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Ohlrich K, Kwon J, Hill MA, Ayala M, Stone A, Bruner S, Pollard M, Dell'Aiera L, Fitzgerald D, Kilic A. A clinical comparison of glycol and water-based heater-cooler systems for cardiopulmonary bypass. Perfusion 2025; 40:947-954. [PMID: 39107676 DOI: 10.1177/02676591241270961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/29/2025]
Abstract
IntroductionWhile newer heater-cooler technologies using ethylene glycol-based (GB) solutions during cardiothoracic surgery have become commercially available, there is a paucity of clinical data describing their effectiveness during cardiopulmonary bypass (CPB) support. This analysis aimed to compare clinical characteristics and procedural outcomes using water-based (WB) and GB heater-cooler systems.MethodsA retrospective analysis was performed on consecutive adult patients undergoing CPB from June to October 2022 comparing WB or GB groups. The primary outcome was a composite of operative death or major morbidity. Secondary endpoints included transfusion requirements on CPB, patient cooling and warming rates, and vasoactive-inotropic scores (VIS) at case completion. P-control charts were used to monitor the weekly incidence of the composite outcome. A sub-analysis was performed to evaluate the primary outcome for cardiac surgery cases indexed by the Society of Thoracic Surgeons (STS).ResultsThere were 167 patients included for analysis; 87 (52.1%) underwent CPB with a WB system and 80 (47.9%) with a GB system. GB procedure subjects were younger (p = .01), experienced longer CPB times (p = .034), and were more likely to receive thoracic transplant or aortic surgery (p = 0.015). The composite outcome of operative mortality or major morbidity occurred in 29.9% and 24% of the WB and GB groups, respectively (p = .372). P-control charts indicated a weekly mean incidence of 30% during WB practice, which decreased to 24% with GB practice. Among 106 STS-indexed cardiac surgery cases, mean composite outcome incidence decreased from 19% to 6% following our GB transition. Additionally, cooling, and warming rates indexed to patient BSA and VIS at case completion were not significantly different.ConclusionOur analysis demonstrated a safe transition from WB to GB heater-cooler technologies in our practice. This early analysis suggests that GB heater coolers may be safely adopted to mitigate the risks of nontuberculous mycobacterium infections for cardiac surgical patients.
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Affiliation(s)
- Kelly Ohlrich
- Department of Cardiothoracic Surgery, Medical University of South Carolina, Charleston, SC, USA
| | - Jennie Kwon
- Department of Cardiothoracic Surgery, Medical University of South Carolina, Charleston, SC, USA
| | - Morgan A Hill
- Department of Cardiothoracic Surgery, Medical University of South Carolina, Charleston, SC, USA
| | - McKenzie Ayala
- Cardiovascular Perfusion, College of Health Professions, Medical University of South Carolina, Charleston, SC, USA
| | - Amber Stone
- Cardiovascular Perfusion, College of Health Professions, Medical University of South Carolina, Charleston, SC, USA
| | - Samantha Bruner
- Cardiovascular Perfusion, College of Health Professions, Medical University of South Carolina, Charleston, SC, USA
| | - Melissa Pollard
- Cardiovascular Perfusion, College of Health Professions, Medical University of South Carolina, Charleston, SC, USA
| | - Laura Dell'Aiera
- Cardiovascular Perfusion, College of Health Professions, Medical University of South Carolina, Charleston, SC, USA
| | - David Fitzgerald
- Cardiovascular Perfusion, College of Health Professions, Medical University of South Carolina, Charleston, SC, USA
| | - Arman Kilic
- Department of Cardiothoracic Surgery, Medical University of South Carolina, Charleston, SC, USA
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Wahba A, Kunst G, De Somer F, Kildahl HA, Milne B, Kjellberg G, Bauer A, Beyersdorf F, Ravn HB, Debeuckelaere G, Erdoes G, Haumann RG, Gudbjartsson T, Merkle F, Pacini D, Paternoster G, Onorati F, Ranucci M, Ristic N, Vives M, Milojevic M. 2024 EACTS/EACTAIC/EBCP Guidelines on cardiopulmonary bypass in adult cardiac surgery. Br J Anaesth 2025; 134:917-1008. [PMID: 39955230 PMCID: PMC11947607 DOI: 10.1016/j.bja.2025.01.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2025] Open
Abstract
Clinical practice guidelines consolidate and evaluate all pertinent evidence on a specific topic available at the time of their formulation. The goal is to assist physicians in determining the most effective management strategies for patients with a particular condition. These guidelines assess the impact on patient outcomes and weigh the risk-benefit ratio of various diagnostic or therapeutic approaches. While not a replacement for textbooks, they provide supplementary information on topics relevant to current clinical practice and become an essential tool to support the decisions made by specialists in daily practice. Nonetheless, it is crucial to understand that these recommendations are intended to guide, not dictate, clinical practice, and should be adapted to each patient's unique needs. Clinical situations vary, presenting a diverse array of variables and circumstances. Thus, the guidelines are meant to inform, not replace, the clinical judgement of healthcare professionals, grounded in their professional knowledge, experience and comprehension of each patient's specific context. Moreover, these guidelines are not considered legally binding; the legal duties of healthcare professionals are defined by prevailing laws and regulations, and adherence to these guidelines does not modify such responsibilities. The European Association for Cardio-Thoracic Surgery (EACTS), the European Association of Cardiothoracic Anaesthesiology and Intensive Care (EACTAIC) and the European Board of Cardiovascular Perfusion (EBCP) constituted a task force of professionals specializing in cardiopulmonary bypass (CPB) management. To ensure transparency and integrity, all task force members involved in the development and review of these guidelines submitted conflict of interest declarations, which were compiled into a single document available on the EACTS website (https://www.eacts.org/resources/clinical-guidelines). Any alterations to these declarations during the development process were promptly reported to the EACTS, EACTAIC and EBCP. Funding for this task force was provided exclusively by the EACTS, EACTAIC and EBCP, without involvement from the healthcare industry or other entities. Following this collaborative endeavour, the governing bodies of EACTS, EACTAIC and EBCP oversaw the formulation, refinement, and endorsement of these extensively revised guidelines. An external panel of experts thoroughly reviewed the initial draft, and their input guided subsequent amendments. After this detailed revision process, the final document was ratified by all task force experts and the leadership of the EACTS, EACTAIC and EBCP, enabling its publication in the European Journal of Cardio-Thoracic Surgery, the British Journal of Anaesthesia and Interdisciplinary CardioVascular and Thoracic Surgery. Endorsed by the EACTS, EACTAIC and EBCP, these guidelines represent the official standpoint on this subject. They demonstrate a dedication to continual enhancement, with routine updates planned to ensure that the guidelines remain current and valuable in the ever-progressing arena of clinical practice.
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Affiliation(s)
- Alexander Wahba
- Department of Cardio-Thoracic Surgery, St. Olavs University Hospital, Trondheim, Norway; Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, NTNU, Trondheim, Norway.
| | - Gudrun Kunst
- Department of Anaesthetics and Pain Therapy King's College Hospital NHS Foundation Trust, London, United Kingdom; School of Cardiovascular and Metabolic Medicine & Sciences, King's College London British Heart Foundation Centre of Excellence, London, United Kingdom.
| | | | - Henrik Agerup Kildahl
- Department of Cardio-Thoracic Surgery, St. Olavs University Hospital, Trondheim, Norway; Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, NTNU, Trondheim, Norway
| | - Benjamin Milne
- Department of Anaesthesia, Guy's & St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Gunilla Kjellberg
- Department of Thoracic Surgery and Anaesthesiology, Uppsala University Hospital, Uppsala, Sweden
| | - Adrian Bauer
- Department of Perfusiology, Evangelic Heart Center, Coswig, Germany
| | - Friedhelm Beyersdorf
- Department of Cardiovascular Surgery, University Hospital Freiburg, Germany; Medical Faculty of the Albert-Ludwigs-University Freiburg, Germany
| | - Hanne Berg Ravn
- Department of Anaesthesia, Odense University Hospital and Institute of Clinical Medicine, Southern Denmark University, Denmark
| | | | - Gabor Erdoes
- University Department of Anesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Renard Gerhardus Haumann
- Department of Cardio-Thoracic Surgery, Thoraxcentrum Twente, Medisch Spectrum Twente, Enschede, The Netherlands; Department of Biomechanical Engineering, TechMed Centre, University of Twente, Enschede, The Netherlands
| | - Tomas Gudbjartsson
- Department of Cardiothoracic Surgery, Landspitali University Hospital, Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| | - Frank Merkle
- Foundation Deutsches Herzzentrum Berlin, Berlin, Germany
| | - Davide Pacini
- Division of Cardiac Surgery, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Italy; University of Bologna, Bologna, Italy
| | - Gianluca Paternoster
- Cardiovascular Anesthesia and Intensive Care San Carlo Hospital, Potenza, Italy; Department of Health Science Anesthesia and ICU School of Medicine, University of Basilicata San Carlo Hospital, Potenza, Italy
| | - Francesco Onorati
- Division of Cardiac Surgery, University of Verona Medical School, Verona, Italy
| | - Marco Ranucci
- Department of Cardiovascular Anesthesia and ICU, IRCCS Policlinico San Donato, Milan, Italy
| | - Nemanja Ristic
- Department of Cardiac Surgery, Dedinje Cardiovascular Institute, Belgrade, Serbia
| | - Marc Vives
- Department of Anesthesia & Critical Care, Clínica Universidad de Navarra, Pamplona, Spain; Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain
| | - Milan Milojevic
- Department of Cardiac Surgery and Cardiovascular Research, Dedinje Cardiovascular Institute, Belgrade, Serbia
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Wahba A, Kunst G, De Somer F, Agerup Kildahl H, Milne B, Kjellberg G, Bauer A, Beyersdorf F, Berg Ravn H, Debeuckelaere G, Erdoes G, Haumann RG, Gudbjartsson T, Merkle F, Pacini D, Paternoster G, Onorati F, Ranucci M, Ristic N, Vives M, Milojevic M. 2024 EACTS/EACTAIC/EBCP Guidelines on cardiopulmonary bypass in adult cardiac surgery. INTERDISCIPLINARY CARDIOVASCULAR AND THORACIC SURGERY 2025; 40:ivaf002. [PMID: 39949317 PMCID: PMC11826094 DOI: 10.1093/icvts/ivaf002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Grants] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/25/2024] [Revised: 07/01/2024] [Indexed: 02/17/2025]
Affiliation(s)
- Alexander Wahba
- Department of Cardio-Thoracic Surgery, St. Olavs University Hospital, Trondheim, Norway
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, NTNU, Trondheim, Norway
| | - Gudrun Kunst
- Department of Anaesthetics and Pain Therapy King’s College Hospital NHS Foundation Trust, London, United Kingdom
- School of Cardiovascular and Metabolic Medicine & Sciences, King’s College London British Heart Foundation Centre of Excellence, London, United Kingdom
| | | | - Henrik Agerup Kildahl
- Department of Cardio-Thoracic Surgery, St. Olavs University Hospital, Trondheim, Norway
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, NTNU, Trondheim, Norway
| | - Benjamin Milne
- Department of Anaesthesia, Guy’s & St Thomas’ NHS Foundation Trust, London, United Kingdom
| | - Gunilla Kjellberg
- Department of Thoracic Surgery and Anaesthesiology, Uppsala University Hospital, Uppsala, Sweden
| | - Adrian Bauer
- Department of Perfusiology, Evangelic Heart Center, Coswig, Germany
| | - Friedhelm Beyersdorf
- Department of Cardiovascular Surgery, University Hospital Freiburg, Germany
- Medical Faculty of the Albert-Ludwigs-University Freiburg, Germany
| | - Hanne Berg Ravn
- Department of Anaesthesia, Odense University Hospital and Institute of Clinical Medicine, Southern Denmark University, Denmark
| | | | - Gabor Erdoes
- University Department of Anesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Renard Gerhardus Haumann
- Department of Cardio-Thoracic surgery, Thoraxcentrum Twente, Medisch Spectrum Twente, Enschede, The Netherlands
- Department Of Biomechanical Engineering, TechMed Centre, University of Twente, Enschede, The Netherlands
| | - Tomas Gudbjartsson
- Department of Cardiothoracic Surgery, Landspitali University Hospital, Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| | - Frank Merkle
- Foundation Deutsches Herzzentrum Berlin, Berlin, Germany
| | - Davide Pacini
- Division of Cardiac Surgery, IRCCS Azienda Ospedaliero-Universitaria di Bologna
- University of Bologna, Bologna, Italy
| | - Gianluca Paternoster
- Cardiovascular Anesthesia and Intensive Care San Carlo Hospital, Potenza, Italy
- Department of Health Science Anesthesia and ICU School of Medicine, University of Basilicata San Carlo Hospital, Potenza, Italy
| | - Francesco Onorati
- Division of Cardiac Surgery, University of Verona Medical School, Verona, Italy
| | - Marco Ranucci
- Department of Cardiovascular Anesthesia and ICU, IRCCS Policlinico San Donato, Milan, Italy
| | - Nemanja Ristic
- Department of Cardiac Surgery, Dedinje Cardiovascular Institute, Belgrade, Serbia
| | - Marc Vives
- Department of Anesthesia & Critical Care, Clínica Universidad de Navarra, Pamplona, Spain
- Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain
| | - Milan Milojevic
- Department of Cardiac Surgery and Cardiovascular Research, Dedinje Cardiovascular Institute, Belgrade, Serbia
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Wahba A, Kunst G, De Somer F, Agerup Kildahl H, Milne B, Kjellberg G, Bauer A, Beyersdorf F, Berg Ravn H, Debeuckelaere G, Erdoes G, Haumann RG, Gudbjartsson T, Merkle F, Pacini D, Paternoster G, Onorati F, Ranucci M, Ristic N, Vives M, Milojevic M. 2024 EACTS/EACTAIC/EBCP Guidelines on cardiopulmonary bypass in adult cardiac surgery. Eur J Cardiothorac Surg 2025; 67:ezae354. [PMID: 39949326 PMCID: PMC11826095 DOI: 10.1093/ejcts/ezae354] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2024] [Revised: 07/01/2024] [Indexed: 02/17/2025] Open
Affiliation(s)
- Alexander Wahba
- Department of Cardio-Thoracic Surgery, St. Olavs University Hospital, Trondheim, Norway
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, NTNU, Trondheim, Norway
| | - Gudrun Kunst
- Department of Anaesthetics and Pain Therapy King’s College Hospital NHS Foundation Trust, London, United Kingdom
- School of Cardiovascular and Metabolic Medicine & Sciences, King’s College London British Heart Foundation Centre of Excellence, London, United Kingdom
| | | | - Henrik Agerup Kildahl
- Department of Cardio-Thoracic Surgery, St. Olavs University Hospital, Trondheim, Norway
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, NTNU, Trondheim, Norway
| | - Benjamin Milne
- Department of Anaesthesia, Guy’s & St Thomas’ NHS Foundation Trust, London, United Kingdom
| | - Gunilla Kjellberg
- Department of Thoracic Surgery and Anaesthesiology, Uppsala University Hospital, Uppsala, Sweden
| | - Adrian Bauer
- Department of Perfusiology, Evangelic Heart Center, Coswig, Germany
| | - Friedhelm Beyersdorf
- Department of Cardiovascular Surgery, University Hospital Freiburg, Germany
- Medical Faculty of the Albert-Ludwigs-University Freiburg, Germany
| | - Hanne Berg Ravn
- Department of Anaesthesia, Odense University Hospital and Institute of Clinical Medicine, Southern Denmark University, Denmark
| | | | - Gabor Erdoes
- University Department of Anesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Renard Gerhardus Haumann
- Department of Cardio-Thoracic surgery, Thoraxcentrum Twente, Medisch Spectrum Twente, Enschede, The Netherlands
- Department Of Biomechanical Engineering, TechMed Centre, University of Twente, Enschede, The Netherlands
| | - Tomas Gudbjartsson
- Department of Cardiothoracic Surgery, Landspitali University Hospital, Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| | - Frank Merkle
- Foundation Deutsches Herzzentrum Berlin, Berlin, Germany
| | - Davide Pacini
- Division of Cardiac Surgery, IRCCS Azienda Ospedaliero-Universitaria di Bologna
- University of Bologna, Bologna, Italy
| | - Gianluca Paternoster
- Cardiovascular Anesthesia and Intensive Care San Carlo Hospital, Potenza, Italy
- Department of Health Science Anesthesia and ICU School of Medicine, University of Basilicata San Carlo Hospital, Potenza, Italy
| | - Francesco Onorati
- Division of Cardiac Surgery, University of Verona Medical School, Verona, Italy
| | - Marco Ranucci
- Department of Cardiovascular Anesthesia and ICU, IRCCS Policlinico San Donato, Milan, Italy
| | - Nemanja Ristic
- Department of Cardiac Surgery, Dedinje Cardiovascular Institute, Belgrade, Serbia
| | - Marc Vives
- Department of Anesthesia & Critical Care, Clínica Universidad de Navarra, Pamplona, Spain
- Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain
| | - Milan Milojevic
- Department of Cardiac Surgery and Cardiovascular Research, Dedinje Cardiovascular Institute, Belgrade, Serbia
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Schrank SD, Gozum DZ, Martin EM, Snyder GM. Identifying healthcare transmission routes of nontuberculous mycobacteria with whole genome sequencing: a systematic review. Infect Control Hosp Epidemiol 2025; 46:1-6. [PMID: 39895079 PMCID: PMC12015626 DOI: 10.1017/ice.2025.6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2024] [Revised: 12/24/2024] [Accepted: 12/31/2024] [Indexed: 02/04/2025]
Abstract
OBJECTIVE To enumerate and describe the effect of whole genome sequencing (WGS) on epidemiological investigations of healthcare-associated transmission of nontuberculous mycobacteria (NTM). DESIGN Systematic review. METHODS We performed a literature search using targeted search terms to identify articles meeting inclusion criteria. Data extraction of study characteristics and outcomes was performed by two independent researchers. The primary outcome was the author interpretation of WGS utility in the investigation of suspected healthcare-associated transmission of NTM. The secondary outcome was whether a transmission route was identified through WGS. RESULTS Thirty-one studies were included in the final analysis with 28 (90%) concluding that WGS was helpful in transmission investigations and in 19 of these 28 (68%) WGS aided in identifying a transmission route. The most common identified transmission routes were water-borne point sources (10), heater-cooler units (6), patient-to-patient (4), and a healthcare worker (1). CONCLUSION WGS is an informative tool in investigating healthcare transmission of NTM.
