1
|
Bolcato V, Bassetti M, Basile G, Bianco Prevot L, Speziale G, Tremoli E, Maffessanti F, Tronconi LP. The State-of-the-Art of Mycobacterium chimaera Infections and the Causal Link with Health Settings: A Systematic Review. Healthcare (Basel) 2024; 12:1788. [PMID: 39273812 PMCID: PMC11395465 DOI: 10.3390/healthcare12171788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2024] [Revised: 08/28/2024] [Accepted: 08/29/2024] [Indexed: 09/15/2024] Open
Abstract
(1) Background. A definition of healthcare-associated infections is essential also for the attribution of the restorative burden to healthcare facilities in case of harm and for clinical risk management strategies. Regarding M. chimaera infections, there remains several issues on the ecosystem and pathogenesis. We aim to review the scientific evidence on M. chimaera beyond cardiac surgery, and thus discuss its relationship with healthcare facilities. (2) Methods. A systematic review was conducted on PubMed and Web of Science on 7 May 2024 according to PRISMA 2020 guidelines for reporting systematic reviews, including databases searches with the keyword "Mycobacterium chimaera". Article screening was conducted by tree authors independently. The criterion for inclusion was cases that were not, or were improperly, consistent with the in-situ deposition of aerosolised M. chimaera. (3) Results. The search yielded 290 eligible articles. After screening, 34 articles (377 patients) were included. In five articles, patients had undergone cardiac surgery and showed musculoskeletal involvement or disseminated infection without cardiac manifestations. In 11 articles, respiratory specimen reanalyses showed M. chimaera. Moreover, 10 articles reported lung involvement, 1 reported meninges involvement, 1 reported skin involvement, 1 reported kidney involvement after transplantation, 1 reported tendon involvement, and 1 reported the involvement of a central venous catheter; 3 articles reported disseminated cases with one concomitant spinal osteomyelitis. (4) Conclusions. The scarce data on environmental prevalence, the recent studies on M. chimaera ecology, and the medicalised sample selection bias, as well as the infrequent use of robust ascertainment of sub-species, need to be weighed up. The in-house aerosolization, inhalation, and haematogenous spread deserve experimental study, as M. chimaera cardiac localisation could depend to transient bacteraemia. Each case deserves specific ascertainment before tracing back to the facility, even if M. chimaera represents a core area for healthcare facilities within a framework of infection prevention and control policies.
Collapse
Affiliation(s)
| | - Matteo Bassetti
- Department of Health Sciences (DISSAL), University of Genova, 16132 Genova, Italy
- Infectious Diseases Unit, IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy
| | - Giuseppe Basile
- IRCCS Orthopaedic Institute Galeazzi, 20157 Milan, Italy
- Section of Legal and Forensic Medicine Clinical Institute San Siro, 20148 Milan, Italy
| | - Luca Bianco Prevot
- IRCCS Orthopaedic Institute Galeazzi, 20157 Milan, Italy
- Residency Program in Orthopaedics and Traumatology, University of Milan, 20122 Milan, Italy
| | | | - Elena Tremoli
- GVM Care and Research, Maria Cecilia Hospital, 49033 Cotignola, Italy
| | | | - Livio Pietro Tronconi
- GVM Care and Research, Maria Cecilia Hospital, 49033 Cotignola, Italy
- Department of Human Science, European University of Rome, 00163 Rome, Italy
| |
Collapse
|
2
|
Moore AE, Ngo T, Donald J, Shorey S, Sivakumar R, Velagapudi V, Walker CM. Radiologic Manifestations of Mycobacterium chimaera Infection After Open Heart Surgery. J Thorac Imaging 2024; 39:304-311. [PMID: 38662632 DOI: 10.1097/rti.0000000000000779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/23/2024]
Abstract
PURPOSE The objective of this study is to identify and detail the radiologic manifestations of surgical site and disseminated Mycobacterium chimaera ( MC) infection. The aim is to facilitate early identification and diagnosis of MC, considering its indolent nature and the challenges involved in clinically and pathologically establishing the diagnosis. PATIENTS AND METHODS This was a retrospective cohort study reviewing computed tomography (CT), positron emission tomography (PET)/CT, and magnetic resonance imaging examinations in patients over the age of 18 years with a history of open heart surgery and a clinical or pathologic diagnosis of MC. Two radiology residents, a fellowship-trained nuclear medicine radiologist, and a fellowship-trained cardiothoracic radiologist performed consensus reads to determine the imaging findings seen in MC infection. RESULTS Twenty-five patients were included. Localized, surgical site infection was more common than disseminated disease. Typical CT findings included peristernal soft tissue thickening, sinus tracts often extending to the cutaneous surface, slowly enlarging fluid collections, and sternal osteolysis. PET/CT findings demonstrated hypermetabolic activity in nearly all patients localized to sites of infection. Imaging findings for disseminated infection included hepatosplenomegaly, lymphadenopathy, involvement of the central nervous system, discitis/osteomyelitis, and distant abscesses. CONCLUSIONS Imaging plays a vital role in suggesting possible surgical sites and disseminated MC infection acquired from open heart surgery. Radiologists must keep a high index of suspicion given the indolent nature and subtle imaging change over time. PET/CT is most useful in diagnosis and helps in differentiating between a sterile postoperative fluid collection or scarring and active MC infection and helps provide a target for debridement.
