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Cocchio S, Nicoletti M, Zanella F, Gaburro D, Bianco R, Gerosa G, Contessa C, Boschetto M, Stano P, Militello V, Cozzolino C, Martello T, Baldo V. Mycobacterium chimaera Infections in a Unit of Cardio Surgery: Study at a General Hospital in Padua, Italy. Microorganisms 2023; 12:29. [PMID: 38257856 PMCID: PMC10818605 DOI: 10.3390/microorganisms12010029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Revised: 12/19/2023] [Accepted: 12/20/2023] [Indexed: 01/24/2024] Open
Abstract
Mycobacterium chimaera is a slow-growing non-tuberculous mycobacterium already known for being able to colonize cardio surgery heater-cooler units (HCUs). This study aims to describe the real magnitude of the phenomenon, providing a methodological protocol and the results of a longitudinal survey. In the period 1 January 2017-23 May 2022, over 1191 samples were collected on 35 HCUs of two different manufacturers. Among them, we identified 118 (10.3%) positive results for M. chimaera. We propose our 4-year biosurveillance experience as a practical model to minimize microbiological patients' risk, suggesting the need for new procedures and interventions for a safer and more ecological cardio surgery.
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Affiliation(s)
- Silvia Cocchio
- Department of Cardiac, Thoracic, Vascular Sciences, and Public Health, University of Padua, 35131 Padua, Italy; (S.C.); (M.N.); (G.G.); (C.C.)
| | - Michele Nicoletti
- Department of Cardiac, Thoracic, Vascular Sciences, and Public Health, University of Padua, 35131 Padua, Italy; (S.C.); (M.N.); (G.G.); (C.C.)
| | - Fabio Zanella
- Cardiocirculatory Pathophysiology Unit, Surgery Department, University of Padua, 35131 Padua, Italy; (F.Z.); (D.G.)
| | - Dania Gaburro
- Cardiocirculatory Pathophysiology Unit, Surgery Department, University of Padua, 35131 Padua, Italy; (F.Z.); (D.G.)
| | - Roberto Bianco
- Department of Cardio Surgery, University of Padua, 35131 Padua, Italy;
| | - Gino Gerosa
- Department of Cardiac, Thoracic, Vascular Sciences, and Public Health, University of Padua, 35131 Padua, Italy; (S.C.); (M.N.); (G.G.); (C.C.)
| | - Cristina Contessa
- Department of Directional Hospital Management, University Hospital of Padua, 35128 Padova, Italy; (C.C.); (T.M.)
| | | | - Paola Stano
- Microbiology and Virology Department, University Hospital of Padua, 35128 Padua, Italy; (P.S.); (V.M.)
| | - Valentina Militello
- Microbiology and Virology Department, University Hospital of Padua, 35128 Padua, Italy; (P.S.); (V.M.)
| | - Claudia Cozzolino
- Department of Cardiac, Thoracic, Vascular Sciences, and Public Health, University of Padua, 35131 Padua, Italy; (S.C.); (M.N.); (G.G.); (C.C.)
| | - Tiziano Martello
- Department of Directional Hospital Management, University Hospital of Padua, 35128 Padova, Italy; (C.C.); (T.M.)
| | - Vincenzo Baldo
- Department of Cardiac, Thoracic, Vascular Sciences, and Public Health, University of Padua, 35131 Padua, Italy; (S.C.); (M.N.); (G.G.); (C.C.)
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Jinah R, Ryan T, Sibbald M. A Case of Pericarditis and Pericardial Masses Associated With Mycobacterium Paragordonae. CLINICAL MEDICINE INSIGHTS-CARDIOLOGY 2023; 17:11795468231189039. [PMID: 37637260 PMCID: PMC10460162 DOI: 10.1177/11795468231189039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Accepted: 06/23/2023] [Indexed: 08/29/2023]
Abstract
Tuberculosis is a common cause of pericarditis worldwide and has been associated with pericardial masses. Non-tuberculous mycobacteria are uncommonly associated with cardiac disease, having primarily been described in cases of endocarditis. Here we describe a case of an immunocompetent patient with Mycobacterium paragordonae infection causing pericarditis with a large effusion containing pericardial masses. The patient presented with chest pain, hypoxia and biochemical evidence of inflammation (CRP 216.1 mg/L). This report illustrates a rare case of pericarditis with pericardial masses associated with non-tuberculous mycobacteria and the first example of pericarditis associated with M. paragordonae.
