Prolonged Outbreak of Mycobacterium chimaera Infection After Open-Chest Heart Surgery

Abstract

The epidemiological and microbiological features of this prolonged outbreak provided evidence for the airborne transmission of M. chimaera from contaminated heater-cooler unit water tanks to patients during open-heart surgery.

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

“…Cases have been reported worldwide reflecting the global problem of microbial colonisation and the need for effective management of HCUs [1][2][3][4] . This review summaries the knowledge to date as well as the challenges faced by those who have to prevent and control infection.…”

Decontamination of Extracorporeal Membrane Oxygenator Devices With an Intensified Disinfection Protocol: How Strict Is Too Strict?

“…Reported contamination rates of HSC grafts range from 1% to 45%. [3][4][5] The clinical significance of infusion of contaminated HSC products is unclear. When fresh products are used, contamination is often not identified prior to HSC infusion.…”

“…Of 26 patients who received grafts contaminated with highly pathogenic bacteria (eg, S. aureus), none developed symptoms or had a positive culture matching an organism found in the HSC graft. 3 In prior reports of infections putatively caused by graft contamination, confirmation that the graft was the source of infection was based solely on the finding of identical species. 6,7 Contrary to these prior reports, we present a case of catheter-related bloodstream infection with methicillinsusceptible S. aureus due to a contaminated HSC graft in which pulsed-field gel electrophoresis (PFGE) confirmed that the graft and patient isolates were identical.…”

“…2 These measures were put in place following reports of invasive and fatal infections with atypical mycobacteria transmitted by heater-cooler devices (HCDs) in cardiac surgery. 3,4 We call the proportionality of these measures into question. First, there is currently no conclusive link between HU35 colonization and human disease.…”

“…The latter involve open water tanks and a fan for cooling, due to which infectious aerosols may be propelled from the device to the patient environment. 3,4 HU35s, in contrast, are closed air tight and have no ventilation to the outside. It would, therefore, require a breach in the ECMO exchange membrane for a transmission to the patient to occur.…”