Mycobacterium chimaera

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Mycobacterium chimaera is a environmental contaminating organism that has proved particularly challenging in cardioid-pulmonary bypass internationally as it can manifest as infection of foreign materials such as prosthetic heart valves years after implantation[1][2][3][4][5][6][7]. It is part of the Mycobacterium avium complex and was first realised to be problematical in this context in Switzerland[8]. Later investigation demonstrated world wide genetic homogeneity that is highly suggestive of point source initial contamination in manufacture of the Stockert 3T heater cooler[9][10][11], which can be mitigated by in field enhanced decontamination strategies[12]. However the general principle discovered is that even techniques such as laminar airflow will not prevent such organisms common in complex biofilms on heater/cooler units from contaminating the operative field. The issue is more general than the most spectacular outbreak which has affected over 100 patients out of the order of a million exposed.

References

  1. Chand M, Lamagni T, Kranzer K, Hedge J, Moore G, Parks S, Collins S, Del Ojo Elias C, Ahmed N, Brown T, Smith EG, Hoffman P, Kirwan P, Mason B, Smith-Palmer A, Veal P, Lalor MK, Bennett A, Walker J, Yeap A, Isidro Carrion Martin A, Dolan G, Bhatt S, Skingsley A, Charlett A, Pearce D, Russell K, Kendall S, Klein AA, Robins S, Schelenz S, Newsholme W, Thomas S, Collyns T, Davies E, McMenamin J, Doherty L, Peto TE, Crook D, Zambon M, Phin N. Insidious Risk of Severe Mycobacterium chimaera Infection in Cardiac Surgery Patients. Clinical infectious diseases : an official publication of the Infectious Diseases Society of America. 2017 Feb; 64(3):335-342.(Print-Electronic) (Link to article – subscription may be required.)
  2. Svensson E, Jensen ET, Rasmussen EM, Folkvardsen DB, Norman A, Lillebaek T. Mycobacterium chimaera in Heater-Cooler Units in Denmark Related to Isolates from the United States and United Kingdom. Emerging infectious diseases. 2017 Mar; 23(3):.(Print-Electronic) (Link to article – subscription may be required.)
  3. Cai Y, Landolfo K, Renew JR. Mycobacterium infection from a cardiopulmonary bypass heater-cooler unit in a patient with steroid-induced immunosuppression. Canadian journal of anaesthesia = Journal canadien d'anesthesie. 2016 Dec.(Print-Electronic) (Link to article – subscription may be required.)
  4. Kanamori H, Weber DJ, Rutala WA. Healthcare-Associated Mycobacterium chimaera Transmission and Infection Prevention Challenges: Role of Heater-Cooler Units as a Water Source in Cardiac Surgery. Clinical infectious diseases : an official publication of the Infectious Diseases Society of America. 2017 Feb; 64(3):343-346.(Print-Electronic) (Link to article – subscription may be required.)
  5. Robinson JO, Coombs GW, Speers DJ, Keehner T, Keil AD, D'Abrera V, Boan P, Pang S. Mycobacterium chimaera colonisation of heater-cooler units (HCU) in Western Australia, 2015: investigation of possible iatrogenic infection using whole genome sequencing. Euro surveillance : bulletin Europeen sur les maladies transmissibles = European communicable disease bulletin. 2016 Nov; 21(46):.(Print) (Link to article – subscription may be required.)
  6. Struelens MJ, Plachouras D. Mycobacterium chimaera infections associated with heater-cooler units (HCU): closing another loophole in patient safety. Euro surveillance : bulletin Europeen sur les maladies transmissibles = European communicable disease bulletin. 2016 Nov; 21(46):.(Print) (Link to article – subscription may be required.)
  7. Trudzinski FC, Schlotthauer U, Kamp A, Hennemann K, Muellenbach RM, Reischl U, Gärtner B, Wilkens H, Bals R, Herrmann M, Lepper PM, Becker SL. Clinical implications of Mycobacterium chimaera detection in thermoregulatory devices used for extracorporeal membrane oxygenation (ECMO), Germany, 2015 to 2016. Euro surveillance : bulletin Europeen sur les maladies transmissibles = European communicable disease bulletin. 2016 Nov; 21(46):.(Print) (Link to article – subscription may be required.)
  8. Achermann Y, Rössle M, Hoffmann M, Deggim V, Kuster S, Zimmermann DR, Bloemberg G, Hombach M, Hasse B. Prosthetic valve endocarditis and bloodstream infection due to Mycobacterium chimaera. Journal of clinical microbiology. 2013 Jun; 51(6):1769-1773.(Print-Electronic) (Link to article – subscription may be required.)
  9. Schreiber PW, Kuster SP, Hasse B, Bayard C, Rüegg C, Kohler P, Keller PM, Bloemberg GV, Maisano F, Bettex D, Halbe M, Sommerstein R, Sax H. Reemergence of Mycobacterium chimaera in Heater-Cooler Units despite Intensified Cleaning and Disinfection Protocol. Emerging Infectious Diseases. 2016 Oct; 22(10):1830-1833.(Print) (Link to article – subscription may be required.)
  10. Hasan NA, Lawsin A, Perry KA, Alyanak E, Toney NC, Malecha A, Rowe LA, Batra D, Moulton-Meissner H, Miller JR, Strong M, Laufer Halpin A. Complete Genome Sequence of Mycobacteriumchimaera Strain CDC2015-22-71. Genome announcements. 2017 Aug; 5(31):.(Electronic) (Link to article – subscription may be required.)
  11. van Ingen J, Kohl TA, Kranzer K, Hasse B, Keller PM, Katarzyna Szafrańska A, Hillemann D, Chand M, Schreiber PW, Sommerstein R, Berger C, Genoni M, Rüegg C, Troillet N, Widmer AF, Becker SL, Herrmann M, Eckmanns T, Haller S, Höller C, Debast SB, Wolfhagen MJ, Hopman J, Kluytmans J, Langelaar M, Notermans DW, Ten Oever J, van den Barselaar P, Vonk ABA, Vos MC, Ahmed N, Brown T, Crook D, Lamagni T, Phin N, Smith EG, Zambon M, Serr A, Götting T, Ebner W, Thürmer A, Utpatel C, Spröer C, Bunk B, Nübel U, Bloemberg GV, Böttger EC, Niemann S, Wagner D, Sax H. Global outbreak of severe Mycobacterium chimaera disease after cardiac surgery: a molecular epidemiological study. The Lancet. Infectious diseases. 2017 Oct; 17(10):1033-1041.(Print-Electronic) (Link to article – subscription may be required.)
  12. Walker J, Moore G, Collins S, Parks S, Garvey MI, Lamagni T, Smith G, Dawkin L, Goldenberg S, Chand M. Microbiological problems and biofilms associated with Mycobacterium chimaera in heater-cooler units used for cardiopulmonary bypass. The Journal of hospital infection. 2017 Jul; 96(3):209-220.(Print-Electronic) (Link to article – subscription may be required.)

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Classification