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Affiliation(s)
- Spencer D. Schrank
- Division of Infectious Diseases, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
- Department of Infection Prevention and Control, UPMC Presbyterian/Shadyside, Pittsburgh, PA, USA
| | - Dale Z. Gozum
- Department of Medicine, UPMC Lititz, Lititz, PA, USA
| | - Elise M. Martin
- Division of Infectious Diseases, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
- Veterans’ Affairs Pittsburgh Healthcare System, Pittsburgh, PA, USA
| | - Graham M. Snyder
- Division of Infectious Diseases, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
- Department of Infection Prevention and Control, UPMC Presbyterian/Shadyside, Pittsburgh, PA, USA
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Cannas A, Messina F, Dal Monte P, Bisognin F, Dirani G, Zannoli S, Gatti G, Butera O, Ferraro V, Nisii C, Vecchi E, Mattei G, Diegoli G, Santoro A, Belloli GL, Girardi E, Lazzarotto T, Sambri V, Fontana C. Sanitary Waters: Is It Worth Looking for Mycobacteria? Microorganisms 2024; 12:1953. [PMID: 39458263 PMCID: PMC11509539 DOI: 10.3390/microorganisms12101953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2024] [Revised: 09/20/2024] [Accepted: 09/24/2024] [Indexed: 10/28/2024] Open
Abstract
The freshwater environment is suitable for nontuberculous mycobacteria (NTMs) growth. Their high adaptability represents a considerable risk for sanitary water systems, which are a potential vector for NTMs transmission. This study investigated the occurrence of NTMs, such as Mycobacterium saskatchewanense, in hospital water systems to support the surveillance and control of potentially pathogenic NTMs. We analyzed 722 ultrapure dialysis fluid samples from Emilia Romagna Dialysis Services. Among these, 35 samples were found to be positive for M. saskatchewanense. The strains were characterized using whole-genome sequencing (WGS) and variability analysis was carried out along the whole M. saskatchewanense genome. This investigation revealed the exclusive presence of M. saskatchewanense in these dialysis machines, with low genetic variability among all strains (with a low number of different alleles: <15). The strong similarity among the strain groups was also confirmed in the WGS-based ML tree, with very few significant nodes, and no clusters were identified. This research highlights the necessity of implementing surveillance protocols and investigating any potential link to human infections, as well as stressing the urgency of enhancing surveillance and infection control measures.
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Affiliation(s)
- Angela Cannas
- National Institute for Infectious Diseases “Lazzaro Spallanzani” IRCCS, 00149 Rome, Italy; (A.C.); (F.M.); (O.B.); (E.G.); (C.F.)
| | - Francesco Messina
- National Institute for Infectious Diseases “Lazzaro Spallanzani” IRCCS, 00149 Rome, Italy; (A.C.); (F.M.); (O.B.); (E.G.); (C.F.)
| | - Paola Dal Monte
- Microbiology Unit, IRCCS Azienda Ospedaliero Universitaria di Bologna, 40138 Bologna, Italy; (F.B.); (V.F.); (T.L.)
- Department of Surgical & Medical Sciences-DIMEC, Alma Mater Studiorum-University of Bologna, 40138 Bologna, Italy; (G.G.); (A.S.); (V.S.)
| | - Francesco Bisognin
- Microbiology Unit, IRCCS Azienda Ospedaliero Universitaria di Bologna, 40138 Bologna, Italy; (F.B.); (V.F.); (T.L.)
| | - Giorgio Dirani
- Operative Unit of Microbiology, The Great Romagna Hub Laboratory, 47522 Pievesestina, Italy; (G.D.); (S.Z.)
| | - Silvia Zannoli
- Operative Unit of Microbiology, The Great Romagna Hub Laboratory, 47522 Pievesestina, Italy; (G.D.); (S.Z.)
| | - Giulia Gatti
- Department of Surgical & Medical Sciences-DIMEC, Alma Mater Studiorum-University of Bologna, 40138 Bologna, Italy; (G.G.); (A.S.); (V.S.)
| | - Ornella Butera
- National Institute for Infectious Diseases “Lazzaro Spallanzani” IRCCS, 00149 Rome, Italy; (A.C.); (F.M.); (O.B.); (E.G.); (C.F.)
| | - Vincenzo Ferraro
- Microbiology Unit, IRCCS Azienda Ospedaliero Universitaria di Bologna, 40138 Bologna, Italy; (F.B.); (V.F.); (T.L.)
| | - Carla Nisii
- National Institute for Infectious Diseases “Lazzaro Spallanzani” IRCCS, 00149 Rome, Italy; (A.C.); (F.M.); (O.B.); (E.G.); (C.F.)
| | - Elena Vecchi
- Collective Prevention and Public Health Sector, Directorate General for Personal Care, Health and Welfare, 40100 Bologna, Italy; (E.V.); (G.M.); (G.D.); (G.L.B.)
| | - Giovanna Mattei
- Collective Prevention and Public Health Sector, Directorate General for Personal Care, Health and Welfare, 40100 Bologna, Italy; (E.V.); (G.M.); (G.D.); (G.L.B.)
| | - Giuseppe Diegoli
- Collective Prevention and Public Health Sector, Directorate General for Personal Care, Health and Welfare, 40100 Bologna, Italy; (E.V.); (G.M.); (G.D.); (G.L.B.)
| | - Antonio Santoro
- Department of Surgical & Medical Sciences-DIMEC, Alma Mater Studiorum-University of Bologna, 40138 Bologna, Italy; (G.G.); (A.S.); (V.S.)
| | - Gian Luigi Belloli
- Collective Prevention and Public Health Sector, Directorate General for Personal Care, Health and Welfare, 40100 Bologna, Italy; (E.V.); (G.M.); (G.D.); (G.L.B.)
| | - Enrico Girardi
- National Institute for Infectious Diseases “Lazzaro Spallanzani” IRCCS, 00149 Rome, Italy; (A.C.); (F.M.); (O.B.); (E.G.); (C.F.)
| | - Tiziana Lazzarotto
- Microbiology Unit, IRCCS Azienda Ospedaliero Universitaria di Bologna, 40138 Bologna, Italy; (F.B.); (V.F.); (T.L.)
- Department of Surgical & Medical Sciences-DIMEC, Alma Mater Studiorum-University of Bologna, 40138 Bologna, Italy; (G.G.); (A.S.); (V.S.)
| | - Vittorio Sambri
- Department of Surgical & Medical Sciences-DIMEC, Alma Mater Studiorum-University of Bologna, 40138 Bologna, Italy; (G.G.); (A.S.); (V.S.)
- Operative Unit of Microbiology, The Great Romagna Hub Laboratory, 47522 Pievesestina, Italy; (G.D.); (S.Z.)
| | - Carla Fontana
- National Institute for Infectious Diseases “Lazzaro Spallanzani” IRCCS, 00149 Rome, Italy; (A.C.); (F.M.); (O.B.); (E.G.); (C.F.)
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Bolcato V, Bassetti M, Basile G, Bianco Prevot L, Speziale G, Tremoli E, Maffessanti F, Tronconi LP. The State-of-the-Art of Mycobacterium chimaera Infections and the Causal Link with Health Settings: A Systematic Review. Healthcare (Basel) 2024; 12:1788. [PMID: 39273812 PMCID: PMC11395465 DOI: 10.3390/healthcare12171788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2024] [Revised: 08/28/2024] [Accepted: 08/29/2024] [Indexed: 09/15/2024] Open
Abstract
(1) Background. A definition of healthcare-associated infections is essential also for the attribution of the restorative burden to healthcare facilities in case of harm and for clinical risk management strategies. Regarding M. chimaera infections, there remains several issues on the ecosystem and pathogenesis. We aim to review the scientific evidence on M. chimaera beyond cardiac surgery, and thus discuss its relationship with healthcare facilities. (2) Methods. A systematic review was conducted on PubMed and Web of Science on 7 May 2024 according to PRISMA 2020 guidelines for reporting systematic reviews, including databases searches with the keyword "Mycobacterium chimaera". Article screening was conducted by tree authors independently. The criterion for inclusion was cases that were not, or were improperly, consistent with the in-situ deposition of aerosolised M. chimaera. (3) Results. The search yielded 290 eligible articles. After screening, 34 articles (377 patients) were included. In five articles, patients had undergone cardiac surgery and showed musculoskeletal involvement or disseminated infection without cardiac manifestations. In 11 articles, respiratory specimen reanalyses showed M. chimaera. Moreover, 10 articles reported lung involvement, 1 reported meninges involvement, 1 reported skin involvement, 1 reported kidney involvement after transplantation, 1 reported tendon involvement, and 1 reported the involvement of a central venous catheter; 3 articles reported disseminated cases with one concomitant spinal osteomyelitis. (4) Conclusions. The scarce data on environmental prevalence, the recent studies on M. chimaera ecology, and the medicalised sample selection bias, as well as the infrequent use of robust ascertainment of sub-species, need to be weighed up. The in-house aerosolization, inhalation, and haematogenous spread deserve experimental study, as M. chimaera cardiac localisation could depend to transient bacteraemia. Each case deserves specific ascertainment before tracing back to the facility, even if M. chimaera represents a core area for healthcare facilities within a framework of infection prevention and control policies.
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Affiliation(s)
| | - Matteo Bassetti
- Department of Health Sciences (DISSAL), University of Genova, 16132 Genova, Italy
- Infectious Diseases Unit, IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy
| | - Giuseppe Basile
- IRCCS Orthopaedic Institute Galeazzi, 20157 Milan, Italy
- Section of Legal and Forensic Medicine Clinical Institute San Siro, 20148 Milan, Italy
| | - Luca Bianco Prevot
- IRCCS Orthopaedic Institute Galeazzi, 20157 Milan, Italy
- Residency Program in Orthopaedics and Traumatology, University of Milan, 20122 Milan, Italy
| | | | - Elena Tremoli
- GVM Care and Research, Maria Cecilia Hospital, 49033 Cotignola, Italy
| | | | - Livio Pietro Tronconi
- GVM Care and Research, Maria Cecilia Hospital, 49033 Cotignola, Italy
- Department of Human Science, European University of Rome, 00163 Rome, Italy
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Liu X, Hu J, Wang W, Yang H, Tao E, Ma Y, Sha S. Mycobacterial Biofilm: Mechanisms, Clinical Problems, and Treatments. Int J Mol Sci 2024; 25:7771. [PMID: 39063012 PMCID: PMC11277187 DOI: 10.3390/ijms25147771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2024] [Revised: 07/12/2024] [Accepted: 07/13/2024] [Indexed: 07/28/2024] Open
Abstract
Tuberculosis (TB) remains a threat to human health worldwide. Mycobacterium tuberculosis (Mtb) and other nontuberculous mycobacteria (NTM) can form biofilms, and in vitro and animal experiments have shown that biofilms cause serious drug resistance and mycobacterial persistence. Deeper investigations into the mechanisms of mycobacterial biofilm formation and, consequently, the exploration of appropriate antibiofilm treatments to improve the efficiency of current anti-TB drugs will be useful for curing TB. In this review, the genes and molecules that have been recently reported to be involved in mycobacterial biofilm development, such as ABC transporter, Pks1, PpiB, GroEL1, MprB, (p)ppGpp, poly(P), and c-di-GMP, are summarized. Biofilm-induced clinical problems, including biofilm-related infections and enhanced virulence, as well as their possible mechanisms, are also discussed in detail. Moreover, we also illustrate newly synthesized anti-TB agents that target mycobacterial biofilm, as well as some assistant methods with high efficiency in reducing biofilms in hosts, such as the use of nanoparticles.
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Affiliation(s)
- Xining Liu
- Department of Biochemistry and Molecular Biology, Dalian Medical University, Dalian 116044, China; (X.L.); (J.H.); (W.W.); (E.T.)
| | - Junxing Hu
- Department of Biochemistry and Molecular Biology, Dalian Medical University, Dalian 116044, China; (X.L.); (J.H.); (W.W.); (E.T.)
| | - Wenzhen Wang
- Department of Biochemistry and Molecular Biology, Dalian Medical University, Dalian 116044, China; (X.L.); (J.H.); (W.W.); (E.T.)
| | - Hanyu Yang
- The Queen’s University of Belfast Joint College, China Medical University, Shenyang 110122, China;
| | - Erning Tao
- Department of Biochemistry and Molecular Biology, Dalian Medical University, Dalian 116044, China; (X.L.); (J.H.); (W.W.); (E.T.)
| | - Yufang Ma
- Department of Biochemistry and Molecular Biology, Dalian Medical University, Dalian 116044, China; (X.L.); (J.H.); (W.W.); (E.T.)
| | - Shanshan Sha
- Department of Biochemistry and Molecular Biology, Dalian Medical University, Dalian 116044, China; (X.L.); (J.H.); (W.W.); (E.T.)
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9
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Chien YC, Chang CH, Huang CK, Chen YH, Liu CJ, Chen CY, Wang PH, Shu CC, Kuo LC, Wang JY, Ku SC, Wang HC, Yu CJ. The impact of nontuberculous mycobacterial lung disease in critically ill patients: Significance for survival and ventilator use. JOURNAL OF MICROBIOLOGY, IMMUNOLOGY, AND INFECTION = WEI MIAN YU GAN RAN ZA ZHI 2024; 57:328-336. [PMID: 38220536 DOI: 10.1016/j.jmii.2023.12.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 12/16/2023] [Accepted: 12/28/2023] [Indexed: 01/16/2024]
Abstract
BACKGROUND This study investigates the impact of nontuberculous mycobacterial lung disease (NTM-LD) on mortality and mechanical ventilation use in critically ill patients. METHODS We enrolled patients with NTM-LD or tuberculosis (TB) in intensive care units (ICU) and analysed their association with 30-day mortality and with mechanical ventilator-free survival (VFS) at 30 days after ICU admission. RESULTS A total of 5996 ICU-admitted patients were included, of which 541 (9.0 %) had TB and 173 (2.9 %) had NTM-LD. The overall 30-day mortality was 22.2 %. The patients with NTM-LD had an adjusted hazard ratio (aHR) of 1.49 (95 % CI, 1.06-2.05), and TB patients had an aHR of 2.33 (95 % CI, 1.68-3.24), compared to ICU patients with negative sputum mycobacterial culture by multivariable Cox proportional hazard (PH) regression. The aHR of age<65 years, obesity, idiopathic pulmonary fibrosis, end-stage kidney disease, active cancer and autoimmune disease and diagnosis of respiratory failure were also significantly positively associated with ICU 30-day mortality. In multivariable Cox PH regression for VFS at 30 days in patients requiring invasive mechanical ventilation, NTM-LD was negatively associated with VFS (aHR 0.71, 95 % CI: 0.56-0.92, p = 0.009), while TB showed no significant association. The diagnosis of respiratory failure itself predicted unfavourable outcome for 30-day mortality and a negative impact on VFS at 30 days. CONCLUSIONS NTM-LD and TB were not uncommon in ICU and both were correlated with increasing 30-day mortality in ICU patients. NTM-LD was associated with a poorer outcome in terms of VFS at 30 days.