Collapse
Affiliation(s)
- Andrew E Moore
- Department of Radiology, University of Kansas Medical Center, Kansas, KS
| | | | | | | | | | | | | |
Collapse
|
3
|
Wetzstein N, Kohl TA, Diricks M, Mas-Peiro S, Holubec T, Kessel J, Graf C, Koch B, Herrmann E, Vehreschild MJGT, Hogardt M, Niemann S, Stephan C, Wichelhaus TA. Clinical characteristics and outcome of Mycobacterium chimaera infections after cardiac surgery: systematic review and meta-analysis of 180 heater-cooler unit-associated cases. Clin Microbiol Infect 2023; 29:1008-1014. [PMID: 36918144 DOI: 10.1016/j.cmi.2023.03.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Revised: 02/13/2023] [Accepted: 03/05/2023] [Indexed: 03/14/2023]
Abstract
OBJECTIVES Since 2013, heater-cooler unit (HCU) associated Mycobacterium chimaera infections linked to a global outbreak have been described. These infections were characterised by high morbidity and mortality due to delayed diagnosis, as well as challenges in antimycobacterial and surgical therapy. This study aimed to investigate the clinical characteristics and outcome of published cases of HCU-associated M. chimaera infections. METHODS We searched PubMed and the Web of Science until 15 June 2022 for case reports, case series, and cohort studies, without language restriction, on patients with M. chimaera infection and a prior history of cardiac surgery. In this systematic review of case reports, no risk of bias assessment could be performed. Clinical, microbiological, and radiological features were recorded. Logistic regression and time-to-event analyses were performed to identify the potential factors associated with better survival. RESULTS One hundred eighty patients from 54 publications were included. Most patients underwent surgical aortic valve (67.0%; 118/176 of patients with available data) or combined aortic valve and root replacement (15.3%; 27/176). The median period between the time point of surgery and the first symptoms was 17 months (interquartile range 13-26 months). The overall case fatality rate was 45.5% (80/176), with a median survival of 24 months after the initiation of antimycobacterial therapy or diagnosis. A reoperation (including the removal or exchange of foreign material) was associated with better survival in multivariate logistic regression (OR 0.32 for lethal events; 95% CI 0.12-0.79; p 0.015) and in time-to-event analysis (p 0.0094). DISCUSSION This systematic review and meta-analysis confirm the high overall mortality of HCU -associated disseminated M. chimaera infections after cardiac surgery. A reoperation seems to be associated with better survival. Physicians have to stay aware of this infection, as patients might still be present today due to the long latency period.
Collapse
Affiliation(s)
- Nils Wetzstein
- Department of Internal Medicine, Infectious Diseases, University Hospital Frankfurt, Goethe University, Frankfurt am Main, Germany.
| | - Thomas A Kohl
- The German Centre for Infection Research (DZIF), partner site Hamburg-Lübeck-Borstel-Riems, Germany; Molecular and Experimental Mycobacteriology, Research Centre Borstel, Borstel, Germany
| | - Margo Diricks
- The German Centre for Infection Research (DZIF), partner site Hamburg-Lübeck-Borstel-Riems, Germany; Molecular and Experimental Mycobacteriology, Research Centre Borstel, Borstel, Germany
| | - Silvia Mas-Peiro
- Department of Internal Medicine, Cardiology, University Hospital Frankfurt, Goethe University, Frankfurt am Main, Germany
| | - Tomas Holubec
- Department of Cardiovascular Surgery, University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Johanna Kessel
- Department of Internal Medicine, Infectious Diseases, University Hospital Frankfurt, Goethe University, Frankfurt am Main, Germany
| | - Christiana Graf
- Department of Internal Medicine, Gastroenterology and Hepatology, University Hospital Frankfurt, Goethe University, Frankfurt am Main, Germany
| | - Benjamin Koch
- Department of Internal Medicine, Nephrology, University Hospital Frankfurt, Goethe University, Frankfurt am Main, Germany
| | - Eva Herrmann
- Institute of Biostatistics and Mathematical Modelling, Goethe University, Frankfurt am Main, Germany
| | - Maria J G T Vehreschild
- Department of Internal Medicine, Infectious Diseases, University Hospital Frankfurt, Goethe University, Frankfurt am Main, Germany
| | - Michael Hogardt
- Institute of Medical Microbiology and Infection Control, University Hospital Frankfurt, Goethe University, Frankfurt am Main, Germany
| | - Stefan Niemann
- The German Centre for Infection Research (DZIF), partner site Hamburg-Lübeck-Borstel-Riems, Germany; Molecular and Experimental Mycobacteriology, Research Centre Borstel, Borstel, Germany
| | - Christoph Stephan
- Department of Internal Medicine, Infectious Diseases, University Hospital Frankfurt, Goethe University, Frankfurt am Main, Germany
| | - Thomas A Wichelhaus
