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M. Chimaera Outbreak

M. chimaera outbreak

Published cases

Worldwide, more than 120 published cases1 of serious invasive infections caused by M. chimaera have been published following cardiothoracic surgery due to exposure to water-based heater-cooler units used during open-heart surgery.

outbreak

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~ 120 published cases

Published cases of M. chimaera infections due to contaminated heater-cooler units

cases

Studies have also positively identified M. chimaera and other non-tuberculous mycobacteria on contaminated heater-cooler units in countries yet to report patient infections, such as Singapore14, Lebanon15 and New Zealand16-23.

MAIN CHALLENGES OF M. CHIMAERA INFECTION

  • The clinical diagnosis of post-cardiac surgical M. chimaera infections may be delayed (latency up to 5 years)17
  • M. chimaera infections have a poor prognosis, with a mortality rate about 50 percent2,18,19
  • Continual lack of awareness has hampered attempts to fully contain M. chimaera infections20
  • Current anti-mycobacterial therapy causes significant toxicity21
  • Redo surgeries to remove contaminated prosthetic material are associated with high rates of complications21
  • Eradication of M. chimaera is extremely difficult as the bacteria is resistant to disinfection22,24,25
1

Acosta F, Perez-Lago L, Ruiz Serrano M, et al. Fast update of undetected Mycobacterium chimaera infections to reveal unsuspected cases. J Hosp Infect. 2018;100:451-455. doi:10.1016/j.jhin.2018.08.018

2

Kasperbauer SH, Daley CL. Mycobacterium Chimaera Infections Related to the Heater-Cooler Unit Outbreak: A Guide to Diagnosis and Management. Clin Infect Dis.2018;68(7):1244-1250. doi:10.1093/cid/ciy789

3

Hamad R, Noly P, Demers P. Mycobacterium chimaera Infection After Cardiac Surgery: First Canadian Outbreak. Ann Thorac Surg. 2017;104(1):e43-e45. doi:10.1016/j.athoracsur.2017.01.115.

4

Overton K, Mennon V, Mothobi N, et al. Cluster of invasive Mycobacteria chimaera infections following cardiac surgery demonstrating novel clinical features and risks of aortic valve replacement. Intern Med J. 2018;48:1514-1520. doi:10.1111/imj.14093

5

Bursle E, Playford EG, Coulter C, Griffin P. First Australian case of disseminated Mycobacterium Chimaera infection post-cardiothoracic surgery. Infect Dis Heal. 2017;22(1):1-5. doi:10.1016/j.idh.2017.01.003.

6

MOH. Safety alert on contamination of heater-cooler device use in cardiothoracic surgery. The Government of the Hong Kong Special Administrative Region. https://www.info.gov.hk/gia/general/201611/15/P2016111500974.htm.

7

European Centre for Disease Prevention and Control. RAPID RISK ASSESSMENT: European Centre for Disease Prevention and Control. Invasive Cardiovascular Infection by Mycobacterium Chimaera Associated with 3T Heater -Cooler System Used during Open-Heart Surgery – 18 November 2016.; 2016. https://ecdc.europa.eu/sites/portal/ files/media/en/publications/Publications/RRA-mycobacterium-chimaera-November-2016.pdf.

8

TV2. To danskere smittet med livsfarlig og sjælden bakterie - flere skal undersøges.http://nyheder.tv2.dk/lokalt/2019-07-11-to-danskere-smittet-med-livsfarlig-ogsjaelden- bakterie-flere-skal-undersoeges.

9

http://www.trovanorme.salute.gov.it/norme/renderNormsanPdf?anno=2019&codLeg=71653&parte=1%20&serie=null

10

DIREZIONE GENERALE DELLA PREVENZIONE SANITARIA. Operational Indications Concerning the Laboratory Aspects Concerning the Cases of Mycobacterium Chimaera Infection in Italy and Information Update Available. ITALY; 2019. http://www.trovanorme.salute.gov.it/norme/renderNormsanPdf?anno=2019&codLeg=68845&parte=1&serie=null.