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Affiliation(s)
- Ying-Chun Chien
- Department of Internal Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan; Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Chin-Hao Chang
- Department of Medical Research, National Taiwan University Hospital, Taipei, Taiwan
| | - Chun-Kai Huang
- Department of Internal Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Yung-Hsuan Chen
- Department of Internal Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Chia-Jung Liu
- Department of Internal Medicine, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu, Taiwan
| | - Chung-Yu Chen
- Department of Internal Medicine, National Taiwan University, Hospital Yun-Lin Branch, Douliu City, Taiwan
| | - Ping-Huai Wang
- Department of Internal Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Chin-Chung Shu
- Department of Internal Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan.
| | - Lu-Cheng Kuo
- Department of Internal Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Jann-Yuan Wang
- Department of Internal Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Shih-Chi Ku
- Department of Internal Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Hao-Chien Wang
- Department of Internal Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan; Department of Medicine, National Taiwan University Cancer Center, Taipei, Taiwan
| | - Chong-Jen Yu
- Department of Internal Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan; Department of Internal Medicine, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu, Taiwan
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10
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Bilodeau KS, Charette K, McMullan DM. Safety and Efficacy of Extracorporeal Membrane Oxygenation Heating Units. World J Pediatr Congenit Heart Surg 2024; 15:30-35. [PMID: 37915224 PMCID: PMC11556897 DOI: 10.1177/21501351231185114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2023]
Abstract
BACKGROUND Patient temperature during extracorporeal membrane oxygenation (ECMO) is commonly managed by dedicated heating units (HUs) that are integrated into ECMO circuitry. Currently, no HU has received approval for ECMO by the FDA in the United States. Older FDA-approved HUs have been implicated in life-threatening patient infections and are no longer manufactured or available for use in the United States. METHODS We performed laboratory tests to evaluate the safety and efficacy of the Micro-Temp and the HTP-1500 HU systems that are potentially suitable for use in ECMO and describe our initial experience with the HTP-1500 HU after being placed in clinical service. RESULTS Both units demonstrated similar heating efficacy, with the HTP-1500 achieving steady-state temperature approximately 5 h earlier than the Micro-Temp. Microorganisms were detected in the water compartment of all HUs prior to and after performing the manufacturer's recommended cleaning procedure, and after implementation of the HTP-1500 into clinical use we observed a decrease in the rate of bloodstream infection/ECMO days which did not reach statistical significance. CONCLUSION Based on the results of this analysis and our institutional experience, we believe that integration of the HTP-1500 HU, an easily replaceable HU, into ECMO systems may reduce the risk of bacterial contamination and thus nosocomial infection when the devices are cleaned and maintained according to manufacturer's guidelines.
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Affiliation(s)
- Kyle S. Bilodeau
- Division of Cardiac Surgery, Seattle Children’s Hospital, Seattle, WA, USA
| | - Kevin Charette
- Division of Perfusion, Seattle Children’s Hospital, Seattle, WA, USA
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11
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Honda JR. Environmental Sources and Transmission of Nontuberculous Mycobacteria. Clin Chest Med 2023; 44:661-674. [PMID: 37890909 DOI: 10.1016/j.ccm.2023.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/29/2023]
Abstract
The field of environmental nontuberculous mycobacteria (NTM) is benefiting from a new era of genomics that has catapulted our understanding of preferred niches, transmission, and outbreak investigations. The ability to forecast environmental features that promote or reduce environmental NTM prevalence will greatly improve with coordinated environmental sampling and by elevating the necessity for uniform disease notifications. Studies that synergize environmental biology, isolate notifications, and comparative genomics in prospective, longitudinal studies, particularly during climate changes and weather events, will be useful to solve longstanding NTM public health quandaries.
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Affiliation(s)
- Jennifer R Honda
- Department of Cellular and Molecular Biology, University of Texas Health Science Center at Tyler, 11937 US Hwy 271, BMR Building, Tyler, TX 75708, USA.
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12
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Cannas A, Campanale A, Minella D, Messina F, Butera O, Nisii C, Mazzarelli A, Fontana C, Lispi L, Maraglino F, Di Caro A, Sabbatucci M. Epidemiological and Molecular Investigation of the Heater-Cooler Unit (HCU)-Related Outbreak of Invasive Mycobacterium chimaera Infection Occurred in Italy. Microorganisms 2023; 11:2251. [PMID: 37764096 PMCID: PMC10536513 DOI: 10.3390/microorganisms11092251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 09/04/2023] [Accepted: 09/05/2023] [Indexed: 09/29/2023] Open
Abstract
BACKGROUND From 2013 onwards, a large outbreak of Mycobacterium chimaera (MC) invasive infection, which was correlated with the use of contaminated heater-cooler units (HCUs) during open chest surgery, was reported from all over the world. Here, we report the results of the epidemiological and molecular investigations conducted in Italy after the alarm raised about this epidemic event. METHODS MC strains isolated from patients or from HCU devices were characterized by genomic sequencing and molecular epidemiological analysis. RESULTS Through retrospective epidemiological analysis conducted between January 2010 and December 2022, 40 possible cases of patients infected with MC were identified. Thirty-six strains isolated from these patients were analysed by whole genome sequencing (WGS) and were found to belong to the genotypes 1.1 or 1.8, which are the genotypes correlated with the outbreak. Most of the cases presented with prosthetic valve endocarditis, vascular graft infection or disseminated infection. Among the cases found, there were 21 deaths. The same analysis was carried out on HCU devices. A total of 251 HCUs were found to be contaminated by MC; genotypes 1.1 or 1.8 were identified in 28 of those HCUs. CONCLUSIONS To ensure patients' safety and adequate follow-up, clinicians and general practitioners were made aware of the results and public health measures, and recommendations were issued to prevent further cases in the healthcare settings. The Italian Society of Cardiac Surgery performed a national survey to assess the incidence of HCU-related MC prosthetic infections in cardiac surgery. No cases were reported after HCU replacement or structural modification and disinfection and possibly safe allocation outside surgical rooms.
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Affiliation(s)
- Angela Cannas
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, 00149 Rome, Italy; (A.C.); (F.M.); (O.B.); (A.M.); (C.F.)
| | - Antonella Campanale
- Unit 5, Directorate General of Medical Devices and Pharmaceutical Service, Ministry of Health, 00144 Rome, Italy; (A.C.); (D.M.); (L.L.)
| | - Daniela Minella
- Unit 5, Directorate General of Medical Devices and Pharmaceutical Service, Ministry of Health, 00144 Rome, Italy; (A.C.); (D.M.); (L.L.)
| | - Francesco Messina
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, 00149 Rome, Italy; (A.C.); (F.M.); (O.B.); (A.M.); (C.F.)
| | - Ornella Butera
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, 00149 Rome, Italy; (A.C.); (F.M.); (O.B.); (A.M.); (C.F.)
| | - Carla Nisii
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, 00149 Rome, Italy; (A.C.); (F.M.); (O.B.); (A.M.); (C.F.)
| | - Antonio Mazzarelli
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, 00149 Rome, Italy; (A.C.); (F.M.); (O.B.); (A.M.); (C.F.)
| | - Carla Fontana
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, 00149 Rome, Italy; (A.C.); (F.M.); (O.B.); (A.M.); (C.F.)
| | - Lucia Lispi
- Unit 5, Directorate General of Medical Devices and Pharmaceutical Service, Ministry of Health, 00144 Rome, Italy; (A.C.); (D.M.); (L.L.)
| | - Francesco Maraglino
- Unit 5, Directorate General Health Prevention Communicable Diseases and International Prophylaxis, Ministry of Health, 00144 Rome, Italy; (F.M.); (M.S.)
| | - Antonino Di Caro
- Department of Microbiology, Unicamillus International University of Medicine, 00131 Rome, Italy;
| | - Michela Sabbatucci
- Unit 5, Directorate General Health Prevention Communicable Diseases and International Prophylaxis, Ministry of Health, 00144 Rome, Italy; (F.M.); (M.S.)
- Department Infectious Diseases, Istituto Superiore di Sanità, 00161 Rome, Italy
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Field E, Strathearn M, Boyd-Skinner C, Dyda A. Usefulness of linked data for infectious disease events: a systematic review. Epidemiol Infect 2023; 151:e46. [PMID: 36843485 PMCID: PMC10052405 DOI: 10.1017/s0950268823000316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 01/20/2023] [Accepted: 02/10/2023] [Indexed: 02/28/2023] Open
Abstract
Surveillance is a key public health function to enable early detection of infectious disease events and inform public health action. Data linkage may improve the depth of data for response to infectious disease events. This study aimed to describe the uses of linked data for infectious disease events. A systematic review was conducted using Pubmed, CINAHL and Web of Science. Studies were included if they used data linkage for an acute infectious disease event (e.g. outbreak of disease). We summarised the event, study aims and designs; data sets; linkage methods; outcomes reported; and benefits and limitations. Fifty-four studies were included. Uses of linkage for infectious disease events included assessment of severity of disease and risk factors; improved case finding and contact tracing; and vaccine uptake, safety and effectiveness. The ability to conduct larger scale population level studies was identified as a benefit, in particular for rarer exposures, risk factors or outcomes. Limitations included timeliness, data quality and inability to collect additional variables. This review demonstrated multiple uses of data linkage for infectious disease events. As infectious disease events occur without warning, there is a need to establish pre-approved protocols and the infrastructure for data-linkage to enhance information available during an event.
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Affiliation(s)
- Emma Field
- National Centre for Epidemiology and Population Health, Australian National University, Canberra, Australia
- Menzies School of Health Research, Charles Darwin University, Darwin, Australia
| | - Melanie Strathearn
- School of Population Health, University of Queensland, Brisbane, Australia
| | | | - Amalie Dyda
- School of Population Health, University of Queensland, Brisbane, Australia
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14
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Schreiber PW, Zihlmann R, Schärer V, Hasse B, Imkamp F, Schulthess B, Sander P, Zingg W. Longitudinal increase in the detection rate of Mycobacterium chimaera in heater-cooler device-derived water samples. J Hosp Infect 2023; 131:190-193. [PMID: 36410531 DOI: 10.1016/j.jhin.2022.11.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 10/26/2022] [Accepted: 11/04/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND Colonization with Mycobacterium chimaera and other non-tuberculous mycobacteria (NTM) has been reported for heater-cooler devices (HCDs) produced by several manufacturers. Up until now, exclusively LivaNova (London, UK) HCDs have been associated with M. chimaera infections after cardiac surgery. The vast majority of studies on HCD colonization were cross-sectional. AIM We were interested in longitudinal dynamics of mycobacterial growth in HCD water samples and analysed data of a prospective mycobacterial surveillance of five LivaNova 3T HCDs. METHODS Five LivaNova HCDs were subjected to prospective mycobacterial surveillance. For each HCD and the total of HCDs, results of mycobacterial detection were analyzed. Logistic regression was applied to model the association between growth of any NTM or M. chimaera and duration of HCD use. RESULTS Non-tuberculous mycobacteria were isolated in 319 (48.0%, 21 water samples grew more than one mycobacterial species) of a total of 665 water samples. The most frequently detected species were M. chimaera (N = 247/319, 77.4%), Mycobacterium gordonae (46/319, 14.4%) and Mycobacterium paragordonae (34/319, 10.7%). Detection rates increased prospectively for any NTM (odds ratio (OR) per year in use: 1.60, 95% confidence interval (CI) 1.17-2.24, P<0.001) and for M. chimaera (OR per year in use: 1.67, 95% CI 1.11-2.57, P<0.01). CONCLUSION Longer duration of HCD use was associated with higher detection rates for any NTM and M. chimaera, respectively.
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Affiliation(s)
- P W Schreiber
- University Hospital Zurich, Division of Infectious Diseases and Hospital Epidemiology and University Zurich, Zurich, Switzerland.
| | - R Zihlmann
- ETH Zurich, Department of Mathematics, Zurich, Switzerland
| | - V Schärer
- University Hospital Zurich, Division of Infectious Diseases and Hospital Epidemiology and University Zurich, Zurich, Switzerland
| | - B Hasse
- University Hospital Zurich, Division of Infectious Diseases and Hospital Epidemiology and University Zurich, Zurich, Switzerland
| | - F Imkamp
- Institute of Medical Microbiology, University of Zurich, Zurich, Switzerland; National Reference Centre for Mycobacteria, Zurich, Switzerland
| | - B Schulthess
- Institute of Medical Microbiology, University of Zurich, Zurich, Switzerland; National Reference Centre for Mycobacteria, Zurich, Switzerland
| | - P Sander
- Institute of Medical Microbiology, University of Zurich, Zurich, Switzerland; National Reference Centre for Mycobacteria, Zurich, Switzerland
| | - W Zingg
- University Hospital Zurich, Division of Infectious Diseases and Hospital Epidemiology and University Zurich, Zurich, Switzerland
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15
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Pradhan A, Martinez E, Sintchenko V, Post J, Overton K. Case of Mycobacterium chimaera vertebral osteomyelitis diagnosed 7 years after cardiac surgery. Intern Med J 2023; 53:150-151. [PMID: 36693641 DOI: 10.1111/imj.15982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 10/16/2022] [Indexed: 01/26/2023]
Affiliation(s)
- Alyssa Pradhan
- Department of Infectious Diseases, Prince of Wales Hospital, Sydney, New South Wales, Australia.,Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Elena Martinez
- Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia.,New South Wales Health Pathology, Sydney, New South Wales, Australia
| | - Vitali Sintchenko
- Sydney Institute for Infectious Diseases, University of Sydney, Sydney, New South Wales, Australia.,Centre for Infectious Diseases and Microbiology-Public Health, Westmead Hospital, Sydney, New South Wales, Australia.,Institute of Clinical Pathology and Medical Research, NSW Health Pathology, Sydney, New South Wales, Australia
| | - Jeffrey Post
- Department of Infectious Diseases, Prince of Wales Hospital, Sydney, New South Wales, Australia.,School of Clinical Medicine, UNSW Medicine & Heath, Sydney, New South Wales, Australia
| | - Kristen Overton
- Department of Infectious Diseases, Prince of Wales Hospital, Sydney, New South Wales, Australia.,School of Clinical Medicine, UNSW Medicine & Heath, Sydney, New South Wales, Australia
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16
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Bisognin F, Messina F, Butera O, Nisii C, Mazzarelli A, Cristino S, Pascale MR, Lombardi G, Cannas A, Dal Monte P. Investigating the Origin of Mycobacterium chimaera Contamination in Heater-Cooler Units: Integrated Analysis with Fourier Transform Infrared Spectroscopy and Whole-Genome Sequencing. Microbiol Spectr 2022; 10:e0289322. [PMID: 36222693 PMCID: PMC9769643 DOI: 10.1128/spectrum.02893-22] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 09/20/2022] [Indexed: 01/09/2023] Open
Abstract
Mycobacterium chimaera is ubiquitously spread in the environment, including factory and hospital water systems. Invasive cases of M. chimaera infection have been associated with aerosols produced by the use of heater-cooler units (HCU) during cardiac surgery. The aim of this study was to evaluate for the first time the performance of IR-Biotyper system on a large number of M. chimaera isolates collected from longitudinal environmental HCUs samples and water sources from hospitals located in three Italian provinces. In addition, IR-Biotyper results were compared with whole-genome sequencing (WGS) analysis, the reference method for molecular epidemiology, to investigate the origin of M. chimaera contamination of HCUs. From November 2018 to May 2021, 417 water samples from 52 HCUs (Stockert 3T, n = 41 and HCU40, n = 11) and 23 hospital taps (used to fill the HCU tanks) were concentrated, decontaminated, and cultured for M. chimaera. Positive cultures (n = 53) were purified by agar plate subcultures and analyzed by IR-Biotyper platform and Ion Torrent sequencing system. IR-Biotyper spectra results were analyzed using a statistical approach of dimensionality reduction by linear discriminant analysis (LDA), generating three separate clusters of M. chimaera, ascribable to each hospital. Furthermore, the only M. chimaera-positive sample from tap water clustered with the isolates from the HCUs of the same hospital, confirming that the plumbing system could represent the source of HCU contamination and, potentially, of patient infection. According to the genome-based phylogenies and following the classification proposed by van Ingen and collaborators in 2017, three distinct M. chimaera groups appear to have contaminated the HCU water systems: subgroups 1.1, 2.1, and branch 2. Most of the strains isolated from HCUs at the same hospital share a highly similar genetic profile. The nonrandom distribution obtained with WGS and IR-Biotyper leads to the hypothesis that M. chimaera subtypes circulating in the local plumbing colonize HCUs through the absolute filter, in addition with the current hypothesis that contamination occurs at the HCU production site. This opens the possibility that other medical equipment, such as endoscope reprocessing device or hemodialysis systems, could be contaminated by M. chimaera. IMPORTANCE Our manuscript focuses on interventions to reduce waterborne disease transmission, improve sanitation, and control infection. Sanitary water can be contaminated by nontuberculous Mycobacteria, including M. chimaera, a causative agent of invasive infections in immunocompromised patients. We found highly similar genetic and phenotypic profiles of M. chimaera isolated from heater-cooler units (HCU) used during surgery to thermo-regulate patients' body temperature, and from the same hospital tap water. These results lead to the hypothesis that M. chimaera subtypes circulating in the local plumbing colonize HCUs through the absolute filter, adding to the current hypothesis that contamination occurs at the HCU production site. In addition, this opens the possibility that other medical equipment using sanitized water, such as endoscope reprocessing devices or hemodialysis systems, could be contaminated by nontuberculous Mycobacteria, suggesting the need for environmental surveillance and associated control measures.
