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J Infect. 2019 Dec 19. pii: S0163-4453(19)30379-2. doi: 10.1016/j.jinf.2019.12.007. [Epub ahead of print]

Long-term follow-up of post-cardiac surgery Mycobacterium chimaera infections: A 5-center case series.

Author information

1
Division of Infectious Diseases, Penn State Milton S. Hershey Medical Center, BMR Bldg, Room C6860, Hershey, PA 17033, United States. Electronic address: kjulian@pennstatehealth.psu.edu.
2
Division of Infectious Diseases, Penn State Milton S. Hershey Medical Center, BMR Bldg, Room C6860, Hershey, PA 17033, United States.
3
Wellspan Infectious Diseases, York Hospital, York, PA, USA.
4
Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA, USA.
5
Department of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Zurich, Switzerland.
6
Division of Mycobacterial and Respiratory Infections, National Jewish Health, Denver, CO, USA.
7
Division of Infectious Disease SHMG, Spectrum Health, Grand Rapids, MI, USA.
8
Division of Infectious Diseases, Mayo Clinic, Jacksonville, FL, USA.

Abstract

OBJECTIVES:

In multiple countries, endovascular/disseminated Mycobacterium chimaera infections have occurred in post-cardiac surgery patients in association with contaminated, widely-distributed cardiac bypass heater-cooler devices. To contribute to long-term characterization of this recently recognized infection, we describe the clinical course of 28 patients with 3-7 years of follow-up for survivors.

METHODS:

Identified at five hospitals in the United States 2010-2016, post-cardiac surgery patients in the cohort had growth of Mycobacterium avium complex (MAC)/M. chimaera from a sterile site or surgical wound, or a clinically compatible febrile illness with granulomatous inflammation on biopsy. Case follow-up was conducted in May 2019.

RESULTS:

Of 28 patients, infection appeared to be localized to the sternum in four patients. Among 18 with endovascular/disseminated infection who received combination anti-mycobacterial treatment and had sufficient follow-up, 39% appeared to have controlled infection (>12 months), 56% died, and one patient is alive with relapsed bacteremia. While the number of patients is small and interpretation is limited, four (67%) of six patients who had cardiac prosthesis removal/replacement appeared to have controlled infection compared to three (25%) of 12 with retained cardiac prosthesis (p >0.14; Fisher's exact test).

CONCLUSIONS:

Given poor response to treatment and potential for delayed relapses, post-cardiac surgery M. chimaera infection warrants aggressive treatment and long-term monitoring.

KEYWORDS:

Cardiopulmonary bypass; Cardiovascular surgical procedures; Endocarditis; Mycobacterium avium complex; Nontuberculous mycobacteria

PMID:
31863789
DOI:
10.1016/j.jinf.2019.12.007

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