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Affiliation(s)
| | | | - Matthew Sibbald
- Department of Medicine, McMaster University, Hamilton, ON, Canada
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3
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Tarashi S, Sakhaee F, Masoumi M, Ghazanfari Jajin M, Siadat SD, Fateh A. Molecular epidemiology of nontuberculous mycobacteria isolated from tuberculosis-suspected patients. AMB Express 2023; 13:49. [PMID: 37202495 DOI: 10.1186/s13568-023-01557-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Accepted: 05/09/2023] [Indexed: 05/20/2023] Open
Abstract
It is a growing problem around the world to deal with nontuberculous mycobacteria infection (NTM), but its clinical significance is still largely unknown. This study aims to investigate the epidemiology of NTM infections from various clinical samples and determine their clinical significance. From December 2020 to December 2021, 6125 clinical samples were collected. In addition to phenotypic detection, genotypic detection through multilocus sequence typing (hsp65, rpoB, and 16S rDNA genes) and sequencing was also conducted. Records of patients were consulted for clinical information, such as symptoms and radiological findings. Of the 6,125 patients, 351 (5.7%) were positive for acid-fast bacteria (AFB). Out of 351 AFB, 289 (82.3%) and 62 (17.7%) subjects were identified as M. tuberculosis complex (MTC) and NTM strains, respectively. Isolates of Mycobacterium simiae and M. fortuitum were the most frequent, followed by isolates of M. kansasii and M. marinum. We also isolated M. chelonae, M. canariasense, and M. jacuzzii, which are rarely reported. Symptoms (P = 0.048), radiographic findings (P = 0.013), and gender (P = 0.039) were associated with NTM isolates. M. Fortuitum, M. simiae, and M. kansasii presented with bronchiectasis, infiltration, and cavitary lesions most frequently, while cough was the most common symptom. In conclusion, Mycobacterium simiae and M. fortuitum were presented in seventeen and twelve NTM isolates from the collected samples. There is evidence that NTM infections in endemic settings may contribute to the dissemination of various diseases and the control of tuberculosis. In spite of this, further research is needed to evaluate the clinical significance of NTM isolates.
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Affiliation(s)
- Samira Tarashi
- Department of Mycobacteriology and Pulmonary Research, Pasteur Institute of Iran, Tehran, Iran
- Microbiology Research Center (MRC), Pasteur Institute of Iran, Tehran, Iran
| | - Fatemeh Sakhaee
- Microbiology Research Center (MRC), Pasteur Institute of Iran, Tehran, Iran
| | - Morteza Masoumi
- Department of Mycobacteriology and Pulmonary Research, Pasteur Institute of Iran, Tehran, Iran
| | | | - Seyed Davar Siadat
- Department of Mycobacteriology and Pulmonary Research, Pasteur Institute of Iran, Tehran, Iran
- Microbiology Research Center (MRC), Pasteur Institute of Iran, Tehran, Iran
| | - Abolfazl Fateh
- Department of Mycobacteriology and Pulmonary Research, Pasteur Institute of Iran, Tehran, Iran.
- Microbiology Research Center (MRC), Pasteur Institute of Iran, Tehran, Iran.
