Healthcare-associated prosthetic heart valve, aortic vascular graft, and disseminated<i>Mycobacterium chimaera</i>infections subsequent to open heart surgery

Köhler, Philipp; Kuster, Stefan P.; Bloemberg, Guido V.; Schulthess, Bettina; Frank, Michelle; Tanner, Felix C.; Rössle, Matthias; Böni, Christian; Falk, Volkmar; Wilhelm, Markus J.; Sommerstein, Rami; Achermann, Yvonne; Oever, Jaap ten; Debast, Sylvia B.; Wolfhagen, M. J. H. M.; Bruinsma, George J. Brandon Bravo; Vos, Margreet C.; Bogers, Ad J.J.C.; Serr, Annerose; Beyersdorf, Friedhelm; Sax, Hugo; Böttger, Erik C.; Weber, Rainer; Ingen, Jakko van; Wagner, Dirk; Hasse, Barbara

doi:10.1093/eurheartj/ehv342

Cited by 198 publications

(305 citation statements)

References 22 publications

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“…M. chimaera has been recovered from in-use 3T HCUs within hospitals worldwide 1,2,4,43,44,55,56 , from new unused 3T HCUs, and from water samples obtained at the manufacturing site of LivaNova PLC 53 . However, microbial contamination of HCUs is widespread and is not specific to particular manufacturers or models 4,57 .…”

Section: Determining the Source Of Infections Related To Hcusmentioning

confidence: 99%

“…A number of investigations have demonstrated an increased risk of invasive M. chimaera infection in patients who have undergone cardiothoracic surgery, particularly valve replacement or repair 1,4,44 . Although infections following coronary artery bypass grafts (CABG), vascular grafts, heart transplant, and left ventricular assist devices have been identified, risk assessment suggests heart valve repair and replacement carry the highest risk 70 .…”

Section: Clinical Features and Diagnosismentioning

confidence: 99%

“…Although infections following coronary artery bypass grafts (CABG), vascular grafts, heart transplant, and left ventricular assist devices have been identified, risk assessment suggests heart valve repair and replacement carry the highest risk 70 . A number of disseminated infections and secondary focal infections such as discitis have been reported 4,44,70 . Patients affected have been primarily but not exclusively adults 4, 44 with a median age of 61 (range 36-76 years) which may reflect the age of those likely to require valve replacement surgery 44 .…”

Section: Clinical Features and Diagnosismentioning

confidence: 99%

“…A number of disseminated infections and secondary focal infections such as discitis have been reported 4,44,70 . Patients affected have been primarily but not exclusively adults 4, 44 with a median age of 61 (range 36-76 years) which may reflect the age of those likely to require valve replacement surgery 44 . The interval from surgery to diagnosis has ranged from 3 months to 6 years with a median interval of 17-18 months 1, 4, 70 .…”

Section: Clinical Features and Diagnosismentioning

confidence: 99%

“…Patient outcome has been described as poor, which is probably multifactorial from late diagnosis and treatment, intrinsic drug resistance of M. chimera biofilm which may hinder the penetration and action of antimicrobials in the cardiac and pulmonary tissue 44,73 .…”

Section: Clinical Features and Diagnosismentioning

confidence: 99%

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Microbiological problems and biofilms associated with Mycobacterium chimaera in heater–cooler units used for cardiopulmonary bypass

Walker

Moore

Collins

et al. 2017

Journal of Hospital Infection

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Summary:The role of heater cooler units (HCUs) in the transmission of Mycobacterium chimaera during open heart surgery has been recognised since 2013. Subsequent investigations uncovered a remarkable global outbreak reflecting the wide distribution of implicated devices. HCUs are an essential component of cardiopulmonary bypass operations and their withdrawal would severely affect capacity for life-saving cardiac surgery. However, studies have demonstrated that many HCUs are contaminated with a wide range of microorganisms, including M. chimaera and complex biofilms. Whole genome sequencing of M. chimaera isolates recovered from one manufacturer's HCUs, worldwide, has demonstrated a high level of genetic similarity, for which the most plausible hypothesis is a point source contamination of the devices. Dissemination of bioaerosols through breaches in the HCU water tanks is the most likely route of transmission and airborne bacteria have been shown to have reached the surgical field even with the use of ultraclean theatre ventilation. Controlling the microbiological quality of the water circulating in HCUs and reducing biofilm formation has been a major challenge for many hospitals. However, enhanced decontamination strategies have been recommended by manufacturers and while not always effective in eradicating M. chimaera from HCUs, UK hospitals have not reported any new cases of M. chimaera infection, since implementing these mitigation strategies. Water safety groups in hospitals should be aware that water in medical devices such as HCUs can act as a vector in the transmission of potentially fatal water-borne infections.

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Section: Determining the Source Of Infections Related To Hcusmentioning

confidence: 99%

Section: Clinical Features and Diagnosismentioning

confidence: 99%

Section: Clinical Features and Diagnosismentioning

confidence: 99%

Section: Clinical Features and Diagnosismentioning

confidence: 99%

Section: Clinical Features and Diagnosismentioning

confidence: 99%

See 3 more Smart Citations

Microbiological problems and biofilms associated with Mycobacterium chimaera in heater–cooler units used for cardiopulmonary bypass

Walker

Moore

Collins

et al. 2017

Journal of Hospital Infection

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Management of Pediatric Cardiopulmonary Bypass

Andersen¹,

Meza²,

Turek³

2023

Pediatric Cardiac Surgery

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Mannopyranoside Glycolipids Inhibit Mycobacterial and Biofilm Growth and Potentiate Isoniazid Inhibition Activities in M. smegmatis

et al. 2019

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Lipomannan and lipoarabinomannan are integral components of the mycobacterial cell wall. Earlier studies demonstrated that synthetic arabinan and arabinomannan glycolipids acted as inhibitors of mycobacterial growth, in addition to exhibiting inhibitory activities of mycobacterial biofilm. Herein, it is demonstrated that synthetic mannan glycolipids are better inhibitors of mycobacterial growth, whereas lipoarabinomannan has a higher inhibition efficiency to biofilm. Syntheses of mannan glycolipids with a graded number of mannan moieties and an arabinomannan glycolipid are conducted by chemical methods and subsequent mycobacterial growth and biofilm inhibition studies are conducted on Mycobacterium smegmatis. Growth inhibition of (73±3) % is observed with a mannose trisaccharide containing a glycolipid, whereas this glycolipid did not promote biofilm inhibition activity better than that of arabinomannan glycolipid. The antibiotic supplementation activities of glycolipids on growth and biofilm inhibitions are evaluated. Increases in growth and biofilm inhibitions are observed if the antibiotic is supplemented with glycolipids, which leads to a significant reduction of inhibition concentrations of the antibiotic.

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Healthcare-associated prosthetic heart valve, aortic vascular graft, and disseminatedMycobacterium chimaerainfections subsequent to open heart surgery

Cited by 198 publications

References 22 publications

Microbiological problems and biofilms associated with Mycobacterium chimaera in heater–cooler units used for cardiopulmonary bypass

Microbiological problems and biofilms associated with Mycobacterium chimaera in heater–cooler units used for cardiopulmonary bypass

Management of Pediatric Cardiopulmonary Bypass

Mannopyranoside Glycolipids Inhibit Mycobacterial and Biofilm Growth and Potentiate Isoniazid Inhibition Activities in M. smegmatis

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