Kathleen G Julian1, Tonya Crook2, Eugene Curley3, A Ben Appenheimer4, Catharine I Paules2, Barbara Hasse5, Daniel J Diekema4, Charles L Daley6, Jorgelina de Sanctis7, Walter C Hellinger8, Adrah Levin6, George McSherry2, Carol Freer2, Cynthia J Whitener2. 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.
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. chimaerainfection warrants aggressive treatment and long-term monitoring.
Authors: Nicholas Y Tan; Alex D Tarabochia; Daniel C DeSimone; Christopher V DeSimone; John W Wilson; Gabor Bagameri; Courtney E Bennett; Omar M Abu Saleh Journal: Open Forum Infect Dis Date: 2021-07-01 Impact factor: 3.835