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Over the past 10 years, there has been a rapid expansion in the use of extracorporeal membrane oxygenation (ECMO) in the care of patients with refractory cardiac or respiratory failure. Infectious diseases clinicians must reconcile conflicting evidence from limited studies as they develop practices at their own institutions, which has resulted in considerably different practices globally. This review describes infection control and prevention as well as antimicrobial prophylaxis strategies in this population. Data on diagnostics and treatment for patients receiving ECMO with a focus on diagnostic and antimicrobial stewardship is then examined. This review summarizes gaps in the current ECMO literature and proposes future needs, including developing clear definitions for infections and encouraging transparent reporting of practices at individual facilities in future clinical trials.

Epstein–Barr Virus (EBV) is a ubiquitous herpes type virus that is associated with post‐transplant lymphoproliferative disorder (PTLD). Usual management includes reduction or cessation of immunosuppression and in some cases chemotherapy including rituximab. However, limited therapies are available if PTLD is refractory to rituximab. Several clinical trials have investigated the use of EBV‐directed T cells in rituximab‐refractory patients; however, data regarding response is scarce and inconclusive. Herein, we describe a patient with EBV‐PTLD refractory to rituximab after orthotopic heart transplantation (OHT) requiring EBV‐directed T‐cell therapy. This article aims to highlight the unique and aggressive clinical presentation and progression of PTLD with utilization of EBV‐directed T‐cell therapy for management and associated pitfalls.