<i>Mycobacterium chimaera</i> in Heater–Cooler Units in Denmark Related to Isolates from the United States and United Kingdom

Svensson, Erik; Jensen, Elsebeth Tvenstrup; Rasmussen, Erik Michael; Folkvardsen, Dorte Bek; Norman, Anders; Lillebæk, Troels

doi:10.3201/eid2303.161941

Cited by 57 publications

(57 citation statements)

References 5 publications

(7 reference statements)

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“…However, a high genetic similarity between M. chimaera isolates recovered from HCUs and patients in other studies is consistent with a role for HCUs in transmission 57 .…”

Section: Determining the Source Of Infections Related To Hcussupporting

confidence: 85%

“…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 . Such contamination implies a systemic failure of the decontamination regimen resulting in the formation of biofilms.…”

Section: Determining the Source Of Infections Related To Hcusmentioning

confidence: 99%

“…However, Svensson et al, 2017 provided evidence that HCUs from other manufacturers (e.g. Maquet) have cultured M. chimaera 57 . However, these M. chimaera isolates were genetically distinct (47-49 SNP differences) compared with isolates from the Sorin 3T HCUs and have not been linked with any clinical cases.…”

Section: Determining the Source Of Infections Related To Hcusmentioning

confidence: 99%

“…However, these M. chimaera isolates were genetically distinct (47-49 SNP differences) compared with isolates from the Sorin 3T HCUs and have not been linked with any clinical cases. In addition, other manufacturer units have been shown to be positive for M. chimaera which indicates that there may be alternative routes to contaminating the HCU, to that of a manufacturing, point source 57 . Indeed, the water supplies within hospitals used to fill HCUs cannot be excluded as a source of M. chimaera contamination 1, 2 and reinforces the need for implementing a water safety plan and decontamination strategies by the water safety group 18 .…”

Section: Determining the Source Of Infections Related To Hcusmentioning

confidence: 99%

“…However, microbial contamination of HCUs is widespread and is not specific to particular manufacturers or models 4,57 . Such contamination implies a systemic failure of the decontamination regimen resulting in the formation of biofilms.…”

Section: Decontamination Recommendationsmentioning

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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“…However, a high genetic similarity between M. chimaera isolates recovered from HCUs and patients in other studies is consistent with a role for HCUs in transmission 57 .…”

Section: Determining the Source Of Infections Related To Hcussupporting

confidence: 85%