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4
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Zhou Y, Xia T, Du M, Cao H, Zheng Q, Yang J, Yan Z. The strategy to track and combat the deep sternal wound infection caused by Mycobacterium farcinogenes. J Hosp Infect 2023:S0195-6701(23)00102-0. [PMID: 37001604 DOI: 10.1016/j.jhin.2023.03.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 03/22/2023] [Indexed: 03/31/2023]
Affiliation(s)
- Y Zhou
- Department of Laboratory Medicine, Second Medical Centre of PLA General Hospital, Beijing, People's Republic of China
| | - T Xia
- Department of Disease Prevention and Control, Hainan Hospital of PLA General Hospital, Sanya, Hainan, People's Republic of China
| | - M Du
- Department of Disease Prevention and Control, First Medical Centre of PLA General Hospital, Beijing, People's Republic of China
| | - H Cao
- Department of Laboratory Medicine, Second Medical Centre of PLA General Hospital, Beijing, People's Republic of China
| | - Q Zheng
- Department of Laboratory Medicine, Second Medical Centre of PLA General Hospital, Beijing, People's Republic of China
| | - J Yang
- Department of Disease Prevention and Control, Hainan Hospital of PLA General Hospital, Sanya, Hainan, People's Republic of China
| | - Z Yan
- Department of Disease Prevention and Control, Hainan Hospital of PLA General Hospital, Sanya, Hainan, People's Republic of China; Department of Disease Prevention and Control, Second Medical Centre of PLA General Hospital, Beijing, People's Republic of China.
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Schreiber PW, Zihlmann R, Schärer V, Hasse B, Imkamp F, Schulthess B, Sander P, Zingg W. Longitudinal increase in the detection rate of Mycobacterium chimaera in heater-cooler device-derived water samples. J Hosp Infect 2023; 131:190-193. [PMID: 36410531 DOI: 10.1016/j.jhin.2022.11.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 10/26/2022] [Accepted: 11/04/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND Colonization with Mycobacterium chimaera and other non-tuberculous mycobacteria (NTM) has been reported for heater-cooler devices (HCDs) produced by several manufacturers. Up until now, exclusively LivaNova (London, UK) HCDs have been associated with M. chimaera infections after cardiac surgery. The vast majority of studies on HCD colonization were cross-sectional. AIM We were interested in longitudinal dynamics of mycobacterial growth in HCD water samples and analysed data of a prospective mycobacterial surveillance of five LivaNova 3T HCDs. METHODS Five LivaNova HCDs were subjected to prospective mycobacterial surveillance. For each HCD and the total of HCDs, results of mycobacterial detection were analyzed. Logistic regression was applied to model the association between growth of any NTM or M. chimaera and duration of HCD use. RESULTS Non-tuberculous mycobacteria were isolated in 319 (48.0%, 21 water samples grew more than one mycobacterial species) of a total of 665 water samples. The most frequently detected species were M. chimaera (N = 247/319, 77.4%), Mycobacterium gordonae (46/319, 14.4%) and Mycobacterium paragordonae (34/319, 10.7%). Detection rates increased prospectively for any NTM (odds ratio (OR) per year in use: 1.60, 95% confidence interval (CI) 1.17-2.24, P<0.001) and for M. chimaera (OR per year in use: 1.67, 95% CI 1.11-2.57, P<0.01). CONCLUSION Longer duration of HCD use was associated with higher detection rates for any NTM and M. chimaera, respectively.
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Affiliation(s)
- P W Schreiber
- University Hospital Zurich, Division of Infectious Diseases and Hospital Epidemiology and University Zurich, Zurich, Switzerland.
