1887
Surveillance and outbreak report Open Access
Like 0

Abstract

Invasive infections with were reported in patients with previous open chest surgery and exposure to contaminated heater-cooler units (HCUs). We present results of the surveillance of clinical cases and of contaminated HCUs as well as environmental investigations in Germany up until February 2016. Clinical infections occurred in five male German cases over 50 years of age (range 53–80). Cases had been exposed to HCUs from one single manufacturer during open chest surgery up to five years prior to onset of symptoms. During environmental investigations, was detected in samples from used HCUs from three different countries and samples from new HCUs as well as in the environment at the manufacturing site of one manufacturer in Germany. Our investigation suggests that at least some of the infections may have been caused by contamination of HCUs at manufacturing site. We recommend that until sustainable measures for safe use of HCUs in operation theatres are implemented, users continue to adhere to instructions for use of HCUs and Field Safety Notices issued by the manufacturer, implement local monitoring for bacterial contamination and continuously check the websites of national and European authorities for current recommendations for the safe operation of HCUs.

Loading

Article metrics loading...

/content/10.2807/1560-7917.ES.2016.21.17.30215
2016-04-28
2017-11-21
http://instance.metastore.ingenta.com/content/10.2807/1560-7917.ES.2016.21.17.30215
Loading
Loading full text...

Full text loading...

/deliver/fulltext/eurosurveillance/21/17/eurosurv-21-30215-3.html?itemId=/content/10.2807/1560-7917.ES.2016.21.17.30215&mimeType=html&fmt=ahah