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Affiliation(s)
- F. Bisognin
- Microbiology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- Department of Experimental, Diagnostic and Specialty Medicine, Alma Mater Studiorum-University of Bologna, Bologna, Italy
| | - F. Messina
- UOC Microbiology and Bio-repository, National Institute for Infectious Diseases “Lazzaro Spallanzani”-IRCCS, Rome, Italy
| | - O. Butera
- UOC Microbiology and Bio-repository, National Institute for Infectious Diseases “Lazzaro Spallanzani”-IRCCS, Rome, Italy
- UOS Technical Health Professions, National Institute for Infectious Diseases “Lazzaro Spallanzani”-IRCCS, Rome, Italy
| | - C. Nisii
- UOC Microbiology and Bio-repository, National Institute for Infectious Diseases “Lazzaro Spallanzani”-IRCCS, Rome, Italy
| | - A. Mazzarelli
- UOC Microbiology and Bio-repository, National Institute for Infectious Diseases “Lazzaro Spallanzani”-IRCCS, Rome, Italy
| | - S. Cristino
- Department of Biological, Geological, and Environmental Sciences, Alma Mater Studiorum-University of Bologna, Bologna, Italy
| | - M. R. Pascale
- Department of Biological, Geological, and Environmental Sciences, Alma Mater Studiorum-University of Bologna, Bologna, Italy
| | - G. Lombardi
- Microbiology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - A. Cannas
- UOC Microbiology and Bio-repository, National Institute for Infectious Diseases “Lazzaro Spallanzani”-IRCCS, Rome, Italy
| | - P. Dal Monte
- Microbiology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- Department of Experimental, Diagnostic and Specialty Medicine, Alma Mater Studiorum-University of Bologna, Bologna, Italy
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17
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Hilt EE, Ferrieri P. Next Generation and Other Sequencing Technologies in Diagnostic Microbiology and Infectious Diseases. Genes (Basel) 2022; 13:genes13091566. [PMID: 36140733 PMCID: PMC9498426 DOI: 10.3390/genes13091566] [Citation(s) in RCA: 58] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 08/24/2022] [Accepted: 08/26/2022] [Indexed: 12/03/2022] Open
Abstract
Next-generation sequencing (NGS) technologies have become increasingly available for use in the clinical microbiology diagnostic environment. There are three main applications of these technologies in the clinical microbiology laboratory: whole genome sequencing (WGS), targeted metagenomics sequencing and shotgun metagenomics sequencing. These applications are being utilized for initial identification of pathogenic organisms, the detection of antimicrobial resistance mechanisms and for epidemiologic tracking of organisms within and outside hospital systems. In this review, we analyze these three applications and provide a comprehensive summary of how these applications are currently being used in public health, basic research, and clinical microbiology laboratory environments. In the public health arena, WGS is being used to identify and epidemiologically track food borne outbreaks and disease surveillance. In clinical hospital systems, WGS is used to identify multi-drug-resistant nosocomial infections and track the transmission of these organisms. In addition, we examine how metagenomics sequencing approaches (targeted and shotgun) are being used to circumvent the traditional and biased microbiology culture methods to identify potential pathogens directly from specimens. We also expand on the important factors to consider when implementing these technologies, and what is possible for these technologies in infectious disease diagnosis in the next 5 years.
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Łyżwa E, Siemion-Szcześniak I, Sobiecka M, Lewandowska K, Zimna K, Bartosiewicz M, Jakubowska L, Augustynowicz-Kopeć E, Tomkowski W. An Unfavorable Outcome of M. chimaera Infection in Patient with Silicosis. Diagnostics (Basel) 2022; 12:diagnostics12081826. [PMID: 36010177 PMCID: PMC9406696 DOI: 10.3390/diagnostics12081826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Revised: 07/24/2022] [Accepted: 07/25/2022] [Indexed: 11/16/2022] Open
Abstract
Mycobacterium chimaera is a slow-growing, nontuberculous mycobacterium (NTM) belonging to the Mycobacterium avium complex (MAC). It was identified as a unique species in 2004. Since 2013 it has been reported as a cause of disseminated infection in patients after cardiac surgeries. Only a few cases associated with underlying lung diseases have been noted. M. chimaera infection is characterized by ambiguous symptoms. There is no treatment with proven effectiveness, and it has a poor prognosis. Silicosis is a disease that can predispose to mycobacterial infection. Silica damages pulmonary macrophages, inhibiting their ability to kill mycobacteria. We present a case of M. chimaera infection in a patient with silicosis and without other comorbidities. To our knowledge, it is the first case of silicosis associated with M. chimaera disease. A 45-year-old man presented with a persistent low-grade fever. Based on the clinical and radiological picture, positive cultures, and histological examination, the nontuberculous mycobacterial disease was diagnosed. First, multidrug therapy according to the treatment guidelines for MAC was implemented, then antibiotics were administrated, based on drug sensitivity. Despite the treatment, eradication was not achieved and the patient died. The analysis of M. chimaera infection cases could contribute to developing recommendations and thus improve the prognosis.
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Affiliation(s)
- Ewa Łyżwa
- 1st Department of Lung Diseases, National Research Institute of Tuberculosis and Lung Diseases, 01-138 Warsaw, Poland; (I.S.-S.); (M.S.); (K.L.); (K.Z.); (M.B.); (W.T.)
- Correspondence:
| | - Izabela Siemion-Szcześniak
- 1st Department of Lung Diseases, National Research Institute of Tuberculosis and Lung Diseases, 01-138 Warsaw, Poland; (I.S.-S.); (M.S.); (K.L.); (K.Z.); (M.B.); (W.T.)
| | - Małgorzata Sobiecka
- 1st Department of Lung Diseases, National Research Institute of Tuberculosis and Lung Diseases, 01-138 Warsaw, Poland; (I.S.-S.); (M.S.); (K.L.); (K.Z.); (M.B.); (W.T.)
| | - Katarzyna Lewandowska
- 1st Department of Lung Diseases, National Research Institute of Tuberculosis and Lung Diseases, 01-138 Warsaw, Poland; (I.S.-S.); (M.S.); (K.L.); (K.Z.); (M.B.); (W.T.)
| | - Katarzyna Zimna
- 1st Department of Lung Diseases, National Research Institute of Tuberculosis and Lung Diseases, 01-138 Warsaw, Poland; (I.S.-S.); (M.S.); (K.L.); (K.Z.); (M.B.); (W.T.)
| | - Małgorzata Bartosiewicz
- 1st Department of Lung Diseases, National Research Institute of Tuberculosis and Lung Diseases, 01-138 Warsaw, Poland; (I.S.-S.); (M.S.); (K.L.); (K.Z.); (M.B.); (W.T.)
| | - Lilia Jakubowska
- Department of Radiology, National Research Institute of Tuberculosis and Lung Diseases, 01-138 Warsaw, Poland;
| | - Ewa Augustynowicz-Kopeć
- Department of Microbiology, National Research Institute of Tuberculosis and Lung Diseases, 01-138 Warsaw, Poland;
| | - Witold Tomkowski
- 1st Department of Lung Diseases, National Research Institute of Tuberculosis and Lung Diseases, 01-138 Warsaw, Poland; (I.S.-S.); (M.S.); (K.L.); (K.Z.); (M.B.); (W.T.)
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Baker MA, Rhee C, Tucker R, Vaidya V, Holtzman M, Seethala RR, Bentain-Melanson M, Lenox J, Smith AR, Gassett A, Huntley M, Sater M, Reilly K, Klompas M. Ralstonia pickettii and Pseudomonas aeruginosa Bloodstream Infections Associated with Contaminated Extracorporeal Membrane Oxygenation Water Heater Devices. Clin Infect Dis 2022; 75:1838-1840. [PMID: 35594555 DOI: 10.1093/cid/ciac379] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Indexed: 11/13/2022] Open
Abstract
We report on probable factory-based contamination of portable water heaters with waterborne pathogens and two bloodstream infections potentially attributable to off-label use of these water heaters to warm extracorporeal membrane oxygenation circuits. Great caution is warranted when using water-based devices to care for critically ill patients.
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Affiliation(s)
- Meghan A Baker
- Department of Population Medicine, Harvard Medical School/Harvard Pilgrim Health Care Institute, Boston, MA, USA.,Brigham and Women's Hospital, Boston, MA, USA.,Infection Control Department, Dana Farber Cancer Institute, Boston, MA, USA
| | - Chanu Rhee
- Department of Population Medicine, Harvard Medical School/Harvard Pilgrim Health Care Institute, Boston, MA, USA.,Brigham and Women's Hospital, Boston, MA, USA
| | | | | | | | | | | | | | | | | | | | | | | | - Michael Klompas
- Department of Population Medicine, Harvard Medical School/Harvard Pilgrim Health Care Institute, Boston, MA, USA.,Brigham and Women's Hospital, Boston, MA, USA
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20
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Rhee C, Baker MA, Tucker R, Vaidya V, Holtzman M, Seethala RR, Bentain-Melanson M, Lenox J, Smith AR, Boyer JC, Gassett A, Brigl M, Sater M, Huntley M, Woolley AE, Goldberg HJ, Reilly K, Resnick A, Pearson M, Klompas M. Cluster of Burkholderia cepacia Complex Infections Associated with Extracorporeal Membrane Oxygenation Water Heater Devices. Clin Infect Dis 2022; 75:1610-1617. [PMID: 35271726 DOI: 10.1093/cid/ciac200] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Burkholderia cepacia complex is a group of potential nosocomial pathogens often linked to contaminated water. We report on a cluster of 8 B.cepacia complex infections in cardiothoracic ICU patients attributed to contaminated ECMO water heaters. METHODS In December 2020, we identified an increase in B.cepacia complex infections in the cardiothoracic ICU at Brigham and Women's Hospital. We sought commonalities, sequenced isolates, obtained environmental specimens, and enacted mitigation measures. RESULTS Whole genome sequencing of 13 B.cepacia complex clinical specimens between November 2020-February 2021 identified 6 clonally related isolates, speciated as Burkholderia contaminans. All 6 occurred in patients on ECMO. Microbiology review identified two additional B.contaminans cases from June 2020, including one ECMO patient, that may have been cluster-related as well. All 8 definite/probable cluster cases required treatment; 3 died and 3 developed recurrent infections. After ECMO was identified as the major commonality, all 9 of the hospital's ECMO water heaters were cultured; all grew B.contaminans. Air sampling adjacent to the water heaters was culture-negative. Water heater touch screens were culture-positive for B.contaminans. The sink drain in the ECMO heater reprocessing room also grew clonal B.contaminans. Observations of reprocessing revealed opportunities for cross-contamination between devices via splash from the contaminated sink. The cluster was aborted by removing all water heaters from clinical service. CONCLUSIONS We identified a cluster of 8 B.cepacia complex infections associated with contaminated ECMO water heaters. This cluster underscores the potential risks associated with water-based ECMO heaters and, more broadly, water-based care for vulnerable patients.
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Affiliation(s)
- Chanu Rhee
- Brigham and Women's Hospital, Boston, MA, USA.,Department of Population Medicine, Harvard Medical School / Harvard Pilgrim Health Care Institute, Boston, MA, USA
| | - Meghan A Baker
- Brigham and Women's Hospital, Boston, MA, USA.,Department of Population Medicine, Harvard Medical School / Harvard Pilgrim Health Care Institute, Boston, MA, USA
| | | | | | | | | | | | | | | | - Jon C Boyer
- Brigham and Women's Hospital, Boston, MA, USA
| | | | | | | | | | | | | | | | | | | | - Michael Klompas
- Brigham and Women's Hospital, Boston, MA, USA.,Department of Population Medicine, Harvard Medical School / Harvard Pilgrim Health Care Institute, Boston, MA, USA
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21
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Greninger AL, Zerr DM. NGSocomial Infections: High-Resolution Views of Hospital-Acquired Infections Through Genomic Epidemiology. J Pediatric Infect Dis Soc 2021; 10:S88-S95. [PMID: 34951469 PMCID: PMC8755322 DOI: 10.1093/jpids/piab074] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Hospital outbreak investigations are high-stakes epidemiology. Contacts between staff and patients are numerous; environmental and community exposures are plentiful; and patients are highly vulnerable. Having the best data is paramount to understanding an outbreak in order to stop ongoing transmission and prevent future outbreaks. In the past 5 years, the high-resolution view of transmission offered by analyzing pathogen whole-genome sequencing (WGS) is increasingly part of hospital outbreak investigations. Concerns over speed and actionability, assay validation, liability, cost, and payment models lead to further opportunities for work in this area. Now accelerated by funding for COVID-19, the use of genomics in hospital outbreak investigations has firmly moved from the academic literature to more quotidian operations, with associated concerns involving regulatory affairs, data integration, and clinical interpretation. This review details past uses of WGS data in hospital-acquired infection outbreaks as well as future opportunities to increase its utility and growth in hospital infection prevention.
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Affiliation(s)
- Alexander L Greninger
- Department of Laboratory Medicine and Pathology, University of Washington Medical Center, Seattle, Washington, USA,Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA,Corresponding Author: Alexander L. Greninger MD, PhD, MS, MPhil, 1616 Eastlake Ave East Suite 320, Seattle, WA 98102, USA. E-mail:
| | - Danielle M Zerr
- Department of Pediatrics, University of Washington Medical Center, Seattle, Washington, USA,Division of Infectious Diseases, Seattle Children’s Hospital, Seattle, Washington, USA
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22
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Condello I, Nasso G, Serraino GF, Mastroroberto P, Fiore F, Speziale G, Santarpino G. The evolution of temperature management for open heart surgery: an historical perspective. J Cardiothorac Vasc Anesth 2021; 36:3237-3243. [DOI: 10.1053/j.jvca.2021.12.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 11/21/2021] [Accepted: 12/17/2021] [Indexed: 11/11/2022]
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Dohál M, Porvazník I, Solovič I, Mokrý J. Whole Genome Sequencing in the Management of Non-Tuberculous Mycobacterial Infections. Microorganisms 2021; 9:microorganisms9112237. [PMID: 34835363 PMCID: PMC8621650 DOI: 10.3390/microorganisms9112237] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 10/22/2021] [Accepted: 10/25/2021] [Indexed: 12/20/2022] Open
Abstract
Infections caused by non-tuberculous mycobacteria (NTM) have been a public health problem in recent decades and contribute significantly to the clinical and economic burden globally. The diagnosis of infections is difficult and time-consuming and, in addition, the conventional diagnostics tests do not have sufficient discrimination power in species identification due to cross-reactions and not fully specific probes. However, technological advances have been made and the whole genome sequencing (WGS) method has been shown to be an essential part of routine diagnostics in clinical mycobacteriology laboratories. The use of this technology has contributed to the characterization of new species of mycobacteria, as well as the identification of gene mutations encoding resistance and virulence factors. Sequencing data also allowed to track global outbreaks of nosocomial NTM infections caused by M. abscessus complex and M. chimaera. To highlight the utility of WGS, we summarize recent scientific studies on WGS as a tool suitable for the management of NTM-induced infections in clinical practice.
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Affiliation(s)
- Matúš Dohál
- Biomedical Center Martin, Department of Pharmacology, Jessenius Faculty of Medicine, Comenius University, 036 01 Martin, Slovakia;
- Correspondence: ; Tel.: +42-19-0252-4199
| | - Igor Porvazník
- National Institute of Tuberculosis, Lung Diseases and Thoracic Surgery, 059 81 Vyšné Hágy, Slovakia; (I.P.); (I.S.)
- Faculty of Health, Catholic University, 034 01 Ružomberok, Slovakia
| | - Ivan Solovič
- National Institute of Tuberculosis, Lung Diseases and Thoracic Surgery, 059 81 Vyšné Hágy, Slovakia; (I.P.); (I.S.)
- Faculty of Health, Catholic University, 034 01 Ružomberok, Slovakia
| | - Juraj Mokrý
- Biomedical Center Martin, Department of Pharmacology, Jessenius Faculty of Medicine, Comenius University, 036 01 Martin, Slovakia;
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24
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Mycobacterium intracellulare subsp. chimaera from Cardio Surgery Heating-Cooling Units and from Clinical Samples in Israel Are Genetically Unrelated. Pathogens 2021; 10:pathogens10111392. [PMID: 34832548 PMCID: PMC8624631 DOI: 10.3390/pathogens10111392] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Revised: 10/20/2021] [Accepted: 10/20/2021] [Indexed: 11/17/2022] Open
Abstract
Non-tuberculous mycobacteria (NTM) are opportunistic pathogens that cause illness primarily in the elderly, in the immunocompromised or in patients with underlying lung disease. Since 2013, a global outbreak of NTM infection related to heater-cooler units (HCU) used in cardio-thoracic surgery has been identified. This outbreak was caused by a single strain of Mycobacterium intracellulare subsp. chimaera. In order to estimate the prevalence of this outbreak strain in Israel, we sampled Mycobacterium intracellulare subsp. chimaera from several HCU machines in Israel, as well as from patients, sequenced their genomes and compared them to the outbreak strain. The presence of mixed mycobacteria species in the samples complicated the analysis of obtained sequences. By applying a metagenomic binning strategy, we were able to obtain, and characterize, genomes of single strains from the mixed samples. Mycobacterium intracellulare subsp. chimaera strains were compared to each other and to previously reported genomes from other countries. The strain causing the outbreak related to the HCU machines was identified in several such machines in Israel but not in any clinical sample.