| | - R Zihlmann
- ETH Zurich, Department of Mathematics, Zurich, Switzerland
| | - V Schärer
- University Hospital Zurich, Division of Infectious Diseases and Hospital Epidemiology and University Zurich, Zurich, Switzerland
| | - B Hasse
- University Hospital Zurich, Division of Infectious Diseases and Hospital Epidemiology and University Zurich, Zurich, Switzerland
| | - F Imkamp
- Institute of Medical Microbiology, University of Zurich, Zurich, Switzerland; National Reference Centre for Mycobacteria, Zurich, Switzerland
| | - B Schulthess
- Institute of Medical Microbiology, University of Zurich, Zurich, Switzerland; National Reference Centre for Mycobacteria, Zurich, Switzerland
| | - P Sander
- Institute of Medical Microbiology, University of Zurich, Zurich, Switzerland; National Reference Centre for Mycobacteria, Zurich, Switzerland
| | - W Zingg
- University Hospital Zurich, Division of Infectious Diseases and Hospital Epidemiology and University Zurich, Zurich, Switzerland
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Yuanchun L, Wenping Z, Jing Z, Wenjie L, Yanlin Z, Yanming L, Jiuxin Q. Mycobacterium paragordonae is an emerging pathogen in human pulmonary disease: clinical features, antimicrobial susceptibility testing and outcomes. Emerg Microbes Infect 2022; 11:1973-1981. [PMID: 35916253 PMCID: PMC9364734 DOI: 10.1080/22221751.2022.2103453] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Objectives: Mycobacterium paragordonae (MPG) is an emerging and less common type of Non-tuberculous mycobacteria (NTM) and we know little about its characteristics and prognosis, hence we constructed this retrospective cohort study. Methods: MPG was identified using MALD-TOF MS, multi-target combined gene sequencing and WGS. Clinical information was collected, antimicrobial susceptibility testing was measured using the SLOMYCO panel, and optimal growth temperature testing was measured using Lowenstein-Jensen medium. Results: Eight MPGs were isolated from 1730 NTMs (0.46%); the mean age of MPG pulmonary disease (MPG-PD) patients was 42.38 ± 9.92 years, 37.5% were male, and the average BMI was 18.4 ± 0.51 kg/m2. All patients had the symptoms of cough and sputum and CT images mainly presented in patchy or streaky shadows, MPG grew at 25°C, 30°C and 37°C, and the optimal growth temperature is 37°C. MPGs were sensitive to clarithromycin, rifabutin, amikacin, linezolid, moxifloxacin, cotrimoxazole and ciprofloxacin, two isolates were resistant to rifampicin. Two patients had follow up information, their imaging remained stable during the follow-up. Conclusions: MPG-PD is a rare NTM disease and is more likely to develop in middle-aged, female, and low BMI patients. The patients present with no specific features within the symptoms as well as the CT imaging. The optimal growth temperature of MPG is at 37°C, MPG-PD has excellent sensitivity to drugs recommended by CLSI and presents with a stable disease.
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Affiliation(s)
- Li Yuanchun
- Department of Clinical Laboratory, The Third People's Hospital of Shenzhen, Southern University of Science and Technology, National Clinical Research Center for Infectious Diseases, Guangdong Provincial Clinical Research Center for Infectious Diseases (Tuberculosis), Shenzhen Clinical Research Center for Tuberculosis, Shenzhen, China
| | - Zhang Wenping
- Department of Clinical Laboratory, The Third People's Hospital of Shenzhen, Southern University of Science and Technology, National Clinical Research Center for Infectious Diseases, Guangdong Provincial Clinical Research Center for Infectious Diseases (Tuberculosis), Shenzhen Clinical Research Center for Tuberculosis, Shenzhen, China
| | - Zhao Jing
- Department of Medical Imaging, The Third People's Hospital of Shenzhen, Southern University of Science and Technology, National Clinical Research Center for Infectious Diseases, Guangdong Provincial Clinical Research Center for Infectious Diseases (Tuberculosis), Shenzhen Clinical Research Center for Tuberculosis, Shenzhen, China
| | - Lai Wenjie
