J E Scriven1, A Scobie2, N Q Verlander3, A Houston4, T Collyns5, V Cajic6, O M Kon7, T Mitchell8, O Rahama9, A Robinson10, S Withama11, P Wilson12, D Maxwell13, D Agranoff14, E Davies15, M Llewelyn16, S-S Soo17, A Sahota18, M A Cooper19, M Hunter20, J Tomlins4, S Tiberi21, S Kendall22, M Dedicoat23, E Alexander2, T Fenech24, M Zambon2, T Lamagni2, E G Smith2, M Chand25. 1. Department of Infection and Tropical Medicine, Birmingham Heartlands Hospital, Birmingham, UK; National Infection Service, Public Health England, Colindale, London, UK. Electronic address: james.scriven@heartofengland.nhs.uk. 2. National Infection Service, Public Health England, Colindale, London, UK. 3. Statistics Unit, National Infection Service, Public Health England, Colindale, London, UK. 4. Department of Infection, St Georges Universities NHS Foundation Trust, London, UK. 5. Department of Microbiology, Leeds Teaching Hospitals NHS Trust, Leeds, UK. 6. Department of Infection, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK. 7. Department of Respiratory Medicine, Imperial College Healthcare NHS Trust, London, UK. 8. Department of Infection and Tropical Medicine, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK. 9. Hull and East Yorkshire Hospitals NHS Trust, Hull, UK. 10. Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK. 11. Royal Brompton and Harefield NHS Foundation Trust, London, UK. 12. University College London Hospitals NHS Foundation Trust, London, UK. 13. Department of Respiratory Medicine, East Sussex Healthcare NHS Trust, Eastbourne, UK. 14. Department of Microbiology and Infection, Brighton and Sussex University Hospitals NHS Trust, Brighton, UK. 15. Public Health Wales Microbiology, Cardiff, UK. 16. Department of Infectious Diseases, Royal Gwent Hospital, Newport, UK. 17. Department of Microbiology, Nottingham University Hospitals NHS Trust, QMC Campus, Nottingham, UK. 18. Department of Infection and Tropical Medicine, University Hospitals of Leicester NHS Trust, Leicester, UK. 19. Department of Microbiology, The Royal Wolverhampton Hospitals NHS Trust, Wolverhampton, UK. 20. Department of Infectious Diseases, Royal Victoria Hospital, Belfast, UK. 21. Division of Infection, Barts Health NHS Trust, Royal London Hospital, London, UK; Blizard Institute, Barts and the London School of Medicine and Dentistry, London, UK. 22. Society for Cardiothoracic Surgery in Great Britain and Ireland, London, UK; South Tees Hospitals Foundation NHS Trust, Middlesbrough, UK. 23. Department of Infection and Tropical Medicine, Birmingham Heartlands Hospital, Birmingham, UK. 24. NHS England, London, UK. 25. National Infection Service, Public Health England, Colindale, London, UK; National Institute for Health Research Health Protection Research Unit in Respiratory Infections, Imperial College London, London, UK; Guy's and St Thomas' NHS Foundation Trust, London, UK.
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 ongoing 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-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. 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.
OBJECTIVES:Mycobacterium chimaerainfection 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 ongoing 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-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. CONCLUSIONS:Mycobacterium chimaerainfection 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.
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