Insidious risk of severe Mycobacterium chimaera infection in cardiac surgery patients.
<h4>Background</h4> <p>An urgent UK investigation was launched to assess risk of invasive Mycobacterium chimaera infection in cardiothoracic surgery and a possible association with cardiopulmonary bypass heater-cooler units following alerts in Switzerland and The Netherlands.</...
| Հիմնական հեղինակներ: | , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , |
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| Ձևաչափ: | Journal article |
| Լեզու: | English |
| Հրապարակվել է: |
Oxford University Press
2016
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| _version_ | 1826276463519727616 |
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| author | Chand, M Lamagni, T Kranzer, K Hedge, J Moore, G Parks, S Collins, S Del Ojo Elias, C Ahmed, N Brown, T Smith, E Hoffman, P Kirwan, P Mason, B Smith-Palmer, A Veal, P Lalor, M Bennett, A Walker, J Yeap, A Isidro Carrion Martin, A Dolan, G Bhatt, S Skingsley, A Charlett, A Pearce, D Russell, K Kendall, S Klein, A Robins, S Schelenz, S Newsholme, W Thomas, S Collyns, T Davies, E McMenamin, J Doherty, L Peto, T Crook, D Zambon, M Phin, N |
| author_facet | Chand, M Lamagni, T Kranzer, K Hedge, J Moore, G Parks, S Collins, S Del Ojo Elias, C Ahmed, N Brown, T Smith, E Hoffman, P Kirwan, P Mason, B Smith-Palmer, A Veal, P Lalor, M Bennett, A Walker, J Yeap, A Isidro Carrion Martin, A Dolan, G Bhatt, S Skingsley, A Charlett, A Pearce, D Russell, K Kendall, S Klein, A Robins, S Schelenz, S Newsholme, W Thomas, S Collyns, T Davies, E McMenamin, J Doherty, L Peto, T Crook, D Zambon, M Phin, N |
| author_sort | Chand, M |
| collection | OXFORD |
| description | <h4>Background</h4> <p>An urgent UK investigation was launched to assess risk of invasive Mycobacterium chimaera infection in cardiothoracic surgery and a possible association with cardiopulmonary bypass heater-cooler units following alerts in Switzerland and The Netherlands.</p> <h4>Methods</h4> <p>Parallel investigations were pursued: (1) identification of cardiopulmonary bypass–associated M. chimaera infection through national laboratory and hospital admissions data linkage; (2) cohort study to assess patient risk; (3) microbiological and aerobiological investigations of heater-coolers in situ and under controlled laboratory conditions; and (4) whole-genome sequencing of clinical and environmental isolates.</p> <h4>Results</h4> <p>Eighteen probable cases of cardiopulmonary bypass–associated M. chimaera infection were identified; all except one occurred in adults. Patients had undergone valve replacement in 11 hospitals between 2007 and 2015, a median of 19 months prior to onset (range, 3 months to 5 years). Risk to patients increased after 2010 from <0.2 to 1.65 per 10 000 person-years in 2013, a 9-fold rise for infections within 2 years of surgery (rate ratio, 9.08 [95% CI, 1.81–87.76]). Endocarditis was the most common presentation (n = 11). To date, 9 patients have died. Investigations identified aerosol release through breaches in heater-cooler tanks. Mycobacterium chimaera and other pathogens were recovered from water and air samples. Phylogenetic analysis found close clustering of strains from probable cases.</p> <h4>Conclusions</h4> <p>We identified low but escalating risk of severe M. chimaera infection associated with heater-coolers with cases in a quarter of cardiothoracic centers. Our investigations strengthen etiological evidence for the role of heater-coolers in transmission and raise the possibility of an ongoing, international point-source outbreak. Active management of heater-coolers and heightened clinical awareness are imperative given the consequences of infection.</p> |
| first_indexed | 2024-03-06T23:14:20Z |
| format | Journal article |
| id | oxford-uuid:6697a49f-e4d4-4e9c-a6b7-32027a33bb49 |
| institution | University of Oxford |
| language | English |
| last_indexed | 2024-03-06T23:14:20Z |
| publishDate | 2016 |
| publisher | Oxford University Press |