- Department of Clinical Laboratory, The Third People's Hospital of Shenzhen, Southern University of Science and Technology, National Clinical Research Center for Infectious Diseases, Guangdong Provincial Clinical Research Center for Infectious Diseases (Tuberculosis), Shenzhen Clinical Research Center for Tuberculosis, Shenzhen, China
| | - Zhao Yanlin
- National Tuberculosis Reference Laboratory, Chinese Center for Disease Control and Prevention. Beijing, P.R. China
| | - Li Yanming
- Department of Pulmonary and Critical Care Medicine, Beijing Hospital, National Center of Gerontology, National Health Commission; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, P.R. China
| | - Qu Jiuxin
- Department of Clinical Laboratory, The Third People's Hospital of Shenzhen, Southern University of Science and Technology, National Clinical Research Center for Infectious Diseases, Guangdong Provincial Clinical Research Center for Infectious Diseases (Tuberculosis), Shenzhen Clinical Research Center for Tuberculosis, Shenzhen, China
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Ulmann V, Modrá H, Babak V, Weston RT, Pavlik I. Recovery of Mycobacteria from Heavily Contaminated Environmental Matrices. Microorganisms 2021; 9:microorganisms9102178. [PMID: 34683499 PMCID: PMC8538195 DOI: 10.3390/microorganisms9102178] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 10/13/2021] [Accepted: 10/14/2021] [Indexed: 11/22/2022] Open
Abstract
For epidemiology studies, a decontamination method using a solution containing 4.0% NaOH and 0.5% tetradecyltrimethylammonium bromide (TDAB) represents a relatively simple and universal procedure for processing heavily microbially contaminated matrices together with increase of mycobacteria yield and elimination of gross contamination. A contamination rate only averaging 7.3% (2.4% in Cluster S; 6.9% in Cluster R and 12.6% in Cluster E) was found in 787 examined environmental samples. Mycobacteria were cultured from 28.5% of 274 soil and water sediments samples (Cluster S), 60.2% of 251 samples of raw and processed peat and other horticultural substrates (Cluster R), and 29.4% of 262 faecal samples along with other samples of animal origin (Cluster E). A total of 38 species of slow and rapidly growing mycobacteria were isolated. M. avium ssp. hominissuis, M. fortuitum and M. malmoense were the species most often isolated. The parameters for the quantitative detection of mycobacteria by PCR can be significantly refined by treating the sample suspension before DNA isolation with PMA (propidium monoazide) solution. This effectively eliminates DNA residue from both dead mycobacterial cells and potentially interfering DNA segments present from other microbial flora. In terms of human exposure risk assessment, the potential exposure to live non-tuberculous mycobacteria can be more accurately determined.
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Affiliation(s)
- Vit Ulmann
- Public Health Institute in Ostrava, Partyzanske Nam. 7, 702 00 Ostrava, Czech Republic;
| | - Helena Modrá
- Faculty of Regional Development and International Studies, Mendel University in Brno, Tr. Generala Piky 7, 613 00 Brno, Czech Republic;
| | - Vladimir Babak
- Veterinary Research Institute, v.v.i., Hudcova 70, 621 00 Brno, Czech Republic;
| | - Ross Tim Weston
- Department of Biochemistry and Genetics, La Trobe Institute for Molecular Science, La Trobe University, Bundoora, Melbourne, VIC 3086, Australia;
| | - Ivo Pavlik
- Faculty of Regional Development and International Studies, Mendel University in Brno, Tr. Generala Piky 7, 613 00 Brno, Czech Republic;
- Correspondence: ; Tel.: +420-773-491-836
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The global outbreak of Mycobacterium chimaera infections in cardiac surgery-a systematic review of whole-genome sequencing studies and joint analysis. Clin Microbiol Infect 2021; 27:1613-1620. [PMID: 34298175 DOI: 10.1016/j.cmi.2021.07.017] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 07/06/2021] [Accepted: 07/11/2021] [Indexed: 11/21/2022]
Abstract