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25
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Hasan NA, Davidson RM, Epperson LE, Kammlade SM, Beagle S, Levin AR, de Moura VC, Hunkins JJ, Weakly N, Sagel SD, Martiniano SL, Salfinger M, Daley CL, Nick JA, Strong M. Population Genomics and Inference of Mycobacterium avium Complex Clusters in Cystic Fibrosis Care Centers, United States. Emerg Infect Dis 2021; 27:2836-2846. [PMID: 34670648 PMCID: PMC8544995 DOI: 10.3201/eid2711.210124] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Mycobacterium avium complex (MAC) species constitute most mycobacteria infections in persons with cystic fibrosis (CF) in the United States, but little is known about their genomic diversity or transmission. During 2016–2020, we performed whole-genome sequencing on 364 MAC isolates from 186 persons with CF from 42 cystic fibrosis care centers (CFCCs) across 23 states. We compared isolate genomes to identify instances of shared strains between persons with CF. Among persons with multiple isolates sequenced, 15/56 (27%) had >1 MAC strain type. Genomic comparisons revealed 18 clusters of highly similar isolates; 8 of these clusters had patients who shared CFCCs, which included 27/186 (15%) persons with CF. We provide genomic evidence of highly similar MAC strains shared among patients at the same CFCCs. Polyclonal infections and high genetic similarity between MAC isolates are consistent with multiple modes of acquisition for persons with CF to acquire MAC infections.
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26
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Chandrasekar H, Hoganson DM, Lachenauer CS, Newburger JW, Sandora TJ, Saleeb SF. Mycobacterium chimaera Outbreak Management and Outcomes at a Large Pediatric Cardiac Surgery Center. Ann Thorac Surg 2021; 114:552-559. [PMID: 34454904 DOI: 10.1016/j.athoracsur.2021.07.074] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 07/15/2021] [Accepted: 07/20/2021] [Indexed: 11/01/2022]
Abstract
BACKGROUND In 2012, a global outbreak of invasive Mycobacterium chimaera (M. chimaera) infection was identified in patients post-cardiopulmonary bypass (CPB) surgery. Investigations revealed the source to be heater-cooler unit (HCU) exhaust, with point-source contamination discovered at the LivaNova HCU manufacturing plant. We report our experience with affected HCUs at a high-volume pediatric cardiac surgery center in the United States. METHODS A multi-disciplinary task force was established for outbreak management, including removing contaminated HCUs from service. Patients identified as exposed to affected HCUs were systematically contacted. A call center was created for patient/family inquiries, and symptomatic patients were assessed using an institutional triage protocol, including lab/culture data and infectious diseases consultation. RESULTS CPB surgeries were performed in 4,276 patients (median age 2.1 years, range 0-48.4) between October 2010 and October 2016. Call center volume was highest in the first 6 weeks following patient notification, totaling 307 calls and yielding 70 clinical patient assessments. Presenting symptoms included fatigue (60%), fever (49%), night sweats (46%), myalgias (34%), and weight loss (24%). Among the 70 assessed patients, echocardiogram (n=30), cardiac CT (n=2), cardiac MRI (n=1), and pulmonary CT (n=1) did not reveal abnormalities suggestive of active infection. Infectious diseases consultation occurred in 23 (33%) patients. Acid fast bacilli blood cultures were obtained in 30 patients; all were negative. CONCLUSIONS Through a highly coordinated outreach effort, no patients have been found to have M. chimaera infection in the six years after exposure to contaminated HCUs. Ongoing vigilance for cases that may yet manifest is needed.
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Affiliation(s)
- Hamsika Chandrasekar
- Department of Pediatric Cardiology, Lucile Packard Children's Hospital, Stanford University School of Medicine, Palo Alto, California.
| | - David M Hoganson
- Department of Cardiac Surgery, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Catherine S Lachenauer
- Division of Infectious Diseases, Departments of Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, MA
| | - Jane W Newburger
- Department of Cardiology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Thomas J Sandora
- Division of Infectious Diseases, Departments of Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, MA
| | - Susan F Saleeb
- Department of Cardiology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
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27
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The global outbreak of Mycobacterium chimaera infections in cardiac surgery-a systematic review of whole-genome sequencing studies and joint analysis. Clin Microbiol Infect 2021; 27:1613-1620. [PMID: 34298175 DOI: 10.1016/j.cmi.2021.07.017] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 07/06/2021] [Accepted: 07/11/2021] [Indexed: 11/21/2022]
Abstract
BACKGROUND With the increasing dimensions of the international cardiac surgery-associated Mycobacterium chimaera outbreak the hypothesis of a point source arose. OBJECTIVES To review the published evidence of clonality among cardiac surgery-associated M. chimaera isolates evaluated by whole-genome sequencing (WGS) and to perform an integrative genomic analysis of available genome data. DATA SOURCES We searched PubMed and EMBASE for studies applying WGS on cardiac surgery-associated M. chimaera isolates. STUDY ELIGIBILITY CRITERIA We included studies that applied WGS on more than a single M. chimaera isolate. METHODS Two authors independently extracted data from included studies. Available genome data from published studies were subjected to a joint analysis. RESULTS Of 121 identified articles, nine studies were included. M. chimaera isolates from LivaNova heater-cooler devices (HCDs) had a high level of genetic similarity, but were genetically distant from isolates from HCDs produced by other manufacturers. With the exception of a single (11.1%) study, the remaining eight (89.9%) studies reported a high level of genetic proximity between the majority of M. chimaera isolates derived from cardiac surgery-associated patients and LivaNova HCDs. In-depth analysis revealed involvement of three distinct M. chimaera subgroups in the outbreak (1.1, 1.8, 2.1), with 1.1 suggested as causative of the outbreak. Samples taken at the LivaNova production site supported contamination with strains of subgroups 1.1 and 1.8. In the combined analysis of 526 publicly available WGS data sets, nearly all isolates from cardiac surgery-associated patients contained strain 1.1 (50/52, 96.2%), and at least one of the outbreak strains was found in almost all LivaNova HCDs (241/257, 93.8%), with strain 1.1 in particular present in 198/257 (77.0%). CONCLUSIONS HCD contamination during production seems plausible as the predominant point source for the global M. chimaera outbreak. Although HCDs can be contaminated with mixed populations, M. chimaera strains of the subgroup 1.1 caused most infections.
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Yiek WK, Coenen O, Nillesen M, van Ingen J, Bowles E, Tostmann A. Outbreaks of healthcare-associated infections linked to water-containing hospital equipment: a literature review. Antimicrob Resist Infect Control 2021; 10:77. [PMID: 33971944 PMCID: PMC8108015 DOI: 10.1186/s13756-021-00935-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 04/09/2021] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Healthcare-associated infections (HAIs) are a significant cause of morbidity and mortality in hospitalized patients. Water in the environment can be a source of infection linked to outbreaks and environmental transmission in hospitals. Water safety in hospitals remains a challenge. This article has summarized available scientific literature to obtain an overview of outbreaks linked to water-containing hospital equipment and strategies to prevent such outbreaks. METHODS We made a list of water-containing hospital equipment and devices in which water is being used in a semi-closed circuit. A literature search was performed in PubMed with a search strategy containing the names of these medical devices and one or more of the following words: outbreak, environmental contamination, transmission, infection. For each medical device, we summarized the following information: the function of the medical device, causes of contamination, the described outbreaks and possible prevention strategies. RESULTS The following water-containing medical equipment or devices were identified: heater-cooler units, hemodialysis equipment, neonatal incubators, dental unit waterlines, fluid warmers, nebulizers, water traps, water baths, blanketrol, scalp cooling, and thermic stimulators. Of the latter three, no literature could be found. Of all other devices, one or more outbreaks associated with these devices were reported in the literature. CONCLUSIONS The water reservoirs in water-containing medical devices can be a source of microbial growth and transmissions to patients, despite the semi-closed water circuit. Proper handling and proper cleaning and disinfection can help to reduce the microbial burden and, consequently, transmission to patients. However, these devices are often difficult to clean and disinfect because they cannot be adequately opened or disassembled, and the manufacturer's cleaning guidelines are often not feasible to execute. The development of equipment without water or fluid containers should be stimulated. Precise cleaning and disinfection guidelines and instructions are essential for instructing healthcare workers and hospital cleaning staff to prevent potential transmission to patients.
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Affiliation(s)
- Wing-Kee Yiek
- Department of Medical Microbiology, Radboud Centre for Infectious Diseases, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Olga Coenen
- Department of Medical Microbiology, Radboud Centre for Infectious Diseases, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Mayke Nillesen
- Department of Medical Microbiology, Radboud Centre for Infectious Diseases, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Jakko van Ingen
- Department of Medical Microbiology, Radboud Centre for Infectious Diseases, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Edmée Bowles
- Department of Medical Microbiology, Radboud Centre for Infectious Diseases, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Alma Tostmann
- Department of Medical Microbiology, Radboud Centre for Infectious Diseases, Radboud University Medical Centre, Nijmegen, The Netherlands.
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Inkster T, Peters C, Seagar AL, Holden MTG, Laurenson IF. Investigation of two cases of Mycobacterium chelonae infection in haemato-oncology patients using whole-genome sequencing and a potential link to the hospital water supply. J Hosp Infect 2021; 114:111-116. [PMID: 33945838 DOI: 10.1016/j.jhin.2021.04.028] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 04/27/2021] [Accepted: 04/27/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Haemato-oncology patients are at increased risk of infection from atypical mycobacteria such as Mycobacterium chelonae which are commonly found in both domestic and hospital water systems. AIMS To describe the investigation and control measures following two patient cases of M. chelonae and positive water samples in the study hospital. METHODS Water testing was undertaken from outlets, storage tanks and mains supply. Whole-genome sequencing (WGS) was used to compare patient and positive water samples. The subsequent infection control measures implemented are described. FINDINGS The WGS results showed two main populations of M. chelonae within the group of sampled isolates. The results showed that the patient strains were unrelated to each other, but that the isolate from one patient was closely related to environmental samples from water outlets, supporting nosocomial acquisition. CONCLUSIONS WGS was used to investigate two patient cases of M. chelonae and positive water samples from a hospital water supply. Relevant control measures and the potential for chemical dosing of water systems to enhance proliferation of atypical mycobacteria are discussed.
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Affiliation(s)
- T Inkster
- Queen Elizabeth University Hospital, Glasgow, UK.
| | - C Peters
- Queen Elizabeth University Hospital, Glasgow, UK
| | - A L Seagar
- Scottish Mycobacteria Reference Laboratory, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - M T G Holden
- School of Medicine, University of St Andrews, St Andrews, UK
| | - I F Laurenson
- Scottish Mycobacteria Reference Laboratory, Royal Infirmary of Edinburgh, Edinburgh, UK
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30
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Baker AW, Maziarz EK, Lewis SS, Stout JE, Anderson DJ, Smith PK, Schroder JN, Daneshmand MA, Alexander BD, Wallace RJ, Sexton DJ, Wolfe CR. Invasive Mycobacterium abscessus Complex Infection After Cardiac Surgery: Epidemiology, Management, and Clinical Outcomes. Clin Infect Dis 2021; 72:1232-1240. [PMID: 32133489 DOI: 10.1093/cid/ciaa215] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Accepted: 02/28/2020] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND We recently mitigated a clonal outbreak of hospital-acquired Mycobacterium abscessus complex (MABC), which included a large cluster of adult patients who developed invasive infection after exposure to heater-cooler units during cardiac surgery. Recent studies have detailed Mycobacterium chimaera infections acquired during cardiac surgery; however, little is known about the epidemiology and clinical courses of cardiac surgery patients with invasive MABC infection. METHODS We retrospectively collected clinical data on all patients who underwent cardiac surgery at our hospital and subsequently had positive cultures for MABC from 2013 through 2016. Patients with ventricular assist devices or heart transplants were excluded. We analyzed patient characteristics, antimicrobial therapy, surgical interventions, and clinical outcomes. RESULTS Ten cardiac surgery patients developed invasive, extrapulmonary infection from M. abscessus subspecies abscessus in an outbreak setting. Median time from presumed inoculation in the operating room to first positive culture was 53 days (interquartile range [IQR], 38-139 days). Disseminated infection was common, and the most frequent culture-positive sites were mediastinum (n = 7) and blood (n = 7). Patients received a median of 24 weeks (IQR, 5-33 weeks) of combination antimicrobial therapy that included multiple intravenous agents. Six patients required antibiotic changes due to adverse events attributed to amikacin, linezolid, or tigecycline. Eight patients underwent surgical management, and 6 patients required multiple sternal debridements. Eight patients died within 2 years of diagnosis, including 4 deaths directly attributable to MABC infection. CONCLUSIONS Despite aggressive medical and surgical management, invasive MABC infection after cardiac surgery caused substantial morbidity and mortality. New treatment strategies are needed, and compliance with infection prevention guidelines remains critical.
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Affiliation(s)
- Arthur W Baker
- Division of Infectious Diseases, Duke University School of Medicine, Durham, North Carolina, USA.,Duke Center for Antimicrobial Stewardship and Infection Prevention, Durham, North Carolina, USA
| | - Eileen K Maziarz
- Division of Infectious Diseases, Duke University School of Medicine, Durham, North Carolina, USA
| | - Sarah S Lewis
- Division of Infectious Diseases, Duke University School of Medicine, Durham, North Carolina, USA.,Duke Center for Antimicrobial Stewardship and Infection Prevention, Durham, North Carolina, USA
| | - Jason E Stout
- Division of Infectious Diseases, Duke University School of Medicine, Durham, North Carolina, USA
| | - Deverick J Anderson
- Division of Infectious Diseases, Duke University School of Medicine, Durham, North Carolina, USA.,Duke Center for Antimicrobial Stewardship and Infection Prevention, Durham, North Carolina, USA
| | - Peter K Smith
- Division of Cardiovascular and Thoracic Surgery, Duke University School of Medicine, Durham, North Carolina, USA
| | - Jacob N Schroder
- Division of Cardiovascular and Thoracic Surgery, Duke University School of Medicine, Durham, North Carolina, USA
| | - Mani A Daneshmand
- Division of Cardiovascular and Thoracic Surgery, Duke University School of Medicine, Durham, North Carolina, USA.,Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Barbara D Alexander
- Division of Infectious Diseases, Duke University School of Medicine, Durham, North Carolina, USA.,Duke University Clinical Microbiology Laboratory, Durham, North Carolina, USA
| | - Richard J Wallace
- Mycobacteria/Nocardia Research Laboratory, Department of Microbiology, University of Texas Health Science Center, Tyler, Texas, USA
| | - Daniel J Sexton
- Division of Infectious Diseases, Duke University School of Medicine, Durham, North Carolina, USA.,Duke Center for Antimicrobial Stewardship and Infection Prevention, Durham, North Carolina, USA
| | - Cameron R Wolfe
- Division of Infectious Diseases, Duke University School of Medicine, Durham, North Carolina, USA
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Lecorche E, Daniau C, La K, Mougari F, Benmansour H, Kumanski S, Robert J, Fournier S, Lebreton G, Carbonne A, Cambau E. Mycobacterium chimaera Genomics With Regard to Epidemiological and Clinical Investigations Conducted for an Open Chest Postsurgical Mycobacterium chimaera Infection Outbreak. Open Forum Infect Dis 2021; 8:ofab192. [PMID: 34189167 PMCID: PMC8231370 DOI: 10.1093/ofid/ofab192] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 04/14/2021] [Indexed: 11/21/2022] Open
Abstract
Background Postsurgical infections due to Mycobacterium chimaera appeared as a novel nosocomial threat in 2015, with a worldwide outbreak due to contaminated heater-cooler units used in open chest surgery. We report the results of investigations conducted in France including whole-genome sequencing comparison of patient and heater-cooler unit isolates. Methods We sought M. chimaera infection cases from 2010 onwards through national epidemiological investigations in health care facilities performing cardiopulmonary bypass, together with a survey on good practices and systematic heater-cooler unit microbial analyses. Clinical and heater-cooler unit isolates were subjected to whole-genome sequencing analyzed with regard to the reference outbreak strain Zuerich-1. Results Only 2 clinical cases were shown to be related to the outbreak, although 23% (41/175) of heater-cooler units were declared positive for M. avium complex. Specific measures to prevent infection were applied in 89% (50/56) of health care facilities, although only 14% (8/56) of them followed the manufacturer maintenance recommendations. Whole-genome sequencing comparison showed that the clinical isolates and 72% (26/36) of heater-cooler unit isolates belonged to the epidemic cluster. Within clinical isolates, 5–9 nonsynonymous single nucleotide polymorphisms were observed, among which an in vivo mutation in a putative efflux pump gene was observed in a clinical isolate obtained for 1 patient on antimicrobial treatment. Conclusions Cases of postsurgical M. chimaera infections have been declared to be rare in France, although heater-cooler units were contaminated, as in other countries. Genomic analyses confirmed the connection to the outbreak and identified specific single nucleotide polymorphisms, including 1 suggesting fitness evolution in vivo.
