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

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...

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Bibliographic Details
Published in:Clinical microbiology and infection 2018-11, Vol.24 (11), p.1164-1170
Main Authors: Scriven, J.E., Scobie, A., Verlander, N.Q., Houston, A., Collyns, T., Cajic, V., Kon, O.M., Mitchell, T., Rahama, O., Robinson, A., Withama, S., Wilson, P., Maxwell, D., Agranoff, D., Davies, E., Llewelyn, M., Soo, S.-S., Sahota, A., Cooper, M.A., Hunter, M., Tomlins, J., Tiberi, S., Kendall, S., Dedicoat, M., Alexander, E., Fenech, T., Zambon, M., Lamagni, T., Smith, E.G., Chand, M.
Format: Article
Language:English
Subjects:
Adolescent
Adult
Aged
Aged, 80 and over
Anti-Bacterial Agents - therapeutic use
Cardiac Surgical Procedures - adverse effects
Cardiopulmonary bypass
Child
Female
Granulomas
Heater–cooler unit
Humans
Infective endocarditis
Male
Middle Aged
Mycobacterium - classification
Mycobacterium - isolation & purification
Mycobacterium Infections - drug therapy
Mycobacterium Infections - epidemiology
Mycobacterium Infections - microbiology
Non-tuberculous mycobacteria
Postoperative Complications
Retrospective Studies
Risk Factors
Treatment Outcome
United Kingdom - epidemiology
Young Adult
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Summary: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. Case note review was performed for cases identified retrospectively through outbreak investigations and prospectively through ongoing surveillance. Case definition was Mycobacterium chimaera detected in any clinical specimen, history of cardiothoracic surgery with cardiopulmonary bypass, and compatible clinical presentation. 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-necrotizing granulomatous inflammation. Diagnostic sensitivity for a single mycobacterial blood culture was 68% but increased if multiple samples were sent. In all, 27 patients started macrolide-based combination treatment and 14 had further surgery. To date, 18 patients have died (60%) a median of 30 months (interquartile range 20–39 months) after initial surgery. Survival analysis identified younger age, mitral valve surgery, mechanical valve replacement, higher serum sodium concentration and lower C-reactive protein as factors associated with better survival. 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.
ISSN:1198-743X
1469-0691
DOI:10.1016/j.cmi.2018.04.027