References

  1. Federal Office of Public Health Switzerland (FOPH). Massnahmen für höhere Patientensicherheit in der Herzchirurgie. [Measures for improved patient safety in cardiac surgery]. Press release. FOPH. Updated 14 Jul 2014. Available from: https://www.news.admin.ch/message/index.html?lang=de&msg-id=53774
  2. Sax H, Bloemberg G, Hasse B, Sommerstein R, Kohler P, Achermann Y, et al. Prolonged Outbreak of Mycobacterium chimaera Infection After Open-Chest Heart Surgery. Clin Infect Dis. 2015;61(1):67-75.  https://doi.org/10.1093/cid/civ198  PMID: 25761866 
  3. Kohler P, Kuster SP, Bloemberg G, Schulthess B, Frank M, Tanner FC, et al. Healthcare-associated prosthetic heart valve, aortic vascular graft, and disseminated Mycobacterium chimaera infections subsequent to open heart surgery. Eur Heart J. 2015;36(40):2745-53.  https://doi.org/10.1093/eurheartj/ehv342  PMID: 26188001 
  4. Sommerstein R, Rüegg C, Kohler P, Bloemberg G, Kuster SP, Sax H. Transmission of Mycobacterium chimaera from heater–cooler units during cardiac surgery despite an ultraclean air ventilation system. Emerg Infect Dis. 2016;22(6).  https://doi.org/10.3201/eid2206.160045  PMID: 27070958 
  5. Public Health England (PHE). Mycobacterial infections associated with cardiopulmonary bypass surgery, 10 June 2015. London: PHE. Available from: https://www.gov.uk/government/news/mycobacterial-infections-associated-with-cardiopulmonary-bypass-surgery
  6. Götting T, Klassen S, Jonas D, Benk C, Serr A, Wagner D, et al. Heater‒cooler units: contamination of crucial devices in cardiothoracic surgery. J Hosp Infect. 2016 Feb 27. pii: S0195-6701(16)00126-2. doi:  https://doi.org/10.1016/j.jhin.2016.02.006 . [Epub ahead of print]
  7. Tortoli E, Rindi L, Garcia MJ, Chiaradonna P, Dei R, Garzelli C, et al. Proposal to elevate the genetic variant MAC-A, included in the Mycobacterium avium complex, to species rank as Mycobacterium chimaera sp. nov. Int J Syst Evol Microbiol. 2004;54(Pt 4):1277-85.  https://doi.org/10.1099/ijs.0.02777-0  PMID: 15280303 
  8. Schweickert B, Goldenberg O, Richter E, Göbel UB, Petrich A, Buchholz P, et al. Occurrence and clinical relevance of Mycobacterium chimaera sp. nov., Germany. Emerg Infect Dis. 2008;14(9):1443-6.  https://doi.org/10.3201/eid1409.071032  PMID: 18760016 
  9. Wallace RJ Jr, Iakhiaeva E, Williams MD, Brown-Elliott BA, Vasireddy S, Vasireddy R, et al. Absence of Mycobacterium intracellulare and presence of Mycobacterium chimaera in household water and biofilm samples of patients in the United States with Mycobacterium avium complex respiratory disease. J Clin Microbiol. 2013;51(6):1747-52.  https://doi.org/10.1128/JCM.00186-13  PMID: 23536397 
  10. European Centre for Disease Prevention and Control (ECDC). Invasive cardiovascular infection by Mycobacterium chimaera potentially associated with heater-cooler units used during cardiac surgery. Stockholm: ECDC. 30 Apr 2015. Available from: http://ecdc.europa.eu/en/publications/Publications/mycobacterium-chimaera-infection-associated-with-heater-cooler-units-rapid-risk-assessment-30-April-2015.pdf
  11. Haller S, Eckmanns T, Benzler J, Tolksdorf K, Claus H, Gilsdorf A, et al. Results from the first 12 months of the national surveillance of healthcare associated outbreaks in Germany, 2011/2012. PLoS One. 2014;9(5):e98100.  https://doi.org/10.1371/journal.pone.0098100  PMID: 24875674 
  12. Robert-Koch-Institut (RKI). Informationen zu einem internationalen Ausbruchsgeschehen mit nicht-tuberkulösen Mykobakterien im Zusammenhang mit Termperaturregulierungsgeräten ber Herzoperationen. [Information on an international outbreak with non-tuberculous Mycobacteria connected to heater cooler units]. Epidemiologisches Bulletin. 2015;20:165. German. Available from: https://www.rki.de/DE/Content/Infekt/EpidBull/Archiv/2015/Ausgaben/20_15.pdf?__blob=publicationFile
  13. Deutsche Gesellschaft für Thorax- Herz- und Gefäßchirurgie (DGTHG) / Deutsche Gesellschaft für Infektiologie (DGI). Wichtige Information der DGTHG und DGI zu Infektionen mit Mycobacterium chimaera nach Herz-Operationen. [Important information of German Society of Thoracic and Cardiovascular Surgery and the German Society of Infection about Mycobacterium chimaera infections occurring after heart surgery]. Coswig: DGTHG/DGI. 30 Apr 2014. German. Available from: www.dgfkt.de/content/hygiene/information_DGTHG-DGI_zu_m_chimaera_2015_04_30.pdf
  14. Robert Koch Institute (RKI). Informationen zu einem internationalen Ausbruchsgeschehen mit nicht-tuberkulösen Mykobakterien im Zusammenhang mit Temperaturregulierungsgeräten bei Herzoperationen. [Information on an international outbreak with non-tuberculous Mycobacteria connected to heater cooler units]. Berlin: RKI. 2015. Available from: https://www.rki.de/DE/Content/Infekt/Krankenhaushygiene/Aufb_MedProd/Mycobacterium_chimaera.html
  15. Mohr O, Velasco E, Fell G, Burckhardt F, Poggensee G, Eckmanns T. [Teleconferences for national surveillance of infectious diseases and public health events in Germany. Evaluation after three quarters in 2009]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz. 2010;53(9):903-9.  https://doi.org/10.1007/s00103-010-1122-z  PMID: 20853087 
  16. Federal Institute for Drugs and Medical Devices (BfArM). (Mandatory notification for incident reports of medical devices in case of Mycobacterium chimaera infection following heart surgery). Medizinprodukte-Beobachtungs- und Medlesystem bei Infektionen mit Myobacterium chimaerea nach Herz-Operationen beachten. Hyg Med. 2015;7/8(40):232.
  17. Federal Institute for Drugs and Medical Devices (BfArM). Möglicher Zusammenhang zwischen Hypothermiegeräten und Infektionsrisiko mit Mykobakterien bei der Herzchirurgie. [Possible association between heater-cooler units and risk for mycobacterial infections in heart surgery]. Bonn: Germany. Updated 10 Jul 2015. Available from: http://www.bfarm.de/SharedDocs/Risikoinformationen/Medizinprodukte/DE/Hypothermiegeraete.htm.
  18. European Centre for Disease Prevention and Control (ECDC). EU protocol for case detection, laboratory diagnosis and environmental testing of Mycobacterium chimaera infections potentially associated with heater cooler units: case definition and environmental testing methodology. Stockholm: ECDC. Aug 2015. Available from: http://ecdc.europa.eu/en/publications/Publications/EU-protocol-for-M-chimaera.pdf
  19. Yuan SM. Mycobacterial endocarditis: a comprehensive review. Rev Bras Cir Cardiovasc. 2015;30(1):93-103. PMID: 25859873 
  20. Kanamori H, Weber DJ, Rutala WA. Healthcare-Associated Outbreaks Associated with a Water Reservoir and Infection Prevention Strategies. Clin Infect Dis. 1 Mar 2016. [Epub ahead of print].
/content/10.2807/1560-7917.ES.2016.21.17.30215
Loading

Data & Media loading...

Comment has been disabled for this content
Submit comment
Close
Comment moderation successfully completed
This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error