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Affiliation(s)
- Emmanuel Lecorche
- Université de Paris, INSERM, IAME, Paris, France.,APHP-GHU Nord, Service de Mycobactériologie Spécialisée et de Référence, Paris, France.,Centre National de Référence des Mycobactéries et de la Résistance des Mycobactéries aux Antituberculeux (CNR-MyRMA), Paris, France
| | - Côme Daniau
- Santé Publique France, Saint-Maurice, France
| | - Kevin La
- Université de Paris, INSERM, IAME, Paris, France.,Centre National de Référence des Mycobactéries et de la Résistance des Mycobactéries aux Antituberculeux (CNR-MyRMA), Paris, France
| | - Faiza Mougari
- APHP-GHU Nord, Service de Mycobactériologie Spécialisée et de Référence, Paris, France.,Centre National de Référence des Mycobactéries et de la Résistance des Mycobactéries aux Antituberculeux (CNR-MyRMA), Paris, France
| | - Hanaa Benmansour
- APHP-GHU Nord, Service de Mycobactériologie Spécialisée et de Référence, Paris, France.,Centre National de Référence des Mycobactéries et de la Résistance des Mycobactéries aux Antituberculeux (CNR-MyRMA), Paris, France
| | - Sylvain Kumanski
- Centre National de Référence des Mycobactéries et de la Résistance des Mycobactéries aux Antituberculeux (CNR-MyRMA), Paris, France
| | - Jérôme Robert
- Centre National de Référence des Mycobactéries et de la Résistance des Mycobactéries aux Antituberculeux (CNR-MyRMA), Paris, France.,Centre d'Immunologie et des Maladies Infectieuses-CIMI-Paris, Sorbonne-Université, INSERM, Paris, France.,Bactériologie-Hygiène, AP-HP, Sorbonne Université, Site Pitié, Paris, France
| | - Sandra Fournier
- Centre d'Immunologie et des Maladies Infectieuses, Sorbonne - Université, INSERM (U1135 - E2), Paris, France
| | - Guillaume Lebreton
- Service de Chirurgie Cardiaque et Thoracique, Hôpital La Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | | | - Emmanuelle Cambau
- Université de Paris, INSERM, IAME, Paris, France.,APHP-GHU Nord, Service de Mycobactériologie Spécialisée et de Référence, Paris, France.,Centre National de Référence des Mycobactéries et de la Résistance des Mycobactéries aux Antituberculeux (CNR-MyRMA), Paris, France
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32
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Ma J, Ruzicki JL, Carrell NW, Baker CF. Ocular manifestations of disseminated Mycobacterium chimaera infection after cardiothoracic surgery. Can J Ophthalmol 2021; 57:90-97. [PMID: 33775595 DOI: 10.1016/j.jcjo.2021.02.032] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 02/16/2021] [Accepted: 02/18/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To describe the ocular manifestations of disseminated Mycobacterium chimaera infection after cardiothoracic surgery. DESIGN Retrospective, observational case series. PARTICIPANTS Patients with disseminated M. chimaera infection treated at the University of Alberta Hospital and Royal Alexandra Hospital in Edmonton, Alberta, Canada. METHODS Seven patients (14 eyes) with systemic M. chimaera infection after aortic graft and/or valvular surgeries were reviewed for ocular involvement. Cases were identified based on histopathologic analysis of cardiac tissue, repeat positive mycobacterial blood cultures, and cerebrospinal fluid analysis. Clinical ocular findings, fundus autofluorescence, fluorescein angiography, spectral-domain optical coherence tomography (SD-OCT), and autopsy results are described. RESULTS The mean age of our patients was 63 years (range, 22-76 years). Aortic graft and/or valvular surgeries were performed between June 2015 and April 2016. The mean duration from surgery to diagnosis of infection was 27 months (range, 19-36 months). All patients exhibited white-yellowish choroidal lesions. Bilateral, multifocal choroiditis was observed in 6 patients (12 eyes), who died of disseminated M. chimaera infection despite aggressive, multiagent antimicrobial therapy. One patient had a solitary, white-yellow choroidal lesion in the left eye only. Choroidal lesions were hyperfluorescent on late-phase fluorescein angiography and corresponded to localized choroidal thickening and retinal elevation on SD-OCT. CONCLUSIONS M. chimaera infection after cardiothoracic surgery can cause life-threatening disease involving multiple organ systems. Ocular involvement is an important and possibly early clinical finding, with good correlation to systemic disease severity. Ophthalmological assessment and multimodal imaging may aid in early diagnosis and can be used to monitor disease progression.
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Affiliation(s)
- Jingyi Ma
- Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alta
| | - Jessica L Ruzicki
- Department of Ophthalmology and Visual Sciences, University of Alberta, Edmonton, Alta
| | - Nathan W Carrell
- Department of Ophthalmology and Visual Sciences, University of Alberta, Edmonton, Alta
| | - Chad F Baker
- Department of Ophthalmology and Visual Sciences, University of Alberta, Edmonton, Alta..
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33
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Siddam AD, Zaslow SJ, Wang Y, Phillips KS, Silverman MD, Regan PM, Amarasinghe JJ. Characterization of Biofilm Formation by Mycobacterium chimaera on Medical Device Materials. Front Microbiol 2021; 11:586657. [PMID: 33505365 PMCID: PMC7829485 DOI: 10.3389/fmicb.2020.586657] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Accepted: 11/13/2020] [Indexed: 12/15/2022] Open
Abstract
Non-tuberculous mycobacteria (NTM) are widespread in the environment and are a public health concern due to their resistance to antimicrobial agents. The colonization of surgical heater-cooler devices (HCDs) by the slow-growing NTM species Mycobacterium chimaera has recently been linked to multiple invasive infections in patients worldwide. The resistance of M. chimaera to antimicrobials may be aided by a protective biofilm matrix of extracellular polymeric substances (EPS). This study explored the hypothesis that M. chimaera can form biofilms on medically relevant materials. Several M. chimaera strains, including two HCD isolates, were used to inoculate a panel of medical device materials. M. chimaera colonization of the surfaces was monitored for 6 weeks. M. chimaera formed a robust biofilm at the air-liquid interface of borosilicate glass tubes, which increased in mass over time. M. chimaera was observed by 3D Laser Scanning Microscopy to have motility during colonization, and form biofilms on stainless steel, titanium, silicone and polystyrene surfaces during the first week of inoculation. Scanning electron microscopy (SEM) of M. chimaera biofilms after 4 weeks of inoculation showed that M. chimaera cells were enclosed entirely in extracellular material, while cryo-preserved SEM samples further revealed that an ultrastructural component of the EPS matrix was a tangled mesh of 3D fiber-like projections connecting cells. Considering that slow-growing M. chimaera typically has culture times on the order of weeks, the microscopically observed ability to rapidly colonize stainless steel and titanium surfaces in as little as 24 h after inoculation is uncharacteristic. The insights that this study provides into M. chimaera colonization and biofilm formation of medical device materials are a significant advance in our fundamental understanding of M. chimaera surface interactions and have important implications for research into novel antimicrobial materials, designs and other approaches to help reduce the risk of infection.
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Affiliation(s)
- Archana D Siddam
- Winchester Engineering and Analytical Center, United States Food and Drug Administration, Winchester, MA, United States
| | - Shari J Zaslow
- Winchester Engineering and Analytical Center, United States Food and Drug Administration, Winchester, MA, United States
| | - Yi Wang
- Center for Devices and Radiological Health, Food and Drug Administration, Silver Spring, MD, United States
| | - K Scott Phillips
- Center for Devices and Radiological Health, Food and Drug Administration, Silver Spring, MD, United States
| | - Matthew D Silverman
- Winchester Engineering and Analytical Center, United States Food and Drug Administration, Winchester, MA, United States
| | - Patrick M Regan
- Winchester Engineering and Analytical Center, United States Food and Drug Administration, Winchester, MA, United States
| | - Jayaleka J Amarasinghe
- Winchester Engineering and Analytical Center, United States Food and Drug Administration, Winchester, MA, United States
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Lau D, Cooper R, Chen J, Sim VL, McCombe JA, Tyrrell GJ, Bhargava R, Adam B, Chapman E, Croxen MA, Garady C, Antonation K, van Landeghem FKH, Ip S, Saxinger L. Mycobacterium chimaera Encephalitis Following Cardiac Surgery: A New Syndrome. Clin Infect Dis 2021; 70:692-695. [PMID: 31247065 DOI: 10.1093/cid/ciz497] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Accepted: 06/17/2019] [Indexed: 11/14/2022] Open
Abstract
We report the cases of 3 patients with fatal, disseminated Mycobacterium chimaera infections following cardiac surgeries. Progressive neurocognitive decline and death were explained by active granulomatous encephalitis, with widespread involvement of other organs. This syndrome is clinically elusive and, thus, may have caused deaths in prior reported series.
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Affiliation(s)
- Darren Lau
- Division of General Internal Medicine, University of Alberta, Edmonton, Canada
| | - Ryan Cooper
- Division of Infectious Diseases, University of Alberta, Edmonton, Canada
| | - Justin Chen
- Division of Infectious Diseases, University of Alberta, Edmonton, Canada
| | - Valerie L Sim
- Division of Neurology, Department of Medicine, University of Alberta, Edmonton, Canada
| | - Jennifer A McCombe
- Division of Neurology, Department of Medicine, University of Alberta, Edmonton, Canada
| | - Gregory J Tyrrell
- Provincial Laboratory for Public Health, University of Alberta, Edmonton, Canada.,Division of Diagnostic and Applied Microbiology, Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, Canada
| | - Ravi Bhargava
- Department of Radiology and Diagnostic Imaging, University of Alberta, Edmonton, Canada
| | - Benjamin Adam
- Division of Anatomical Pathology, Department of Laboratory Medicine and Pathology, University of Alberta, Canada
| | - Erin Chapman
- Division of Anatomical Pathology, Department of Laboratory Medicine and Pathology, University of Alberta, Canada
| | - Matthew A Croxen
- Provincial Laboratory for Public Health, University of Alberta, Edmonton, Canada.,Division of Diagnostic and Applied Microbiology, Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, Canada
| | - Cherif Garady
- Division of Anatomical Pathology, Department of Laboratory Medicine and Pathology, University of Alberta, Canada
| | - Kym Antonation
- National Microbiology Laboratory, Winnipeg, Manitoba, University of Alberta, Edmonton, Canada
| | - Frank K H van Landeghem
- Division of Anatomical Pathology, Department of Laboratory Medicine and Pathology, University of Alberta, Canada.,Neuroscience and Mental Health Institute, University of Alberta, Edmonton, Canada
| | - Shannon Ip
- Division of General Internal Medicine, University of Alberta, Edmonton, Canada
| | - Lynora Saxinger
- Division of Infectious Diseases, University of Alberta, Edmonton, Canada
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Persistence of Legionella in Routinely Disinfected Heater-Cooler Units and Heater Units assessed by Propidium Monoazide qPCR. Pathogens 2020; 9:pathogens9110978. [PMID: 33238543 PMCID: PMC7700499 DOI: 10.3390/pathogens9110978] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 11/20/2020] [Accepted: 11/21/2020] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Evidence to date indicates that heater-cooler units (HCUs) and heater units (HUs) can generate potentially infectious aerosols containing a range of opportunistic pathogens such as Mycobacterium chimaera, other non-tuberculous mycobacterial (NTM) species, Pseudomonas aeruginosa and Legionella spp. Our purpose was to determine the extent of Legionella contamination and total viable count (TVC) in HCUs and HUs and to analyze the relationship by water system design of devices of two different brands (LivaNova vs. Maquet). METHODS Legionella spp. were detected and quantified by our optimized PMA-qPCR protocol; TVCs were assessed according to ISO protocol 6222. Analyses were performed in the first sampling round and after six months of surveillance. RESULTS Overall, Legionella spp. was detected in 65.7% of devices. In the second sampling round, Legionella positivity rates were significantly lower in water samples from the Maquet devices compared to the LivaNova ones (27.3% vs. 61.5%). LivaNova HCUs also yielded more Legionella, and aquatic bacteria counts than Maquet in both first and second-round samples. CONCLUSIONS We recommend that all surgical patients and staff exposed to aerosols from thermoregulatory devices should be followed up for Legionella infection and that microbiological surveillance on such devices should be conducted regularly as precautionary principle.
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36
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Ditommaso S, Giacomuzzi M, Memoli G, Zotti CM. Real-time PCR, the best approaches for rapid testing for Mycobacterium chimaera detection in heater cooler units and extracorporeal membrane oxygenation. Perfusion 2020; 36:626-629. [PMID: 33054627 DOI: 10.1177/0267659120963878] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
According to recent investigations, the risk of M. chimaera contamination of heater-cooler units (HCUs) has reached global proportions. Our aim was to field evaluate a protocol for early detection of M. chimaera contamination. We assessed the presence of viable M. chimaera in 395 water samples obtained from 48 devices (HCUs and extracorporeal membrane oxygenation) by Real Time PCR. Thirty devices were NTM positive, of which 14 were contaminated with M. chimaera. The most frequently contaminated devices were the Stockert 3T. Noteworthy, Stockert 3T devices were positive for M. chimaera. In conclusion, this study introduces novel PMA-PCR designed to specifically detect M. chimaera in HCUs and ECMO devices; this method can replace the culture method for continuous microbiological surveillance. The timely detection of M. chimaera contamination can then be used to improve effective management of the devices.
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Affiliation(s)
- Savina Ditommaso
- Department of Public Health and Pediatrics, University of Turin, Turin, Italy
| | - Monica Giacomuzzi
- Department of Public Health and Pediatrics, University of Turin, Turin, Italy
| | - Gabriele Memoli
- Department of Public Health and Pediatrics, University of Turin, Turin, Italy
| | - Carla M Zotti
- Department of Public Health and Pediatrics, University of Turin, Turin, Italy
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37
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Dafaalla M, Weight N, Cajic V, Dandekar U, Gopalakrishnan K, Adesanya O, Low CS, Banerjee P. The utility of 18F-fluorodeoxyglucose positron emission tomography with computed tomography in Mycobacterium chimaera endocarditis: a case series. EUROPEAN HEART JOURNAL-CASE REPORTS 2020; 3:1-6. [PMID: 33043236 PMCID: PMC7534152 DOI: 10.1093/ehjcr/ytz209] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Revised: 03/18/2019] [Accepted: 10/30/2019] [Indexed: 11/23/2022]
Abstract
Background Infective endocarditis secondary to Mycobacterium chimaera can present with classical constitutional symptoms of infective endocarditis but can be blood culture negative and without vegetations on transthoracic or transoesophageal echocardiogram. Patients with prosthetic valves are at particularly high risk. Case summary We present two patients who were diagnosed with infective endocarditis secondary to M. chimaera infection. They presented similarly with pyrexia of unknown origin and night sweats. Both patients had previously undergone aortic valve replacement; one with a tissue valve and the other with a metallic valve. New cardiac murmurs were evident on auscultation, but clinical examination showed no peripheral stigmata of endocarditis. Transoesophageal echo and transthoracic echo were both unremarkable, as were serial blood cultures. FDG PET CT scan was the key investigation, which showed increased uptake in the spleen beside other areas. Histopathology and mycobacterial cultures confirmed the diagnosis of M. chimaera infection in both cases. The first patient completed medical therapy and is now fit and well. However, the second patient unfortunately developed disseminated infection causing death. Discussion The management of M. chimaera infective endocarditis is challenging, often with delayed diagnosis and poor outcomes. In the context of negative blood cultures and inconclusive echocardiograms where there remains a high index of suspicion for endocarditis, FDG PET CT scanning can be a crucial diagnostic importance and should be considered early in patients with prosthetic valves.
