Mycobacterium chimaera infection following cardiac surgery in the United Kingdom: clinical features and outcome of the first 30 cases.

Scriven, James E and Scobie, Antonia and Verlander, Neville Q and Houston, Angela and Collyns, Tim and Cajic, Vjeran and Kon, Onn Min and Mitchell, Tamara and Rahama, Omar and Robinson, Amy and Withama, Shirmila and Wilson, Peter and Maxwell, David and Agranoff, Daniel and Davies, Eleri and Llewelyn, Meirion and Soo, Shiu-Shing and Sahota, Amandip and Cooper, Mike and Hunter, Michael and Tomlins, Jennifer and Tiberi, Simon and Kendall, Simon and Dedicoat, Martin and Alexander, Eliza and Fenech, Teresa and Zambon, Maria and Lamagni, Theresa and Smith, E Grace and Chand, Meera (2018) Mycobacterium chimaera infection following cardiac surgery in the United Kingdom: clinical features and outcome of the first 30 cases. Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases. ISSN 1469-0691. This article is available to all HEFT staff and students via ASK Discovery tool http://tinyurl.com/z795c8c by using their HEFT Athens login IDs

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Abstract

OBJECTIVES

Mycobacterium chimaera infection following cardiac surgery, due to contaminated cardiopulmonary bypass heater-cooler units, has been reported worldwide. However, the spectrum of clinical disease remains poorly understood. To address this, we report the clinical and laboratory features, treatment and outcome of the first 30 UK cases.

METHODS

Case note review was performed for cases identified retrospectively through outbreak investigations and prospectively through on-going surveillance. Case definition was Mycobacterium chimaera detected in any clinical specimen, history of cardiothoracic surgery with cardiopulmonary bypass, and compatible clinical presentation.

RESULTS

Thirty patients were identified (28 with prosthetic material) exhibiting a spectrum of disease including prosthetic valve endocarditis (14/30), sternal wound infection (2/30), aortic graft infection (4/30), and disseminated (non-cardiac) disease (10/30). Patients presented a median of 14 months post surgery (maximum 5 years) most commonly complaining of fever and weight loss. Investigations frequently revealed lymphopenia, thrombocytopenia, liver cholestasis and non-necrotising granulomatous inflammation. Diagnostic sensitivity for a single mycobacterial blood culture was 68% but increased if multiple samples were sent. 27 patients started macrolide-based combination treatment and 14 had further surgery. To date, 18 patients have died (60%) a median of 30 months (IQR 20-39) after initial surgery. Survival analysis identified younger age, mitral valve surgery, mechanical valve replacement, higher serum sodium concentration and lower CRP as factors associated with better survival.

CONCLUSIONS

Mycobacterium chimaera infection following cardiac surgery is associated with a wide spectrum of disease. The diagnosis should be considered in all patients who develop an unexplained illness following cardiac surgery.

Item Type: Article
Additional Information: This article is available to all HEFT staff and students via ASK Discovery tool http://tinyurl.com/z795c8c by using their HEFT Athens login IDs
Subjects: WC Communicabable diseases
Divisions: Clinical Support > Infection Control
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Depositing User: Mrs Semanti Chakraborty
Date Deposited: 12 Jun 2018 15:37
Last Modified: 12 Jun 2018 15:38
URI: http://www.repository.heartofengland.nhs.uk/id/eprint/1667

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