 = 36%) shows an OR of 0.81 (95%CI 0.71–0.92) in favor of the antibiotic prophylaxis group, with a number-needed-to-treat (NNT) of 39.7 patients. Conclusion According to a very low degree of certainty, antibiotic prophylaxis appears to have no impact on the 30-day mortality rate of ECMO recipients. The risk of NIs seems to decrease with antibiotic prophylaxis, even though the NNT is high. Prospective high-quality studies that address these specific clinical questions are necessary. Clinical trial registration PROSPERO: International prospective register of systematic reviews, 2024, CRD42024567037.

Details

Language :
English
ISSN :
14712253
Volume :
24
Issue :
1
Database :
Directory of Open Access Journals
Journal :
BMC Anesthesiology
Publication Type :
Academic Journal
Accession number :
edsdoj.1852de0de00a4bbd9bfbb21b50ba1679
Document Type :
article
Full Text :
https://doi.org/10.1186/s12871-024-02796-z