BACKGROUND With the increasing dimensions of the international cardiac surgery-associated Mycobacterium chimaera outbreak the hypothesis of a point source arose. OBJECTIVES To review the published evidence of clonality among cardiac surgery-associated M. chimaera isolates evaluated by whole-genome sequencing (WGS) and to perform an integrative genomic analysis of available genome data. DATA SOURCES We searched PubMed and EMBASE for studies applying WGS on cardiac surgery-associated M. chimaera isolates. STUDY ELIGIBILITY CRITERIA We included studies that applied WGS on more than a single M. chimaera isolate. METHODS Two authors independently extracted data from included studies. Available genome data from published studies were subjected to a joint analysis. RESULTS Of 121 identified articles, nine studies were included. M. chimaera isolates from LivaNova heater-cooler devices (HCDs) had a high level of genetic similarity, but were genetically distant from isolates from HCDs produced by other manufacturers. With the exception of a single (11.1%) study, the remaining eight (89.9%) studies reported a high level of genetic proximity between the majority of M. chimaera isolates derived from cardiac surgery-associated patients and LivaNova HCDs. In-depth analysis revealed involvement of three distinct M. chimaera subgroups in the outbreak (1.1, 1.8, 2.1), with 1.1 suggested as causative of the outbreak. Samples taken at the LivaNova production site supported contamination with strains of subgroups 1.1 and 1.8. In the combined analysis of 526 publicly available WGS data sets, nearly all isolates from cardiac surgery-associated patients contained strain 1.1 (50/52, 96.2%), and at least one of the outbreak strains was found in almost all LivaNova HCDs (241/257, 93.8%), with strain 1.1 in particular present in 198/257 (77.0%). CONCLUSIONS HCD contamination during production seems plausible as the predominant point source for the global M. chimaera outbreak. Although HCDs can be contaminated with mixed populations, M. chimaera strains of the subgroup 1.1 caused most infections.
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Kaluza M, Färber G, May B, Dobermann U, Pletz MW, Edel B, Löffler B, Doenst T. Heater-Cooler Devices and Risk of Contamination during Cardiac Surgery. Thorac Cardiovasc Surg 2021; 69:703-709. [PMID: 33882611 DOI: 10.1055/s-0040-1721745] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Heater-cooler devices (HCD) have been implicated in a cardiosurgical contamination scenario causing prosthetic valve endocarditis. AIM We characterized contamination of new HCDs and assessed the risk of intraoperative microorganism transmission from the HCD to the operating field. METHODS We initially acquired four new FlexTherm and then four new Maquet HCU40 HCDs and assessed occurrence and speed of microbial contamination (including mycobacteria) assessing swab and water samples from the device. In parallel, we collected repeated samples from different sites in the operating room either by swab sticks or by exposing different sample plates to room air. We also reviewed microbiological results from the hospital and compared them to cardiosurgical wound infections and endocarditis cases. Finally, we simulated cardiosurgical conditions and assessed the devices' ability to expel air to the operative field. RESULTS All new HCDs were clean before first use. Despite authority-mandated decontamination procedures, microbial growth (Fusarium solani, Sphingomonas paucimobilis, Pseudomonas aeruginosa, Mycobacterium chelonae, and gordonae) was identified in all HCDs over time and could not be permanently eliminated. Four of these mircoorganisms were also found in tap water. However, none of the HCD-organisms were found inside the laminar airflow operating area. Importantly, except for P. aeruginosa, none of the HCD organisms were found in patients with surgical wound infections or endocarditis. HCD-expelled air did not rise more than 40 cm above ground. CONCLUSION HCDs cannot be expected to remain sterile despite extensive decontamination procedures. However, airborne transmission of microorganisms directly from the HCD to the operating field appears unlikely.
