Healthcare-Associated Mycobacterium chimaera Infection Subsequent to Heater-Cooler Device Exposure During Cardiac Surgery

Contact Effect of a Methylobacterium sp. Extract on Biofilm of a Mycobacterium chimaera Strain Isolated from a 3T Heater-Cooler System

“…All isolated strains from these above-mentioned cases were genetically related and were found in the oxygenation membrane, indicating that this outbreak was an origin contamination, meaning it originated in the factory [25,26]. In-depth studies have shown that the infection focus was M. chimaera biofilms on the membrane of the 3T HCD extracorporeal oxygenators, a membrane placed between two water tanks used to maintain blood and cardioplegia solution at a constant temperature and control oxygen level in patient blood [21,22]. Thereupon, M. chimaera would reach the bloodstream due to the formation and dispersion of aerosols harboring small pieces of M. chimaera biofilm from the membrane [21,22].…”

“…Indeed, taking into account that not all the hospital cases are reported in scientific articles, the actual prevalence of M. chimaera infections related to the use of 3T HCD extracorporeal could range between 156 and 282 cases in Europe alone [20]. Each case showed a similar past history and symptoms: all patients underwent open-chest surgery, and the main manifestation was prosthetic valve endocarditis [21,22]. Moreover, other clinic manifestations have been described associated to this infection, such as osteoarthritis, spondylodiscitis, breastbone infections, hepatitis, nephritis, and bacteremia [23].…”

“…In-depth studies have shown that the infection focus was M. chimaera biofilms on the membrane of the 3T HCD extracorporeal oxygenators, a membrane placed between two water tanks used to maintain blood and cardioplegia solution at a constant temperature and control oxygen level in patient blood [ 21 , 22 ]. Thereupon, M. chimaera would reach the bloodstream due to the formation and dispersion of aerosols harboring small pieces of M. chimaera biofilm from the membrane [ 21 , 22 ]. Following these reports, the manufacturer of the device recalled a part of the instruments and recommended to use a stricter and deeper disinfection [ 27 ] and new revised protocols of use [ 13 , 27 , 28 , 29 ] which turned out to be completely ineffective [ 30 ].…”

The global Mycobacterium chimaera outbreak

“…Due to different signs and symptoms of M. chimaera infection, a large number of health specialists (infectious diseases, cardiology, rheumatology, ophthalmology, haematology, pulmonology), together with primary care providers, have been alerted worldwide by national health authorities to maintain high level of attention for patients with a history of surgery with cardiopulmonary bypass and presenting with deep infections of unknown origin or with granulomatous disease sarcoidosis like (16,17,28). Noteworthy is that a misdiagnosis of sarcoidosis often leads to start steroid treatment, thus causing a worsening of the disease (10,15).…”

Mycobacterium chimaera Identification Using MALDI-TOF MS Technology: A Practical Approach for the Clinical Microbiology Laboratories

“…Since 2015, MC gained importance, being recognized as the cause of outbreaks in patients who underwent cardiac surgery described in several countries [6,7]. Clinically, these infections are mainly disseminated diseases, even if prosthetic valve endocarditis, surgical site infections, or vascular graft infections are described; they all occur in a prolonged time-lapse (range, 3-72 months), and are characterized by a poor prognosis, with a mortality rate around 50% [8][9][10].…”