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Affiliation(s)
- Mohamed Dafaalla
- Department of Cardiology, University Hospitals Coventry and Warwickshire NHS Trust, Clifford Bridge Road, Coventry CV2 2DX, UK
| | - Nicholas Weight
- Department of Cardiology, University Hospitals Coventry and Warwickshire NHS Trust, Clifford Bridge Road, Coventry CV2 2DX, UK
| | - Verran Cajic
- Department of Infectious Diseases, University Hospitals Coventry and Warwickshire NHS Trust, Clifford Bridge Road, Coventry CV2 2DX, UK
| | - Uday Dandekar
- Department of Cardiothoracic Surgery, University Hospitals Coventry and Warwickshire NHS Trust, Clifford Bridge Road, Coventry CV2 2DX, UK
| | - Kishore Gopalakrishnan
- Department of Histopathology University Hospitals Coventry and Warwickshire NHS Trust, Clifford Bridge Road, Coventry CV2 2DX, UK
| | - Oludolapo Adesanya
- Department of Radiology, University Hospitals Coventry and Warwickshire NHS Trust, Clifford Bridge Road, Coventry CV2 2DX, UK
| | - Chen S Low
- Department of Radiology, University Hospitals Coventry and Warwickshire NHS Trust, Clifford Bridge Road, Coventry CV2 2DX, UK
| | - Prithwish Banerjee
- Department of Cardiology, University Hospitals Coventry and Warwickshire NHS Trust, Clifford Bridge Road, Coventry CV2 2DX, UK
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38
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Lamagni TL, Charlett A, Phin N, Zambon M, Chand M. Invasive Mycobacterium chimaera Infections and Heater-Cooler Devices in Cardiac Surgery. Emerg Infect Dis 2020; 26:632. [PMID: 32096464 PMCID: PMC7045823 DOI: 10.3201/eid2603.180452] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Bolcato M, Rodriguez D, Aprile A. Risk Management in the New Frontier of Professional Liability for Nosocomial Infection: Review of the Literature on Mycobacterium Chimaera. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17197328. [PMID: 33036499 PMCID: PMC7579562 DOI: 10.3390/ijerph17197328] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 09/30/2020] [Accepted: 10/03/2020] [Indexed: 12/19/2022]
Abstract
Background: Mycobacterium chimaera (MC) is of recent origin and belongs to the large family of non-tuberculous mycobacteria. In recent years, it has shown a high infectious capacity via the aerosol produced by operating room equipment, such as heater–cooler units (HCU). The infection has a long latent period and high mortality rate. Genetic and epidemiological studies have shown that there is a clear link between the infection and a specific HCU model manufactured by LivaNova/Sorin. There is, therefore, a strong possibility that contamination occurs during device construction. The objective of this article is to describe the characteristics of this particular infection in view of the medico–legal implications on professional liability, specifically focusing on current evidence regarding contamination prevention. Methods: we have analyzed the clinical characteristics and data from the autopsic investigations performed on a patient who died as a result of MC infection, in addition to analyzing all pertinent recommendation documents available internationally. We searched for all articles in the literature available on MEDLINE between 1995 and 30 July 2020, using the search words “Mycobacterium chimaera”. We then analyzed those articles and reported only those that provide useful information regarding prevention techniques for containing dissemination and contamination. Results: the literature review produced 169 results that highlight the need to develop systems to mitigate and eliminate the risk of MC infection in operating rooms such as physical containment measures, e.g. device replacement, use of safe water, providing patients with information, and training healthcare professionals. Conclusions: from a medico–legal viewpoint, this particular situation represents a new frontier of professional liability, which includes manufacturers of electromedical equipment. In order to comprehend the true extent of this silent global epidemic, the development of an organic, preventative monitoring system is essential.
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40
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Ditommaso S, Giacomuzzi M, Memoli G, Zotti CM. Failure to eradicate non-tuberculous mycobacteria upon disinfection of heater-cooler units: results of a microbiological investigation in northwestern Italy. J Hosp Infect 2020; 106:585-593. [PMID: 32889028 DOI: 10.1016/j.jhin.2020.08.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 08/26/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Heater-cooler units (HCUs) used during cardiopulmonary bypass may become colonized with non-tuberculous mycobacteria (NTM), including Mycobacterium chimaera. Recently, a worldwide investigation conducted in hospitalized infected patients has detected M. chimaera in several Stockert 3T HCUs manufactured by LivaNova. AIM Microbiological surveillance on Stockert 3T (LivaNova) and Maquet HCU40 (Getinge) devices as well as an evaluation of the efficacy of their recommended decontamination protocols. METHODS A total of 308 water samples were collected from 29 HCUs: 264 samples were collected from 17 Stockert 3T HCUs and 44 samples from 12 Maquet HCU40 devices. Samples were tested for total viable counts (TVCs) at both 22 and 36°C, Pseudomonas aeruginosa, coliform bacteria, and NTM. The microbiological surveillance began in June 2017 and ran until October 2019. FINDINGS A total of 308 HCU water samples were analysed, 65.5% of which yielded NTM. The most frequently colonized device with NTM was the Stockert 3T (88.2%), with a frequency of positive samples of 59.5% (157/264). The Maquet HCU40 devices less frequently yielded NTM (33.3%), with a frequency of positive water samples of 13.6% (6/44). Disinfection procedures were effective in reducing TVCs of bacteria with the exception of NTM species. NTM were detected in both pre-disinfection (50.1%) and post-disinfection (55.7%) samples, and no significant association was found between disinfection and NTM results both in Stockert 3T and Maquet HCU40 devices. CONCLUSION This study suggests that manufacturers' procedures for disinfection are ineffective and/or inadequate. Until effective disinfection protocols become available, the only way to minimize the risk of NTM contamination is to closely monitor the water quality in the HCU, keep it as clean as possible, and treat it like any other biohazardous material.
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Affiliation(s)
- S Ditommaso
- Department of Public Health and Pediatrics, University of Turin, Italy.
| | - M Giacomuzzi
- Department of Public Health and Pediatrics, University of Turin, Italy
| | - G Memoli
- Department of Public Health and Pediatrics, University of Turin, Italy
| | - C M Zotti
- Department of Public Health and Pediatrics, University of Turin, Italy
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41
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Pradal I, Esteban J, Mediero A, García-Coca M, Aguilera-Correa JJ. Contact Effect of a Methylobacterium sp. Extract on Biofilm of a Mycobacterium chimaera Strain Isolated from a 3T Heater-Cooler System. Antibiotics (Basel) 2020; 9:E474. [PMID: 32756304 PMCID: PMC7460266 DOI: 10.3390/antibiotics9080474] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 07/22/2020] [Accepted: 07/29/2020] [Indexed: 11/17/2022] Open
Abstract
Mycobacterium chimaera is an opportunistic slowly growing non-tuberculous mycobacteriumof increasing importance due to the outbreak of cases associated with contaminated 3T heater-cooler device (HCD) extracorporeal membrane oxygenator (ECMO). The aim of this study was to evaluate the effect of pre-treating a surface with a Methylobacterium sp. CECT 7180 extract to inhibit the M. chimaera ECMO biofilm as well as of the treatment after different dehydration times. Surface adherence, biofilm formation and treatment effect were evaluated by estimating colony-forming units (CFU) per square centimeter and characterizing the amount of covered surface area, thickness, cell viability, and presence of intrinsic autofluorescence at different times using confocal laser scanning microscopy and image analysis. We found that exposing a surface to the Methylobacterium sp. CECT 7180 extract inhibited M. chimaera ECMO biofilm development. This effect could be result of the effect of Methylobacterium proteins, such as DNaK, trigger factor, and xanthine oxidase. In conclusion, exposing a surface to the Methylobacteriumsp. extract inhibits M. chimaera ECMO biofilm development. Furthermore, this extract could be used as a pre-treatment prior to disinfection protocols for equipment contaminated with mycobacteria after dehydration for at least 96 h.
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Affiliation(s)
- Inés Pradal
- Clinical Microbiology Department, IIS-Fundación Jiménez Díaz, UAM, 28040 Madrid, Spain
| | - Jaime Esteban
- Clinical Microbiology Department, IIS-Fundación Jiménez Díaz, UAM, 28040 Madrid, Spain
| | - Arancha Mediero
- Bone and Joint Unit, IIS-Fundación Jiménez Díaz, UAM, 28040 Madrid, Spain
| | - Marta García-Coca
- Clinical Microbiology Department, Quironsalud-Madrid University Hospital, 28223 Pozuelo de Alarcón, Spain
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Lecorche E, Pean de Ponfilly G, Mougari F, Benmansour H, Poisnel E, Janvier F, Cambau E. Disseminated Mycobacterium chimaera Following Open-Heart Surgery, the Heater-Cooler Unit Worldwide Outbreak: Case Report and Minireview. Front Med (Lausanne) 2020; 7:243. [PMID: 32613002 PMCID: PMC7308416 DOI: 10.3389/fmed.2020.00243] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Accepted: 05/07/2020] [Indexed: 12/17/2022] Open
Abstract
Invasive cardiovascular infections by Mycobacterium chimaera associated with open-heart surgery have been reported worldwide since 2013. Here, we report a case of a 61 year old man, without any other particular medical background, who underwent cardiac surgery for replacing part of the ascending aorta by a bio-prosthetic graft. Eighteen months later, the patient was painful at the lower back with fever. A pyogenic vertebral osteomyelitis due to M. chimaera associated to graft infection was diagnosed after 6 months of sub-acute infection. The patient presented a disseminated disease with cerebral lesions, chorioretinitis, and chronic renal failure. Despite adequate antimicrobial treatment and graft explantation, the patient died after 6 years. We reviewed the literature on M. chimaera infections associated with open-heart surgery. The worldwide outbreak has been explained by airborne bioaerosol generated by the 3T heater–cooler unit (HCU) used during cardiac by-pass surgical procedures. These infections are difficult to diagnose because of a long latency period (up to several years), with no specific symptoms and a highly specialized microbiological diagnosis. The treatment is based on antibiotics and surgery. These infections are also difficult to treat, since the mortality rate is high around 50%. Prevention is necessary by modifying the use of HCUs in operating rooms.
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Affiliation(s)
- Emmanuel Lecorche
- Université de Paris, IAME, INSERM, UMR1137, UFR de Médecine, Paris, France.,CNR-MyRMA, Centre National de Reference pour les Mycobactéries et les Antituberculeux, APHP, Paris, France.,APHP, Hôpital Lariboisière, Service de Microbiologie, Paris, France
| | | | - Faiza Mougari
- Université de Paris, IAME, INSERM, UMR1137, UFR de Médecine, Paris, France.,CNR-MyRMA, Centre National de Reference pour les Mycobactéries et les Antituberculeux, APHP, Paris, France.,APHP, Hôpital Lariboisière, Service de Microbiologie, Paris, France
| | - Hanaa Benmansour
- Université de Paris, IAME, INSERM, UMR1137, UFR de Médecine, Paris, France.,CNR-MyRMA, Centre National de Reference pour les Mycobactéries et les Antituberculeux, APHP, Paris, France.,APHP, Hôpital Lariboisière, Service de Microbiologie, Paris, France
| | - Elodie Poisnel
- Service de Medecine Interne, Hôpital d'Instruction des Armées Sainte Anne, Toulon, France
| | - Frederic Janvier
- Service de microbiologie, Hôpital d'Instruction des Armées Sainte Anne, Toulon, France.,Ecole du Val-de-Grâce, Paris, France
| | - Emmanuelle Cambau
- Université de Paris, IAME, INSERM, UMR1137, UFR de Médecine, Paris, France.,CNR-MyRMA, Centre National de Reference pour les Mycobactéries et les Antituberculeux, APHP, Paris, France.,APHP, Hôpital Lariboisière, Service de Microbiologie, Paris, France
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Kasperbauer SH, Daley CL. Mycobacterium chimaera Infections Related to the Heater-Cooler Unit Outbreak: A Guide to Diagnosis and Management. Clin Infect Dis 2020; 68:1244-1250. [PMID: 30371755 DOI: 10.1093/cid/ciy789] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Accepted: 10/06/2018] [Indexed: 01/01/2023] Open
Abstract
We are in the midst of a global outbreak of Mycobacterium chimaera infections related to a point source contamination of a widely used surgical device, the 3T heater-cooler unit. More than 250000 heart bypass procedures using heater-cooler devices are performed in the United States every year. It is estimated that 60% of these operations use the device associated with this outbreak. Most of the reported cases present with a disseminated infection that is striking in both the latency of presentation and the high mortality. The diagnosis can be elusive due to intermittent bacteremia and normal echocardiography. Therapy includes several months of antibiotics, and surgical intervention appears to be critical for successful outcomes. Here, we review diagnostic methods and treatment options to guide clinicians in the management of this complicated infection.
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Affiliation(s)
- Shannon H Kasperbauer
- Department of Medicine, National Jewish Health, Denver.,University of Colorado, Aurora
| | - Charles L Daley
- Department of Medicine, National Jewish Health, Denver.,University of Colorado, Aurora
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MULTIMODAL IMAGING OF CHOROIDAL LESIONS IN DISSEMINATED MYCOBACTERIUM CHIMAERA INFECTION AFTER CARDIOTHORACIC SURGERY. Retina 2020; 39:452-464. [PMID: 29206759 DOI: 10.1097/iae.0000000000001991] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To explore morphologic characteristics of choroidal lesions in patients with disseminated Mycobacterium chimaera infection subsequent to open-heart surgery. METHODS Nine patients (18 eyes) with systemic M. chimaera infection were reviewed. Activity of choroidal lesions were evaluated using biomicroscopy, fundus autofluorescence, enhanced depth imaging optical coherence tomography, fluorescein angiography/indocyanine green angiography, and optical coherence tomography angiography. Relationships of choroidal findings to systemic disease activity were sought. RESULTS All 9 male patients, aged between 49 and 66 years, were diagnosed with endocarditis and/or aortic graft infection. Mean follow-up was 17.6 months. Four patients had only inactive lesions (mild disease). In all five patients (10 eyes) with progressive ocular disease, indocyanine green angiography was superior to other tests for revealing new lesions and active lesions correlated with hyporeflective choroidal areas on enhanced depth imaging optical coherence tomography. One eye with a large choroidal granuloma developed choroidal neovascularization. Optical coherence tomography angiography showed areas with reduced perfusion at the inner choroid. All 5 patients with progressive ocular disease had evidence of systemic disease activity within ±6 weeks' duration. CONCLUSION Choroidal manifestation of disseminated M. chimaera infection indicates systemic disease activity. Multimodal imaging is suitable to recognize progressive ocular disease. We propose ophthalmologic screening examinations for patients with M. chimaera infection.
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45
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Mak EEH, Sng LH, Lee BWM, Peh JWL, Colman RE, Seifert M. The effect of sodium thiosulfate on the recovery of Mycobacterium chimaera from heater-cooler unit water samples. J Hosp Infect 2020; 105:252-257. [PMID: 32112827 DOI: 10.1016/j.jhin.2020.02.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Accepted: 02/19/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Heater-cooler units (HCUs) have been implicated in the recent global outbreak of invasive Mycobacterium chimaera infection among patients following cardiothoracic surgery. Because infected patients tend to remain asymptomatic for extended periods, detection of M. chimaera from HCUs in real time is essential to halting the ongoing M. chimaera HCU-associated outbreak. Sample collection protocols to evaluate the presence of M. chimaera offer conflicting recommendations regarding the addition of sodium thiosulfate (NaT) during the collection process. AIM To study the effect of NaT on M. chimaera recovery and culture contamination. METHODS Seventy-six paired HCU water samples (with and without NaT) were collected, processed and cultured simultaneously into Lowenstein-Jensen slants, Middlebrook 7H10 agar plates, and mycobacterial growth indicator tubes (MGITs), and incubated at 37°C. A subset of 31 paired samples was additionally cultured on MGITs and incubated at 30°C. FINDINGS Of 76 samples incubated at 37°C in each of the three media, with and without NaT, M. chimaera was identified in at least one aliquot of 21 samples. CONCLUSION The presence of NaT did not significantly increase the probability of recovering M. chimaera in a multi-variable conditional logistic model and culture contamination rates were similar between aliquots with and without NaT. In the subset of samples cultured on MGITs at both 30°C and 37°C, the presence of NaT again was not associated with M. chimaera recovery, but was significantly associated with reduced culture contamination.
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Affiliation(s)
- E E H Mak
- Department of Medicine, University of California, San Diego, CA, USA
| | - L H Sng
- Singapore General Hospital, Singhealth, Singapore.
| | - B W M Lee
- Singapore General Hospital, Singhealth, Singapore
| | - J W L Peh
- Singapore General Hospital, Singhealth, Singapore
| | - R E Colman
- Department of Medicine, University of California, San Diego, CA, USA
| | - M Seifert
- Department of Medicine, University of California, San Diego, CA, USA.
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46
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Colucciello M. Mycobacterium chimaera chorioretinitis as a biomarker of systemic disease activity following nosocomial acquisition during cardiopulmonary bypass. Postgrad Med 2019; 132:167-171. [PMID: 31766930 DOI: 10.1080/00325481.2019.1697545] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Objectives: To understand the role of ophthalmoscopic examination (dilated retina examination and widefield fundus photography) in the diagnosis and management of nosocomial acquisition of Mycobacterium chimaera following open heart surgery with cardiopulmonary bypass utilizing a heater-cooler unit, an entity that is associated with >50% mortality during the worldwide outbreak that has occurred since 2013.Methods: Case report with review of previous cases.Results: Signature Mycobacterium chimaera chorioretinal lesions can be used as a diagnostic sign and a biomarker for assessment of treatment efficacy.Conclusions: Ophthalmologic examination can play a key role in diagnosis and management of systemic Mycobacterium chimaera following cardiopulmonary bypass; such examinations may yield earlier diagnosis, diminishing mortality rates.
