Comparison of Antimicrobial Resistance Patterns in ECMO, ICU, and Hospital-Wide Patient Cohorts

Tuesday, March 24, 2026

11:15 AM - 12:15 PM Central Time

Location: Connections Central - RST 05

Jamal A. Anthony, MD (he/him/his)

New Jersey

Disclosure(s): No relevant financial relationship(s) to disclose.
Zaw H. Naing, MD (he/him/his)

Cooper University Hospital, New Jersey

Disclosure(s): No relevant financial relationship(s) to disclose.
AC

Abhi Chandel, MD

Critical Care Intensivist
Uniformed Services University of the Health Sciences

Disclosure information not submitted.
AH

Alexandra Hanretty, PharmD

Clinical Pharmacy Specialist
Cooper University Hospital

Disclosure information not submitted.
GK

Geena Kludjian, PharmD

Clinical Pharmacy Specialist
Cooper University Hospital

Disclosure information not submitted.
RN

Raquel Nahra, MD

Critical Care Intensivist
Cooper University Hospital

Disclosure information not submitted.
AG

Adam Green, MD, MBA

Critical Care Intensivist
Cooper University Health Care

Disclosure information not submitted.

Introduction: Patients receiving extracorporeal membrane oxygenation (ECMO) are at heightened risk for multidrug-resistant organism (MDRO) infections. However, antimicrobial resistance trends in ECMO patients compared to non-ECMO populations remain under-characterized.

Methods: We conducted a retrospective cohort study of 81 ECMO patients (2019–2023) at a tertiary academic center. ECMO-specific antibiograms were constructed using all isolates obtained throughout the ECMO course, capturing evolving resistance patterns. Organism–antibiotic susceptibility data were compared with 2021 MICU and hospital-wide antibiograms. Only organisms with ≥20 isolates were included in comparative analyses. Fisher’s exact test was used to assess statistical significance (α = 0.05). AI-assisted tools were used for the statistical coding and editorial refinement.

Results: The most common ECMO Gram-negative isolates were K. pneumoniae (18.7%), P. aeruginosa (17.2%), and K. aerogenes (10.3%). MDRO infections occurred in 38% (31/81) of ECMO patients. ECMO isolates demonstrated significantly lower susceptibilities for key agents: K. pneumoniae cefepime susceptibility was 75.7% (ECMO) vs. 85% (MICU) vs. 93% (hospital); p = 0.0152; P. aeruginosa piperacillin-tazobactam: 58.8% (ECMO) vs. 81% (MICU) vs. 90% (hospital); p = 0.0032; P. aeruginosa meropenem: 62.9% (ECMO) vs. 96% (MICU) vs. 90% (hospital); p = 0.0062; K. aerogenes ceftriaxone/aztreonam: 61.9% (ECMO) vs. >94% (hospital); p < 0.01. While aminoglycosides retained high susceptibility (e.g., 100% for amikacin), ECMO isolates of K. pneumoniae had lower susceptibility to tobramycin (78.4% vs. 91% MICU vs. 96% hospital).

Conclusions: ECMO patients experience significantly higher rates of antimicrobial resistance compared to MICU and hospital-wide cohorts. Hospital antibiograms may underestimate resistance patterns in this population. ECMO-specific antibiograms should be adopted to guide empiric antimicrobial therapy and improve infection outcomes in critically ill patients.