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. 2017 May;23(5):796-805.
doi: 10.3201/eid2305.161899.

Invasive Nontuberculous Mycobacterial Infections among Cardiothoracic Surgical Patients Exposed to Heater-Cooler Devices1

Meghan M Lyman, Cheri Grigg, Cara Bicking Kinsey, M Shannon Keckler, Heather Moulton-Meissner, Emily Cooper, Minn M Soe, Judith Noble-Wang, Allison Longenberger, Shane R Walker, Jeffrey R Miller, Joseph F Perz, Kiran M Perkins

Invasive Nontuberculous Mycobacterial Infections among Cardiothoracic Surgical Patients Exposed to Heater-Cooler Devices1

Meghan M Lyman et al. Emerg Infect Dis. 2017 May.

Abstract

Invasive nontuberculous mycobacteria (NTM) infections may result from a previously unrecognized source of transmission, heater-cooler devices (HCDs) used during cardiac surgery. In July 2015, the Pennsylvania Department of Health notified the Centers for Disease Control and Prevention (CDC) about a cluster of NTM infections among cardiothoracic surgical patients at 1 hospital. We conducted a case-control study to identify exposures causing infection, examining 11 case-patients and 48 control-patients. Eight (73%) case-patients had a clinical specimen identified as Mycobacterium avium complex (MAC). HCD exposure was associated with increased odds of invasive NTM infection; laboratory testing identified patient isolates and HCD samples as closely related strains of M. chimaera, a MAC species. This investigation confirmed a large US outbreak of invasive MAC infections in a previously unaffected patient population and suggested transmission occurred by aerosolization from HCDs. Recommendations have been issued for enhanced surveillance to identify potential infections associated with HCDs and measures to mitigate transmission risk.

Keywords: NTM; bacteria; cardiac surgery; cardiopulmonary bypass; heater–cooler device; nontuberculous mycobacteria; tuberculosis and other mycobacteria.

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Figures

Figure 1
Figure 1
Inclusion criteria flowchart for case–control study of patients with NTM-positive specimens in investigation of invasive extrapulmonary NTM infections among patients who underwent cardiothoracic surgery, York, Pennsylvania, USA, 2015. CT, cardiothoracic; NTM, nontuberculous mycobacteria.
Figure 2
Figure 2
Biofilm visualized on surfaces submerged in an internal water reservoir of a heater–cooler device during investigation of invasive extrapulmonary nontuberculous mycobacteria infections among patients who underwent cardiothoracic surgery, York, Pennsylvania, USA, 2015.
Figure 3
Figure 3
Molecular strain typing by pulsed-field gel electrophoresis of case-patients and environmental isolates of Mycobacterium chimaera in investigation of invasive extrapulmonary nontuberculous mycobacteria infections among patients who underwent cardiothoracic surgery, York, Pennsylvania, USA, 2015. HCD, heater–cooler device.
See this image and copyright information in PMC

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