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Eur Heart J. 2015 Oct 21;36(40):2745-53. doi: 10.1093/eurheartj/ehv342. Epub 2015 Jul 17.

Healthcare-associated prosthetic heart valve, aortic vascular graft, and disseminated Mycobacterium chimaera infections subsequent to open heart surgery.

Author information

1
Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Raemistrasse 100, Zurich 8091, Switzerland.
2
Institute of Medical Microbiology, University of Zurich, Gloriastrasse 30/32, Zurich 8006, Switzerland.
3
Institute of Medical Microbiology, University of Zurich, Gloriastrasse 30/32, Zurich 8006, Switzerland National Reference Center for Mycobacteria, University of Zurich, Gloriastrasse 30/32, Zurich 8006, Switzerland.
4
Department of Cardiology, Cardiovascular Center, University Hospital Zurich, University of Zurich, Raemistrasse 100, Zurich 8091, Switzerland.
5
Institute of Surgical Pathology, University Hospital Zurich, University of Zurich, Schmelzbergstrasse 12, Zurich 8091, Switzerland.
6
Department of Ophthalmology, University Hospital Zurich, University of Zurich, Raemistrasse 100, Zurich 8091, Switzerland.
7
Clinic for Cardiovascular Surgery, University Hospital Zurich, University of Zurich, Raemistrasse 100, Zurich 8091, Switzerland Deutsches Herzzentrum Berlin, Augustenburger Platz 1, Berlin 13353, Germany.
8
Clinic for Cardiovascular Surgery, University Hospital Zurich, University of Zurich, Raemistrasse 100, Zurich 8091, Switzerland.
9
Department of Internal Medicine, Radboud University Medical Center, Nijmegen, The Netherlands.
10
Laboratory of Medical Microbiology and Infectious Diseases, Isala Clinics, Zwolle, The Netherlands.
11
Department of Cardiothoracic Surgery, Isala Clinics, Zwolle, The Netherlands.
12
Medical Microbiology and infectious Diseases, Erasmus MC, Rotterdam, The Netherlands.
13
Cardiothoracic Surgery, Erasmus MC, Rotterdam, The Netherlands.
14
Centre for Microbiology and Hygiene, University Hospital of Freiburg, Freiburg i.Br, Germany.
15
Department of Cardiovascular Surgery, Heart Center Freiburg University, Freiburg i.Br, Germany.
16
Department of Medical Microbiology, Radboud University Medical Center, Nijmegen, The Netherlands.
17
Department of Medicine, Center for Infectious Diseases and Travel Medicine and Center for Chronic Immunodeficiency, University Medical Center, Freiburg i.Br, Germany.
18
Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Raemistrasse 100, Zurich 8091, Switzerland barbara.hasse@usz.ch b.hasse@gmx.ch.

Abstract

AIMS:

We identified 10 patients with disseminated Mycobacterium chimaera infections subsequent to open-heart surgery at three European Hospitals. Infections originated from the heater-cooler unit of the heart-lung machine. Here we describe clinical aspects and treatment course of this novel clinical entity.

METHODS AND RESULTS:

Interdisciplinary care and follow-up of all patients was documented by the study team. Patients' characteristics, clinical manifestations, microbiological findings, and therapeutic measures including surgical reinterventions were reviewed and treatment outcomes are described. The 10 patients comprise a 1-year-old child and nine adults with a median age of 61 years (range 36-76 years). The median duration from cardiac surgery to diagnosis was 21 (range 5-40) months. All patients had prosthetic material-associated infections with either prosthetic valve endocarditis, aortic graft infection, myocarditis, or infection of the prosthetic material following banding of the pulmonary artery. Extracardiac manifestations preceded cardiovascular disease in some cases. Despite targeted antimicrobial therapy, M. chimaera infection required cardiosurgical reinterventions in eight patients. Six out of 10 patients experienced breakthrough infections, of which four were fatal. Three patients are in a post-treatment monitoring period.

CONCLUSION:

Healthcare-associated infections due to M. chimaera occurred in patients subsequent to cardiac surgery with extracorporeal circulation and implantation of prosthetic material. Infections became clinically apparent after a time lag of months to years. Mycobacterium chimaera infections are easily missed by routine bacterial diagnostics and outcome is poor despite long-term antimycobacterial therapy, probably because biofilm formation hinders eradication of pathogens.

KEYWORDS:

Aortic graft infection; Cardiac surgery; Health-care associated infection; Mycobacterium chimaera; Myocarditis; Prosthetic valve endocarditis

PMID:
26188001
DOI:
10.1093/eurheartj/ehv342
[Indexed for MEDLINE]
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