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Mycobacterium chimaera infections in cardiothoracic surgery patients exposed to heating and cooling devices despite infection control measures
- Jensie Burton, Yosra Alkabab, Susan Dorman, Jeremy D. Moore, Danny Nixon, Cassandra Salgado, Scott Curry
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- Journal:
- Antimicrobial Stewardship & Healthcare Epidemiology / Volume 3 / Issue S2 / June 2023
- Published online by Cambridge University Press:
- 29 September 2023, pp. s15-s16
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- Article
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Background: LivaNova 3T heating and cooling devices (HCDs) have been associated with Mycobacterium chimaera, a Mycobacterium avium-intracellulare (MAIC) species, infections after cardiothoracic surgery. We describe our outbreak, which persisted despite escalating infection control measures. Methods: We identified patients with a positive MAIC culture following cardiothoracic surgery from January 2015 to the present at our institution. We classified these as “definite,” “possible,” or “operating room contamination” cases based on positive cultures from sterile sites, airway, or surgical specimens without evidence of infection. To identify patient or surgery characteristics associated with risk for MAIC infection, we conducted a case–control study comparing definite cases to randomly selected unmatched controls of patients over the same period without a positive MAIC culture after cardiothoracic surgery. Results: We identified 26 patients with a positive MAIC culture after cardiothoracic surgery: 13 definite, 9 possible, and 4 contamination cases. Among definite cases, the most common surgeries were valve replacements and left ventricular assist devices (5 cases each). The mean time from cardiothoracic surgery to diagnosis was 525 days. Overall, 10 (77%) cases occurred after exposure to our oldest HCDs (manufactured in 2013 or earlier). To date, 16 (62%) have undergone or are undergoing treatment for MAIC infection, and 4 (15%) have died due to NTM infection or complications. Compared to 47 controls, definite cases were associated with chronic kidney disease, implants, procedure type, use of cardiopulmonary bypass, and HCD age. Cases were not associated with time on bypass, time in the operating room, or other comorbid conditions (Table). All cases occurred despite enhanced disinfection and reorienting the HCD within the operating room, according to manufacturer recommendations. Moreover, 18 cases, including 7 definite cases, occurred after most HCDs were either deep cleaned or upgraded by the manufacturer. Also, 5 cases, including 3 possible cases and 2 contamination cases, occurred after physical separation of the HCD from the operating room. In August 2022, we purchased a fleet of glycol-cooled HCDs, and we have not identified additional MAIC cases since their deployment (Fig.). Conclusions: MAIC infections after cardiothoracic surgery were associated with procedure type, especially implants, use of cardiopulmonary bypass, and HCD age. Contrary to prior reports, neither operative nor CPB time was associated with MAIC infection after cardiothoracic surgery. The outbreak persisted despite disinfection and/or deep cleaning and reorienting HCDs within the operating room; some possible and contamination cases occurred even after moving HCDs outside the operating room. Thus, HCD water contamination events in the operating room (eg, spills from HCD tubing) may be a route of exposure, and different infection prevention measures are needed.
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- By Shamsuddin Akhtar, Greg Albert, Sidney Allison, Muhammad Anwar, Haruo Arita, Amanda Barker, Mary Hanna Bekhit, Jeanna Blitz, Tyson Bolinske, David Burbulys, Asokumar Buvanendran, Gregory Cain, Keith A. Candiotti, Daniel B. Carr, Derek Chalmers, John Charney, Rex Cheng, Roger Chou, Keun Sam Chung, Anna Clebone, Frederick Conlin, Susan Dabu-Bondoc, Tiffany Denepitiya-Balicki, Jeanette Derdemezi, Anahat Kaur Dhillon, Ho Dzung, Juan Jose Egas, Stephen M. Eskaros, Zhuang T. Fang, Claudia R. Fernandez Robles, Victor A. Filadora, Ellen Flanagan, Dan Froicu, Allison Gandey, Nehal Gatha, Boris Gelman, Christopher Gharibo, Muhammad K. Ghori, Brian Ginsberg, Michael E. Goldberg, Jeff Gudin, Thomas Halaszynski, Martin Hale, Dorothea Hall, Craig T. Hartrick, Justin Hata, Lars E. Helgeson, Joe C. Hong, Richard W. Hong, Balazs Horvath, Eric S. Hsu, Gabriel Jacobs, Jonathan S. Jahr, Rongjie Jaing, Inderjeet Singh Julka, Zeev N. Kain, Clinton Kakazu, Kianusch Kiai, Mary Keyes, Michael M. Kim, Peter G. Lacouture, Ryan Lanier, Vivian K. Lee, Mark J. Lema, Oscar A. de Leon-Casasola, Imanuel Lerman, Philip Levin, Steven Levin, JinLei Li, Eric C. Lin, Sharon Lin, David A. Lindley, Ana M. Lobo, Marisa Lomanto, Mirjana Lovrincevic, Brenda C. McClain, Tariq Malik, Jure Marijic, Joseph Marino, Laura Mechtler, Alan Miller, Carly Miller, Amit Mirchandani, Sukanya Mitra, Fleurise Montecillo, James M. Moore, Debra E. Morrison, Philip F. Morway, Carsten Nadjat-Haiem, Hamid Nourmand, Dana Oprea, Sunil J. Panchal, Edward J. Park, Kathleen Ji Park, Kellie Park, Parisa Partownavid, Akta Patel, Bijal Patel, Komal D. Patel, Neesa Patel, Swati Patel, Paul M. Peloso, Danielle Perret, Anthony DePlato, Marjorie Podraza Stiegler, Despina Psillides, Mamatha Punjala, Johan Raeder, Siamak Rahman, Aziz M. Razzuk, Maggy G. Riad, Kristin L. Richards, R. Todd Rinnier, Ian W. Rodger, Joseph Rosa, Abraham Rosenbaum, Alireza Sadoughi, Veena Salgar, Leslie Schechter, Michael Seneca, Yasser F. Shaheen, James H. Shull, Elizabeth Sinatra, Raymond S. Sinatra, Neil Singla, Neil Sinha, Denis V. Snegovskikh, Dmitri Souzdalnitski, Julie Sramcik, Zoreh Steffens, Alexander Timchenko, Vadim Tokhner, Marc C. Torjman, Co T. Truong, Nalini Vadivelu, Ashley Vaughn, Anjali Vira, Eugene R. Viscusi, Dajie Wang, Shu-ming Wang, J. Michael Watkins-Pitchford, Steven J. Weisman, Ira Whitten, Bryan S. Williams, Jeremy M. Wong, Thomas Wong, Christopher Wray, Yaw Wu, Anthony T. Yarussi, Laurie Yonemoto, Bita H. Zadeh, Jill Zafar, Martha Zegarra, Keren Ziv
- Edited by Raymond S. Sinatra, Jonathan S. Jahr, University of California, Los Angeles, School of Medicine, J. Michael Watkins-Pitchford
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- Book:
- The Essence of Analgesia and Analgesics
- Published online:
- 06 December 2010
- Print publication:
- 14 October 2010, pp xi-xviii
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