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Affiliation(s)
- Mirko Kaluza
- Department of Cardiothoracic Surgery, Jena University Hospital, Friedrich-Schiller University of Jena, Jena, Germany.,Life Systems Medizintechnik Service GmbH, Mönchengladbach, Germany
| | - Gloria Färber
- Department of Cardiothoracic Surgery, Jena University Hospital, Friedrich-Schiller University of Jena, Jena, Germany
| | - Benjamin May
- Department of Cardiothoracic Surgery, Jena University Hospital, Friedrich-Schiller University of Jena, Jena, Germany
| | - Ute Dobermann
- Center for Infectious Diseases and Infection Control, Jena University Hospital, Friedrich-Schiller University of Jena, Jena, Germany
| | - Mathias W Pletz
- Center for Infectious Diseases and Infection Control, Jena University Hospital, Friedrich-Schiller University of Jena, Jena, Germany
| | - Birgit Edel
- Institute of Medical Microbiology, Jena University Hospital, Friedrich-Schiller University of Jena, Jena, Germany
| | - Bettina Löffler
- Institute of Medical Microbiology, Jena University Hospital, Friedrich-Schiller University of Jena, Jena, Germany
| | - Torsten Doenst
- Department of Cardiothoracic Surgery, Jena University Hospital, Friedrich-Schiller University of Jena, Jena, Germany
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10
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Lecorche E, Daniau C, La K, Mougari F, Benmansour H, Kumanski S, Robert J, Fournier S, Lebreton G, Carbonne A, Cambau E. Mycobacterium chimaera Genomics With Regard to Epidemiological and Clinical Investigations Conducted for an Open Chest Postsurgical Mycobacterium chimaera Infection Outbreak. Open Forum Infect Dis 2021; 8:ofab192. [PMID: 34189167 PMCID: PMC8231370 DOI: 10.1093/ofid/ofab192] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 04/14/2021] [Indexed: 11/21/2022] Open
Abstract
Background Postsurgical infections due to Mycobacterium chimaera appeared as a novel nosocomial threat in 2015, with a worldwide outbreak due to contaminated heater-cooler units used in open chest surgery. We report the results of investigations conducted in France including whole-genome sequencing comparison of patient and heater-cooler unit isolates. Methods We sought M. chimaera infection cases from 2010 onwards through national epidemiological investigations in health care facilities performing cardiopulmonary bypass, together with a survey on good practices and systematic heater-cooler unit microbial analyses. Clinical and heater-cooler unit isolates were subjected to whole-genome sequencing analyzed with regard to the reference outbreak strain Zuerich-1. Results Only 2 clinical cases were shown to be related to the outbreak, although 23% (41/175) of heater-cooler units were declared positive for M. avium complex. Specific measures to prevent infection were applied in 89% (50/56) of health care facilities, although only 14% (8/56) of them followed the manufacturer maintenance recommendations. Whole-genome sequencing comparison showed that the clinical isolates and 72% (26/36) of heater-cooler unit isolates belonged to the epidemic cluster. Within clinical isolates, 5–9 nonsynonymous single nucleotide polymorphisms were observed, among which an in vivo mutation in a putative efflux pump gene was observed in a clinical isolate obtained for 1 patient on antimicrobial treatment. Conclusions Cases of postsurgical M. chimaera infections have been declared to be rare in France, although heater-cooler units were contaminated, as in other countries. Genomic analyses confirmed the connection to the outbreak and identified specific single nucleotide polymorphisms, including 1 suggesting fitness evolution in vivo.
