Insidious risk of severe mycobacterium chimaera infection in cardiac surgery patients.
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Authors
Robins, Stephen
Issue Date
2017-02-01
Journal
Type
Article
Peer-Reviewed Publication
Peer-Reviewed Publication
Keywords
Adult
Aerosol release
Aged
Air microbiology
Cardiac surgical procedures
Cardiac surgery
Cardiopulmonary bypass
Cardiopulmonary bypass heater-cooler units
Child
Cohort study
Disease management
Disease outbreaks
Equipment contamination
Female
Male
Middle aged
Mycobacterium chimaera Infection
Mycobacterium infections
Mycobacterium mycobacteria
Nontuberculous mycobacterium infections
Peer-reviewed article
Retrospective study
Risk factors
Surgical equipment
Surgical wound infection
United Kingdom
Water microbiology
Aerosol release
Aged
Air microbiology
Cardiac surgical procedures
Cardiac surgery
Cardiopulmonary bypass
Cardiopulmonary bypass heater-cooler units
Child
Cohort study
Disease management
Disease outbreaks
Equipment contamination
Female
Male
Middle aged
Mycobacterium chimaera Infection
Mycobacterium infections
Mycobacterium mycobacteria
Nontuberculous mycobacterium infections
Peer-reviewed article
Retrospective study
Risk factors
Surgical equipment
Surgical wound infection
United Kingdom
Water microbiology
Journal Title
Clinical Infectious Diseases
Volume
64
Issue
3
Begin page
335
End page
342
Abstract
Background: An urgent UK investigation was launched to assess risk of invasive Mycobacterium chimaera infection in cardiothoracic surgery and a possible association with cardiopulmonary bypass heater-cooler units following alerts in Switzerland and The Netherlands.
Methods: Parallel investigations were pursued: (1) identification of cardiopulmonary bypass-associated M. chimaera infection through national laboratory and hospital admissions data linkage; (2) cohort study to assess patient risk; (3) microbiological and aerobiological investigations of heater-coolers in situ and under controlled laboratory conditions; and (4) whole-genome sequencing of clinical and environmental isolates.
Results: Eighteen probable cases of cardiopulmonary bypass-associated M. chimaera infection were identified; all except one occurred in adults. Patients had undergone valve replacement in 11 hospitals between 2007 and 2015, a median of 19 months prior to onset (range, 3 months to 5 years). Risk to patients increased after 2010 from <0.2 to 1.65 per 10000 person-years in 2013, a 9-fold rise for infections within 2 years of surgery (rate ratio, 9.08 [95% CI, 1.81-87.76]). Endocarditis was the most common presentation (n = 11). To date, 9 patients have died. Investigations identified aerosol release through breaches in heater-cooler tanks. Mycobacterium chimaera and other pathogens were recovered from water and air samples. Phylogenetic analysis found close clustering of strains from probable cases.
Conclusions: We identified low but escalating risk of severe M. chimaera infection associated with heater-coolers with cases in a quarter of cardiothoracic centers. Our investigations strengthen etiological evidence for the role of heater-coolers in transmission and raise the possibility of an ongoing, international point-source outbreak. Active management of heater-coolers and heightened clinical awareness are imperative given the consequences of infection.
Citation
Chand M, Lamagni T, Kranzer K, Hedge J, Moore G, Parks S, Collins S, Del Ojo Elias C, Ahmed N, Brown T, Smith EG, Hoffman P, Kirwan P, Mason B, Smith-Palmer A, Veal P, Lalor MK, Bennett A, Walker J, Yeap A, Isidro Carrion Martin A, Dolan G, Bhatt S, Skingsley A, Charlett A, Pearce D, Russell K, Kendall S, Klein AA, Robins S, Schelenz S, Newsholme W, Thomas S, Collyns T, Davies E, McMenamin J, Doherty L, Peto TE, Crook D, Zambon M, Phin N. Insidious Risk of Severe Mycobacterium chimaera Infection in Cardiac Surgery Patients. Clin Infect Dis. 2017 Feb 1;64(3):335-342. doi: 10.1093/cid/ciw754. Epub 2016 Dec 7. Erratum in: Clin Infect Dis. 2017 Sep 1;65(5):875. PMID: 27927870; PMCID: PMC5881635.