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Affiliation(s)
- Michael Colucciello
- Clinical Associate, University of Pennsylvania School of Medicine; Retina Specialist, Vantage Eye Care, South Jersey Eye Physicians Division, Moorestown, NJ, USA
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47
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Abstract
Mycobacterium chimaera was identified as a species within the Mycobacterium avium complex in 2004. Until recently, it was predominantly seen in immunocompromised patients. In 2015, an outbreak of disseminated M. chimaera disease was described in European patients after undergoing open-heart surgery in which contaminated heater-cooler water units were used. Using whole genomic sequencing and phylogenetic analysis, investigators found a highly clonal outbreak from the German manufacturing site of the heater-cooler water units. This outbreak has now proven to be world-wide. Patients present with fever, fatigue, and weight loss months to many years after surgery. They are found to have systemic manifestations, including endocarditis, pancytopenia, renal dysfunction, chorioretinitis, and hepatitis. Preliminary reports suggest a high mortality rate despite aggressive treatment. In some patients, the predominant laboratory abnormalities are elevations in liver function tests, leading to diagnostic hepatobiliary work-ups, including liver biopsy. The pathologic changes in the liver have not yet been described. Herein, we report the clinicopathologic findings of the largest series of M. chimaera liver disease in the United States to date: 7 cases within a large, multihospital health care network. Five (71%) patients died of disease, despite aggressive treatment. Liver function test abnormalities were predominantly biliary: mean values of alkaline phosphate 288 U/L, aspartate aminotransferase 79 U/L, alanine aminotransferase 64 U/L. All 7 biopsies showed a consistent and characteristic dual pattern of injury: small, ill-formed collections of sinusoidal histiocytes with rare multinucleated giant cells, and scattered architectural changes of venous outflow obstruction. Two (29%) cases showed mild pericellular fibrosis. Nodular regenerative hyperplasia was seen in 2 (29%) cases, consistent with a sinusoidal/venous obstructive pattern of injury. We postulate that the sinusoidal location of the granulomas contributes to the venous obstructive changes. Recognition of this characteristic dual pattern of injury can allow pathologists to suggest the diagnosis and prompt the appropriate diagnostic and therapeutic interventions.
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48
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Hasse B, Hannan MM, Keller PM, Maurer FP, Sommerstein R, Mertz D, Wagner D, Fernández-Hidalgo N, Nomura J, Manfrin V, Bettex D, Hernandez Conte A, Durante-Mangoni E, Tang THC, Stuart RL, Lundgren J, Gordon S, Jarashow MC, Schreiber PW, Niemann S, Kohl TA, Daley CL, Stewardson AJ, Whitener CJ, Perkins K, Plachouras D, Lamagni T, Chand M, Freiberger T, Zweifel S, Sander P, Schulthess B, Scriven JE, Sax H, van Ingen J, Mestres CA, Diekema D, Brown-Elliott BA, Wallace RJ, Baddour LM, Miro JM, Hoen B, Athan E, Bayer A, Barsic B, Corey GR, Chu VH, Durack DT, Fortes CQ, Fowler V, Hoen B, Krachmer AW, Durante-Magnoni E, Miro JM, Wilson WR. International Society of Cardiovascular Infectious Diseases Guidelines for the Diagnosis, Treatment and Prevention of Disseminated Mycobacterium chimaera Infection Following Cardiac Surgery with Cardiopulmonary Bypass. J Hosp Infect 2019; 104:214-235. [PMID: 31715282 DOI: 10.1016/j.jhin.2019.10.009] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Accepted: 10/08/2019] [Indexed: 02/09/2023]
Abstract
Mycobacterial infection-related morbidity and mortality in patients following cardiopulmonary bypass surgery is high and there is a growing need for a consensus-based expert opinion to provide international guidance for diagnosing, preventing and treating in these patients. In this document the International Society for Cardiovascular Infectious Diseases (ISCVID) covers aspects of prevention (field of hospital epidemiology), clinical management (infectious disease specialists, cardiac surgeons, ophthalmologists, others), laboratory diagnostics (microbiologists, molecular diagnostics), device management (perfusionists, cardiac surgeons) and public health aspects.
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Affiliation(s)
- B Hasse
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital and University of Zurich, Switzerland.
| | - M M Hannan
- Clinical Microbiology, Mater Misericordiae University Hospital, Dublin, Ireland
| | - P M Keller
- Institute for Infectious Diseases, University of Bern, Bern, Switzerland
| | - F P Maurer
- Diagnostic Mycobacteriology Group, National and WHO Supranational Reference Center for Mycobacteria, Research Center, Borstel, Germany
| | - R Sommerstein
- Department of Infectious Diseases, Bern University Hospital, University of Bern, Bern, Switzerland
| | - D Mertz
- Departments of Medicine, Health Research Methods, Evidence and Impact, and Pathology and Molecular Medicine, McMaster University, Hamilton, ON, Canada
| | - D Wagner
- Department of Internal Medicine II, Division of Infectious Diseases, Medical Center - University of Freiburg, Freiburg i.Br, Germany
| | - N Fernández-Hidalgo
- Servei de Malalties Infeccioses, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - J Nomura
- Kaiser Permanente Infectious Diseases, Los Angeles Medical Center, CA, USA
| | - V Manfrin
- Infectious and Tropical Diseases Department, San Bortolo Hospital, Vincenca, Italy
| | - D Bettex
- Institute of Anesthesiology, University Hospital Zurich, Switzerland
| | - A Hernandez Conte
- Department of Anaesthesiology, Kaiser Permanente, Los Angeles Medical Center, CA, USA
| | - E Durante-Mangoni
- Infectious and Transplant Medicine, University of Campania 'L. Vanvitelli', Monaldi Hospital, Naples, Italy
| | - T H-C Tang
- Division of Infectious Diseases, Department of Medicine, Queen Elizabeth Hospital, Hong Kong, China
| | - R L Stuart
- Monash Infectious Diseases, Monash Health, Australia
| | - J Lundgren
- Department of Infectious Diseases, Rigshospitalet, University of Copenhagen, Denmark
| | - S Gordon
- Department of Infectious Diseases, Cleveland Clinic, OH, USA
| | - M C Jarashow
- Acute Communicable Disease Control, Los Angeles Department of Public Health, LA, USA
| | - P W Schreiber
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital and University of Zurich, Switzerland
| | - S Niemann
- Molecular and Experimental Mycobacteriology Group, Research Center Borstel, Borstel, Germany and German Center for Infection Research (DZIF), partner site Hamburg - Lübeck - Borstel - Riems, Borstel, Germany
| | - T A Kohl
- Molecular and Experimental Mycobacteriology Group, Research Center Borstel, Borstel, Germany and German Center for Infection Research (DZIF), partner site Hamburg - Lübeck - Borstel - Riems, Borstel, Germany
| | - C L Daley
- Division of Mycobacterial and Respiratory Infections, National Jewish Health, Denver, CO, USA
| | - A J Stewardson
- Department of Infectious Diseases, The Alfred and Central Clinical School, Monash University, Melbourne, Australia
| | - C J Whitener
- Penn State Health, Milton S. Hershey Medical Center, Hershey, PA, USA
| | - K Perkins
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, USA
| | - D Plachouras
- Healthcare-associated Infections, European Centre for Disease Prevention and Control (ECDC), Solna, Sweden
| | - T Lamagni
- National Infection Service, Public Health England, London, UK
| | - M Chand
- National Infection Service, Public Health England, London, UK; Guy's and St Thomas' NHS Foundation Trust, Imperial College London, UK
| | - T Freiberger
- Centre for Cardiovascular Surgery and Transplantation, Brno, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - S Zweifel
- Ophthalmology Unit, University of Zurich, Switzerland
| | - P Sander
- National Center for Mycobacteria, Zurich, Switzerland, Institute of Medical Microbiology, University of Zurich, Zurich, Switzerland
| | - B Schulthess
- Institute of Medical Microbiology, University of Zurich, Zurich, Switzerland
| | - J E Scriven
- Department of Infection and Tropical Medicine, University Hospitals Birmingham, Birmingham, UK
| | - H Sax
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital and University of Zurich, Switzerland
| | - J van Ingen
- Department of Medical Microbiology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - C A Mestres
- Clinic for Cardiovascular Surgery, University Hospital and University of Zurich, Switzerland
| | - D Diekema
- Division of Infectious Diseases, University of Iowa, Carver College of Medicine, IA, USA
| | - B A Brown-Elliott
- Department of Microbiology, The University of Texas Health Science Center at Tyler, Tyler, TX, USA
| | - R J Wallace
- Department of Microbiology, The University of Texas Health Science Center at Tyler, Tyler, TX, USA
| | - L M Baddour
- Division of Infectious Diseases, Departments of Medicine and Cardiovascular Diseases, Mayo Clinic, College of Medicine and Science, Rochester, MN, USA
| | - J M Miro
- Infectious Diseases Service at the Hospital Clinic-IDIBAPS, University of Barcelona, Barcelona, Spain
| | - B Hoen
- Department of Infectious Diseases and Tropical Medicine, University Medical Center of Nancy, Vandoeuvre Cedex, France.
| | | | | | - E Athan
- Infectious Diseases Department at Barwon Health, University of Melbourne and Deakin University, Australia
| | - A Bayer
- Geffen School of Medicine at UCLA Senior Investigator - LA Biomedical Research Institute at Harbor-UCLA, USA
| | - B Barsic
- Department for Infectious Diseases, School of Medicine, University of Zagreb, Croatia
| | - G R Corey
- Duke University Medical Center, Hubert-Yeargan Center for Global Health, Department of Medicine, Duke University Medical Center, Durham, NC, USA
| | - V H Chu
- Division of Infectious Diseases, Duke University Medical Center, Durham, NC, USA
| | - D T Durack
- Division of Infectious Diseases, Duke University Medical Center, Durham, NC, USA
| | - C Q Fortes
- Division of Infectious Diseases, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - V Fowler
- Departments of Medicine and Molecular Genetics & Microbiology, Duke University Medical Center, Durham, NC, USA
| | - B Hoen
- Department of Infectious Diseases and Tropical Medicine, University Medical Center of Nancy, Vandoeuvre Cedex, France
| | - A W Krachmer
- Harvard Medical School, Division of Infectious Diseases at the Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - E Durante-Magnoni
- Infectious and Transplant Medicine of the 'V. Monaldi' Teaching Hospital in Naples, University of Campania 'L. Vanvitelli', Italy
| | - J M Miro
- Infectious Diseases at the Hospital Clinic-IDIBAPS, University of Barcelona, Barcelona, Spain
| | - W R Wilson
- Division of Infectious Diseases, Department of Internal Medicine, Mayo Clinic, College of Medicine and Science, Rochester, MN, USA
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Ditommaso S, Giacomuzzi M, Memoli G, Cavallo R, Curtoni A, Avolio M, Silvestre C, Zotti CM. Reduction of turnaround time for non-tuberculous mycobacteria detection in heater-cooler units by propidium monoazide-real-time polymerase chain reaction. J Hosp Infect 2019; 104:365-373. [PMID: 31628958 DOI: 10.1016/j.jhin.2019.10.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Revised: 10/08/2019] [Accepted: 10/10/2019] [Indexed: 11/17/2022]
Abstract
BACKGROUND Invasive non-tuberculous mycobacteria (NTM) infections are emerging worldwide in patients undergoing open-chest cardiac bypass surgery exposed to contaminated heater-cooler units (HCUs). Although this outbreak has been investigated by culturing bacteria isolated from HCU aerosol and water samples, these conventional methods have low-analytic sensitivity, high rates of sample contamination, and long turnaround time. AIM To develop a simple and effective method to detect NTM in HCUs by real-time polymerase chain reaction (PCR), with a short laboratory turnaround time and reliable culture results. METHODS A total of 281 water samples collected from various HCUs at seven Italian hospitals were simultaneously screened for NTM by a propidium monoazide (PMA)-PCR assay and by conventional culture testing. The results were analysed with culture testing as the reference method. FINDINGS (i) The agreement between culture testing and PMA-PCR was 85.0% with a cycle threshold (CT) cut-off value of <38 vs 80.0% with a CT of <43, with a moderate Cohen's κ-coefficient; (ii) the CT cut-off value of <42 was deemed more suitable for predicting positive specimens; (iii) given the low concentration of target DNA in water samples, the minimum volume to be tested was 1 L. CONCLUSION The use of PMA-PCR for fast detection of NTM from environmental samples is highly recommended in order to ascertain whether HCUs may represent a potential source of human exposure to NTM. This reliable and simple method reduces laboratory turnaround time compared to conventional methods (one to two days vs eight weeks, respectively), thereby improving control strategies and effective management of HCUs.
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Affiliation(s)
- S Ditommaso
- Department of Public Health and Pediatrics, University of Turin, Turin, Italy.
| | - M Giacomuzzi
- Department of Public Health and Pediatrics, University of Turin, Turin, Italy
| | - G Memoli
- Department of Public Health and Pediatrics, University of Turin, Turin, Italy
| | - R Cavallo
- Department of Public Health and Pediatrics, University of Turin, Turin, Italy; Microbiology and Virology Unit, University Hospital Città della Salute e della Scienza di Torino, Turin, Italy
| | - A Curtoni
- Microbiology and Virology Unit, University Hospital Città della Salute e della Scienza di Torino, Turin, Italy
| | - M Avolio
- Microbiology and Virology Unit, University Hospital Città della Salute e della Scienza di Torino, Turin, Italy
| | - C Silvestre
- AOU Città della salute e della Scienza, Turin, Italy
| | - C M Zotti
- Department of Public Health and Pediatrics, University of Turin, Turin, Italy
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50
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Inojosa WO, Giobbia M, Muffato G, Minniti G, Baldasso F, Carniato A, Farina F, Forner G, Rossi MC, Formentini S, Rigoli R, Scotton PG. Mycobacterium chimaera infections following cardiac surgery in Treviso Hospital, Italy, from 2016 to 2019: Cases report. World J Clin Cases 2019; 7:2776-2786. [PMID: 31616692 PMCID: PMC6789390 DOI: 10.12998/wjcc.v7.i18.2776] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2019] [Revised: 08/19/2019] [Accepted: 09/09/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND An epidemic of Mycobacterium chimaera (M. chimaera) infections following cardiac surgery is ongoing worldwide. The outbreak was first discovered in 2011, and it has been traced to a point source contamination of the LivaNova 3T heater-cooler unit, which is used also in Italy. International data are advocated to clarify the spectrum of clinical features of the disease as well as treatment options and outcome. We report a series of M. chimaera infections diagnosed in Treviso Hospital, including the first cases notified in Italy in 2016.
CASE SUMMARY Since June 2016, we diagnosed a M. chimaera infection in nine patient who had undergone cardiac valve surgery between February 2011 and November 2016. The time between cardiac surgery and developing symptoms ranged from 6 to 97 mo. Unexplained fever, psychophysical decay, weight loss, and neurological symptoms were common complaints. The median duration of symptoms was 32 wk, and the longest was almost two years. A new cardiac murmur, splenomegaly, choroidoretinitis, anaemia or lymphopenia, abnormal liver function tests and hyponatremia were common findings. All the patients presented a prosthetic valve endocarditis, frequently associated to an ascending aortic pseudoneurysm or spondylodiscitis. M. chimaera was cultured from blood, bioprosthetic tissue, pericardial abscess, vertebral tissue, and bone marrow. Mortality is high in our series, reflecting the poor outcome observed in other reports. Three patients have undergone repeat cardiac surgery. Five patients are being treated with a targeted multidrug antimycobacterial regimen.
CONCLUSION Patients who have undergone cardiac surgery in Italy and presenting with signs and symptoms of endocarditis must be tested for M. chimaera.
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Affiliation(s)
- Walter O Inojosa
- Infectious Diseases Unit, Treviso Hospital, Treviso 31100, Italy
| | - Mario Giobbia
- Infectious Diseases Unit, Treviso Hospital, Treviso 31100, Italy
| | | | | | | | | | - Francesca Farina
- Infectious Diseases Unit, Treviso Hospital, Treviso 31100, Italy
| | - Gabriella Forner
- Infectious Diseases Unit, Treviso Hospital, Treviso 31100, Italy
| | - Maria C Rossi
- Infectious Diseases Unit, Treviso Hospital, Treviso 31100, Italy
| | | | - Roberto Rigoli
- Microbiology Unit, Treviso Hospital, Treviso 31100, Italy
| | - Pier G Scotton
- Infectious Diseases Unit, Treviso Hospital, Treviso 31100, Italy
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