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Affiliation(s)
- Emmanuel Lecorche
- Université de Paris, INSERM, IAME, Paris, France.,APHP-GHU Nord, Service de Mycobactériologie Spécialisée et de Référence, Paris, France.,Centre National de Référence des Mycobactéries et de la Résistance des Mycobactéries aux Antituberculeux (CNR-MyRMA), Paris, France
| | - Côme Daniau
- Santé Publique France, Saint-Maurice, France
| | - Kevin La
- Université de Paris, INSERM, IAME, Paris, France.,Centre National de Référence des Mycobactéries et de la Résistance des Mycobactéries aux Antituberculeux (CNR-MyRMA), Paris, France
| | - Faiza Mougari
- APHP-GHU Nord, Service de Mycobactériologie Spécialisée et de Référence, Paris, France.,Centre National de Référence des Mycobactéries et de la Résistance des Mycobactéries aux Antituberculeux (CNR-MyRMA), Paris, France
| | - Hanaa Benmansour
- APHP-GHU Nord, Service de Mycobactériologie Spécialisée et de Référence, Paris, France.,Centre National de Référence des Mycobactéries et de la Résistance des Mycobactéries aux Antituberculeux (CNR-MyRMA), Paris, France
| | - Sylvain Kumanski
- Centre National de Référence des Mycobactéries et de la Résistance des Mycobactéries aux Antituberculeux (CNR-MyRMA), Paris, France
| | - Jérôme Robert
- Centre National de Référence des Mycobactéries et de la Résistance des Mycobactéries aux Antituberculeux (CNR-MyRMA), Paris, France.,Centre d'Immunologie et des Maladies Infectieuses-CIMI-Paris, Sorbonne-Université, INSERM, Paris, France.,Bactériologie-Hygiène, AP-HP, Sorbonne Université, Site Pitié, Paris, France
| | - Sandra Fournier
- Centre d'Immunologie et des Maladies Infectieuses, Sorbonne - Université, INSERM (U1135 - E2), Paris, France
| | - Guillaume Lebreton
- Service de Chirurgie Cardiaque et Thoracique, Hôpital La Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | | | - Emmanuelle Cambau
- Université de Paris, INSERM, IAME, Paris, France.,APHP-GHU Nord, Service de Mycobactériologie Spécialisée et de Référence, Paris, France.,Centre National de Référence des Mycobactéries et de la Résistance des Mycobactéries aux Antituberculeux (CNR-MyRMA), Paris, France
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Pradal I, Esteban J, Mediero A, García-Coca M, Aguilera-Correa JJ. Contact Effect of a Methylobacterium sp. Extract on Biofilm of a Mycobacterium chimaera Strain Isolated from a 3T Heater-Cooler System. Antibiotics (Basel) 2020; 9:E474. [PMID: 32756304 PMCID: PMC7460266 DOI: 10.3390/antibiotics9080474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 07/22/2020] [Accepted: 07/29/2020] [Indexed: 11/17/2022] Open
Abstract
Mycobacterium chimaera is an opportunistic slowly growing non-tuberculous mycobacteriumof increasing importance due to the outbreak of cases associated with contaminated 3T heater-cooler device (HCD) extracorporeal membrane oxygenator (ECMO). The aim of this study was to evaluate the effect of pre-treating a surface with a Methylobacterium sp. CECT 7180 extract to inhibit the M. chimaera ECMO biofilm as well as of the treatment after different dehydration times. Surface adherence, biofilm formation and treatment effect were evaluated by estimating colony-forming units (CFU) per square centimeter and characterizing the amount of covered surface area, thickness, cell viability, and presence of intrinsic autofluorescence at different times using confocal laser scanning microscopy and image analysis. We found that exposing a surface to the Methylobacterium sp. CECT 7180 extract inhibited M. chimaera ECMO biofilm development. This effect could be result of the effect of Methylobacterium proteins, such as DNaK, trigger factor, and xanthine oxidase. In conclusion, exposing a surface to the Methylobacteriumsp. extract inhibits M. chimaera ECMO biofilm development. Furthermore, this extract could be used as a pre-treatment prior to disinfection protocols for equipment contaminated with mycobacteria after dehydration for at least 96 h.
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Affiliation(s)
- Inés Pradal
- Clinical Microbiology Department, IIS-Fundación Jiménez Díaz, UAM, 28040 Madrid, Spain
| | - Jaime Esteban
- Clinical Microbiology Department, IIS-Fundación Jiménez Díaz, UAM, 28040 Madrid, Spain
| | - Arancha Mediero
- Bone and Joint Unit, IIS-Fundación Jiménez Díaz, UAM, 28040 Madrid, Spain
| | - Marta García-Coca
- Clinical Microbiology Department, Quironsalud-Madrid University Hospital, 28223 Pozuelo de Alarcón, Spain
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