11

Robert Koch Institut. Information on an international outbreak with non-tuberculous mycobacteria associated with temperature control devices during cardiac surgery.https://www.rki.de/DE/Content/Infekt/Krankenhaushygiene/Aufb_MedProd/Mycobacterium_chimaera.html. Published 2019.

12

Sax H, Bloemberg G, Hasse B, et al. Prolonged Outbreak of Mycobacterium Chimaera Infection After Open-Chest Heart Surgery. Clin Infect Dis. 2015;61:67-75. doi:10.1093/cid/civ198.

13

Scriven JE, Scobie A, Verlander NQ, et al. Mycobacterium Chimaera infection following cardiac surgery in the United Kingdom: clinical features and outcome of the first 30 cases. Clin Microbiol Infect. 2018;24(11):1164-1170. doi:10.1016/j.cmi.2018.04.027.

14

Chan T, Ling ML, Teng SY, Chiu KY, James EM. Microbiological monitoring of heater-cooler unit to keep free of Mycobacterium Chimaera infection. Perfu. 2019;34(1):9-14. doi:10.1177/0267659118787152.

15

Zahreddine N, Tannous J, Kanafani Z, et al. Isolation of Nontuberculous Mycobacterium (NTM) from heater cooler devices, in a tertiary care center in Lebanon. Antimicrob Resist Infect Control. 2017;6(Abstracts from the 4th International Conference on Prevention & Infection Control (ICPIC 2017)):8-9.

16

Williamson D, Howden B, Stinear T. To the Editor: Mycobacterium Chimaera Spread from Heating and Cooling Units in Heart Surgery. N Engl J Med. 2017;376(6):601-602. doi:10.1056/NEJMc1614275.

17

Kanamori H, Weber DJ, Rutala WA. Healthcare-Associated Mycobacterium Chimaera Transmission and Infection Prevention Challenges : Role of Heater-Cooler Unitsas a Water Source in Cardiac Surgery. Clin Infect Dis. 2017;27514(3):343-346. doi:10.1093/cid/ciw755.

18

Schreiber PW, Sax H. Mycobacterium Chimaera infections associated with heater – cooler units in cardiac surgery. Curr Opin Infect Dis. 2017;30(4):388-394.doi:10.1097/QCO.0000000000000385.

19

Martí MC, Bermejo BB, Gil LA. Infections with Mycobacterium Chimaera and open chest surgery. An unresolved problem. Med Clínica (English Ed. 2019:1-7.doi:10.1016/j.medcle.2019.02.006.

20

Sommerstein R, Hasse B, Marschall J, et al. Global Health Estimate of Invasive Mycobacterium Chimaera Infections Associated with Heater – Cooler Devices in Cardiac Surgery. Emerg Infect Dis. 2018;24(3):1-3.

21

Cappabianca G, Paparella D, Onofrio AD, et al. Mycobacterium Chimaera infections following cardiac surgery in Italy: results from a National Survey Endorsed by the Italian Society of Cardiac Surgery. J Cardiovasc Med. 2018;19:748-755. doi:10.2459/JCM.0000000000000717.

22

Taylor RH, Falkinham JO, Norton CD, LeChevallier MW. Chlorine, Chloramine, Chlorine Dioxide, and Ozone Susceptibility of Mycobacterium avium

23

Argent HM, Crouch GC, Roberts S, Finucane AK. Prosthetic Conduit Endocarditis With Nontuberculous Mycobacteria in a Child: Associated With the Water Mattress and Heater Chiller Unit. World J Pediatr Congenit Hear Surg. 2020;11(2):241-243. doi:10.1177/2150135119828988

24

Garvey MI, Ashford R, Bradley CW, et al. Decontamination of heater - cooler units associated with contamination by atypical mycobacteria. J Hosp Infect. 2016;93(3):229-234. doi:10.1016/j.jhin.2016.02.007

25

Barker TA, Dandekar U, Fraser N, et al. Minimising the risk of Mycobacterium chimaera infection during cardiopulmonary bypass by the removal of heater-cooler units from the operating room. Perfusion. 2018;33(4):264-269. doi:10.1177/0267659117739103