Journal ArticleDOI
Global outbreak of severe Mycobacterium chimaera disease after cardiac surgery: a molecular epidemiological study
Jakko van Ingen,Thomas Kohl,Katharina Kranzer,Barbara Hasse,Peter M. Keller,Anna K. Szafrańska,Doris Hillemann,Meera Chand,Meera Chand,Meera Chand,Peter W Schreiber,Rami Sommerstein,Rami Sommerstein,Christoph Berger,Michele Genoni,Christian Rüegg,Nicolas Troillet,Andreas F. Widmer,Sören L. Becker,Sören L. Becker,Mathias Herrmann,Tim Eckmanns,Sebastian Haller,Christiane Höller,Sylvia B. Debast,Maurice J H M Wolfhagen,Joost Hopman,Jan Kluytmans,Merel Langelaar,Daan W. Notermans,Jaap ten Oever,Peter van den Barselaar,Alexander B.A. Vonk,Margreet C. Vos,Nada Ahmed,Tim Brown,Derrick W. Crook,Derrick W. Crook,Theresa Lamagni,Nick Phin,E. Grace Smith,Maria Zambon,Annerose Serr,Tim Götting,W. Ebner,Alexander Thürmer,Christian Utpatel,Cathrin Spröer,Boyke Bunk,Ulrich Nübel,Guido V. Bloemberg,Erik C. Böttger,Stefan Niemann,Dirk Wagner,Hugo Sax +54 more
TLDR
HCU contamination with M chimaera at the LivaNova factory seems a likely source for cardiothoracic surgery-related severe M chimeera infections diagnosed in Switzerland, Germany, the Netherlands, the UK, the USA, and Australia.Abstract:
Summary Background Since 2013, over 100 cases of Mycobacterium chimaera prosthetic valve endocarditis and disseminated disease were notified in Europe and the USA, linked to contaminated heater–cooler units (HCUs) used during cardiac surgery. We did a molecular epidemiological investigation to establish the source of these patients' disease. Methods We included 24 M chimaera isolates from 21 cardiac surgery-related patients in Switzerland, Germany, the Netherlands, and the UK, 218 M chimaera isolates from various types of HCUs in hospitals, from LivaNova (formerly Sorin; London, UK) and Maquet (Rastatt, Germany) brand HCU production sites, and unrelated environmental sources and patients, as well as eight Mycobacterium intracellulare isolates. Isolates were analysed by next-generation whole-genome sequencing using Illumina and Pacific Biosciences technologies, and compared with published M chimaera genomes. Findings Phylogenetic analysis based on whole-genome sequencing of 250 isolates revealed two major M chimaera groups. Cardiac surgery-related patient isolates were all classified into group 1, in which all, except one, formed a distinct subgroup. This subgroup also comprised isolates from 11 cardiac surgery-related patients reported from the USA, most isolates from LivaNova HCUs, and one from their production site. Isolates from other HCUs and unrelated patients were more widely distributed in the phylogenetic tree. Interpretation HCU contamination with M chimaera at the LivaNova factory seems a likely source for cardiothoracic surgery-related severe M chimaera infections diagnosed in Switzerland, Germany, the Netherlands, the UK, the USA, and Australia. Protective measures and heightened clinician awareness are essential to guarantee patient safety. Funding Partly funded by the EU Horizon 2020 programme, its FP7 programme, the German Center for Infection Research (DZIF), the Swiss National Science Foundation, the Swiss Federal Office of Public Health, and National Institute of Health Research Oxford Health Protection Research Units on Healthcare Associated Infection and Antimicrobial Resistance.read more
Citations
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The Comparison of Metagenomic Next-Generation Sequencing with Conventional Microbiological Tests for Identification of Pathogens and Antibiotic Resistance Genes in Infectious Diseases
Hongzhi Lu,Li Ma,Yong Zhang,Li-yun Feng,Ying Yu,Yihan Zhao,Li Li,Yujiao Zhou,Li Song,Wushuang Li,Jiangman Zhao,Lanxiang Liu +11 more
TL;DR: In this study, mNGS had a higher sensitivity than CMT and culture method and the result of ARGs frequency and cluster analysis of A. baumannii was of great significance to the anti-infective therapy.
Journal ArticleDOI
Failure to eradicate non-tuberculous mycobacteria upon disinfection of heater–cooler units: results of a microbiological investigation in northwestern Italy
TL;DR: 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 cooler-heater, keep it as clean as possible, and treat it like any other biohazardous material.
Journal ArticleDOI
Mycobacterium chimaera infections after cardiac surgery-lessons learned.
TL;DR: A series of experiments have established the current understanding of the transmission pathway and howinfectious aerosols are generated from the contaminated water system of operating HCDs, and how these aerosols can reach cardiac implants and the surgical site through the air flow caused by cooling fans of the LivaNova 3T H CDs.
Journal ArticleDOI
Long-term follow-up of post-cardiac surgery Mycobacterium chimaera infections: A 5-center case series
Kathleen G. Julian,Tonya Crook,Eugene Curley,A. Ben Appenheimer,Catharine I. Paules,Barbara Hasse,Daniel J. Diekema,Charles L. Daley,Jorgelina de Sanctis,Walter C. Hellinger,Adrah Levin,George McSherry,Carol Freer,Cynthia Whitener +13 more
TL;DR: Given poor response to treatment and potential for delayed relapses, post-cardiac surgery M. chimaera infection warrants aggressive treatment and long-term monitoring.
Journal ArticleDOI
Difference in drug susceptibility distribution and clinical characteristics between Mycobacterium avium and Mycobacterium intracellulare lung diseases in Shanghai, China
TL;DR: In this article, the authors evaluated the differences in antimicrobial susceptibility profiles between two major MAC species (Mycobacterium avium and Mycobacteria intracellulare) from patients with pulmonary infections and provided epidemiologic data with minimum inhibitory concentration (MIC) distributions.
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