- Institute of Medical Microbiology and Infection Control, University Hospital Frankfurt, Goethe University, Frankfurt am Main, Germany
| |
Collapse
|
4
|
Long-Term Follow-Up after Mycobacterium Chimaera Infection Following Cardiac Surgery: Single-Center Experience. J Clin Med 2023; 12:jcm12030948. [PMID: 36769596 PMCID: PMC9917935 DOI: 10.3390/jcm12030948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Revised: 01/19/2023] [Accepted: 01/21/2023] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Disseminated Mycobacterium chimaera (M. chimaera) infection following cardiac surgery has been associated with a high mortality. The long-term impact of surgery and the appropriate surgical approach are still matters of debate. METHODS From 2015 to 2019, seven patients with M. chimaera infection following cardiac surgery were isolated. RESULTS The median incubation time was 30 months (IQR 18-38). Echocardiography was unremarkable in three patients (43%). We decided to redo cardiac surgery in all patients and explanted all previously implanted prosthetic material. All explant cultures yielded M. chimaera. One patient (14%) died in-hospital seven months after the redo surgery. After a median follow-up of 59.6 months (IQR 39.1-69.6), we observed three infection relapses among the survivors (43%), presumably due to concomitant extracardiac infection and recurrent cardiac implant infection. CONCLUSIONS M. chimaera infection following cardiac surgery is associated with a delayed and unspecific clinical presentation. Echocardiogaphy has a limited sensitivity for prosthetic valve infection with M. chimaera, and negative findings should not preclude the surgical decision. The extraction of all previously implanted material is crucial to achieving the source control, as the re-implantation of prosthetic material as well as uncontrolled extracardiac infection at the time of the redo cardiac surgery appear to be key factors for persisting/relapsing infection.
Collapse
|
5
|
Pradhan A, Martinez E, Sintchenko V, Post J, Overton K. Case of Mycobacterium chimaera vertebral osteomyelitis diagnosed 7 years after cardiac surgery. Intern Med J 2023; 53:150-151. [PMID: 36693641 DOI: 10.1111/imj.15982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 10/16/2022] [Indexed: 01/26/2023]
Affiliation(s)
- Alyssa Pradhan
- Department of Infectious Diseases, Prince of Wales Hospital, Sydney, New South Wales, Australia.,Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Elena Martinez
- Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia.,New South Wales Health Pathology, Sydney, New South Wales, Australia
| | - Vitali Sintchenko
- Sydney Institute for Infectious Diseases, University of Sydney, Sydney, New South Wales, Australia.,Centre for Infectious Diseases and Microbiology-Public Health, Westmead Hospital, Sydney, New South Wales, Australia.,Institute of Clinical Pathology and Medical Research, NSW Health Pathology, Sydney, New South Wales, Australia
| | - Jeffrey Post
- Department of Infectious Diseases, Prince of Wales Hospital, Sydney, New South Wales, Australia.,School of Clinical Medicine, UNSW Medicine & Heath, Sydney, New South Wales, Australia
| | - Kristen Overton
- Department of Infectious Diseases, Prince of Wales Hospital, Sydney, New South Wales, Australia.,School of Clinical Medicine, UNSW Medicine & Heath, Sydney, New South Wales, Australia
| |
Collapse
|
6
|
Provenzano N, Boris J, Nelluri B, Berman L, Singer R, You H. An Unusual Case of Prosthetic Valve Endocarditis. Cureus 2022; 14:e25735. [PMID: 35812612 PMCID: PMC9270098 DOI: 10.7759/cureus.25735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/07/2022] [Indexed: 11/05/2022] Open
Abstract
Mycobacterium chimaera is a slow-growing nontuberculous mycobacterium. It has been identified as a contaminant during open-heart surgery. It contaminates water in heater-cooler units that then become aerosolized, contaminating the surgical field. We report a 56-year-old male who presented with culture-negative endocarditis six years after his initial open-heart surgery.
Collapse
|
7
|
Vendramin I, Peghin M, Tascini C, Bortolotti U, Livi U. Mycobacterium chimaera infection after cardiac surgery: Catastrophic effects of delayed diagnosis. J Card Surg 2020; 36:408. [PMID: 33124088 DOI: 10.1111/jocs.15172] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2020] [Accepted: 09/12/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Igor Vendramin
- Cardiothoracic Department, University Hospital of Udine, Udine, Italy
| | - Maddalena Peghin
- Division of Infectious Diseases, University Hospital of Udine, Udine, Italy
| | - Carlo Tascini
- Division of Infectious Diseases, University Hospital of Udine, Udine, Italy
| | - Uberto Bortolotti
- Cardiothoracic Department, University Hospital of Udine, Udine, Italy
| | - Ugolino Livi
- Cardiothoracic Department, University Hospital of Udine, Udine, Italy.,Department of Medical Area (DAME), University of Udine, Udine, Italy
| |
Collapse
|