| record_format | dspace |
| spelling | oxford-uuid:6697a49f-e4d4-4e9c-a6b7-32027a33bb492022-03-26T18:33:02ZInsidious risk of severe Mycobacterium chimaera infection in cardiac surgery patients.Journal articlehttp://purl.org/coar/resource_type/c_dcae04bcuuid:6697a49f-e4d4-4e9c-a6b7-32027a33bb49EnglishSymplectic Elements at OxfordOxford University Press2016Chand, MLamagni, TKranzer, KHedge, JMoore, GParks, SCollins, SDel Ojo Elias, CAhmed, NBrown, TSmith, EHoffman, PKirwan, PMason, BSmith-Palmer, AVeal, PLalor, MBennett, AWalker, JYeap, AIsidro Carrion Martin, ADolan, GBhatt, SSkingsley, ACharlett, APearce, DRussell, KKendall, SKlein, ARobins, SSchelenz, SNewsholme, WThomas, SCollyns, TDavies, EMcMenamin, JDoherty, LPeto, TCrook, DZambon, MPhin, N <h4>Background</h4> <p>An urgent UK investigation was launched to assess risk of invasive Mycobacterium chimaera infection in cardiothoracic surgery and a possible association with cardiopulmonary bypass heater-cooler units following alerts in Switzerland and The Netherlands.</p> <h4>Methods</h4> <p>Parallel investigations were pursued: (1) identification of cardiopulmonary bypass–associated M. chimaera infection through national laboratory and hospital admissions data linkage; (2) cohort study to assess patient risk; (3) microbiological and aerobiological investigations of heater-coolers in situ and under controlled laboratory conditions; and (4) whole-genome sequencing of clinical and environmental isolates.</p> <h4>Results</h4> <p>Eighteen probable cases of cardiopulmonary bypass–associated M. chimaera infection were identified; all except one occurred in adults. Patients had undergone valve replacement in 11 hospitals between 2007 and 2015, a median of 19 months prior to onset (range, 3 months to 5 years). Risk to patients increased after 2010 from <0.2 to 1.65 per 10 000 person-years in 2013, a 9-fold rise for infections within 2 years of surgery (rate ratio, 9.08 [95% CI, 1.81–87.76]). Endocarditis was the most common presentation (n = 11). To date, 9 patients have died. Investigations identified aerosol release through breaches in heater-cooler tanks. Mycobacterium chimaera and other pathogens were recovered from water and air samples. Phylogenetic analysis found close clustering of strains from probable cases.</p> <h4>Conclusions</h4> <p>We identified low but escalating risk of severe M. chimaera infection associated with heater-coolers with cases in a quarter of cardiothoracic centers. Our investigations strengthen etiological evidence for the role of heater-coolers in transmission and raise the possibility of an ongoing, international point-source outbreak. Active management of heater-coolers and heightened clinical awareness are imperative given the consequences of infection.</p> |
| spellingShingle | Chand, M Lamagni, T Kranzer, K Hedge, J Moore, G Parks, S Collins, S Del Ojo Elias, C Ahmed, N Brown, T Smith, E Hoffman, P Kirwan, P Mason, B Smith-Palmer, A Veal, P Lalor, M Bennett, A Walker, J Yeap, A Isidro Carrion Martin, A Dolan, G Bhatt, S Skingsley, A Charlett, A Pearce, D Russell, K Kendall, S Klein, A Robins, S Schelenz, S Newsholme, W Thomas, S Collyns, T Davies, E McMenamin, J Doherty, L Peto, T Crook, D Zambon, M Phin, N Insidious risk of severe Mycobacterium chimaera infection in cardiac surgery patients. |
| title | Insidious risk of severe Mycobacterium chimaera infection in cardiac surgery patients. |
| title_full | Insidious risk of severe Mycobacterium chimaera infection in cardiac surgery patients. |
| title_fullStr | Insidious risk of severe Mycobacterium chimaera infection in cardiac surgery patients. |
| title_full_unstemmed | Insidious risk of severe Mycobacterium chimaera infection in cardiac surgery patients. |
| title_short | Insidious risk of severe Mycobacterium chimaera infection in cardiac surgery patients. |
| title_sort | insidious risk of severe mycobacterium chimaera infection in cardiac surgery patients |
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