Research article Open Access
Like 0


, a non-tuberculous mycobacterium, was recently identified as causative agent of deep-seated infections in patients who had previously undergone open-chest cardiac surgery. Outbreak investigations suggested an aerosol-borne pathogen transmission originating from water contained in heater-cooler units (HCUs) used during cardiac surgery. Similar thermoregulatory devices are used for extracorporeal membrane oxygenation (ECMO) and might also be detectable in ECMO treatment settings. We performed a prospective microbiological study investigating the occurrence of in water from ECMO systems and in environmental samples, and a retrospective clinical review of possible ECMO-related mycobacterial infections among patients in a pneumological intensive care unit. We detected in 9 of 18 water samples from 10 different thermoregulatory ECMO devices; no mycobacteria were found in the nine room air samples and other environmental samples. Among 118 ECMO patients, 76 had bronchial specimens analysed for mycobacteria and was found in three individuals without signs of mycobacterial infection at the time of sampling. We conclude that can be detected in water samples from ECMO-associated thermoregulatory devices and might potentially pose patients at risk of infection. Further research is warranted to elucidate the clinical significance of in ECMO treatment settings.


Article metrics loading...

Loading full text...

Full text loading...



  1. 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 
  2. 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 
  3. Boyle DP, Zembower TR, Reddy S, Qi C. Comparison of clinical features, virulence, and relapse among Mycobacterium avium complex species. Am J Respir Crit Care Med. 2015;191(11):1310-7.  https://doi.org/10.1164/rccm.201501-0067OC  PMID: 25835090 
  4. 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 
  5. Achermann Y, Rössle M, Hoffmann M, Deggim V, Kuster S, Zimmermann DR, et al. Prosthetic valve endocarditis and bloodstream infection due to Mycobacterium chimaera. J Clin Microbiol. 2013;51(6):1769-73.  https://doi.org/10.1128/JCM.00435-13  PMID: 23536407 
  6. Kohler P, Küster 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 
  7. Tan N, Sampath R, Abu Saleh OM, Tweet MS, Jevremovic D, Alniemi S, et al. Disseminated Mycobacterium chimaera infection after cardiothoracic surgery. Open Forum Infect Dis. 2016;3(3):ofw131.  https://doi.org/10.1093/ofid/ofw131  PMID: 27703994 
  8. 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 
  9. Makovcova J, Slany M, Babak V, Slana I, Kralik P. The water environment as a source of potentially pathogenic mycobacteria. J Water Health. 2014;12(2):254-63.  https://doi.org/10.2166/wh.2013.102  PMID: 24937219 
  10. Garvey MI, Ashford R, Bradley CW, Bradley CR, Martin TA, Walker J, et al. Decontamination of heater-cooler units associated with contamination by atypical mycobacteria. J Hosp Infect. 2016;93(3):229-34.  https://doi.org/10.1016/j.jhin.2016.02.007  PMID: 27112044 
  11. Kanamori H, Weber DJ, Rutala WA. Healthcare outbreaks associated with a water reservoir and infection prevention strategies. Clin Infect Dis. 2016;62(11):1423-35.  https://doi.org/10.1093/cid/ciw122  PMID: 26936670 
  12. Götting T, Klassen S, Jonas D, Benk Ch, Serr A, Wagner D, et al. Heater-cooler units: contamination of crucial devices in cardiothoracic surgery. J Hosp Infect. 2016;93(3):223-8.  https://doi.org/10.1016/j.jhin.2016.02.006  PMID: 27101883 
  13. 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):1008-13.  https://doi.org/10.3201/eid2206.160045  PMID: 27070958 
  14. Haller S, Holler C, Jacobshagen A, Hamouda O, Abu Sin M, Monnet DL, et al. Contamination during production of heater-cooler units by Mycobacterium chimaera potential cause for invasive cardiovascular infections: results of an outbreak investigation in Germany, April 2015 to February 2016. Euro Surveill. 2016;21(17):30215.
  15. Brodie D, Bacchetta M. Extracorporeal membrane oxygenation for ARDS in adults. N Engl J Med. 2011;365(20):1905-14.  https://doi.org/10.1056/NEJMct1103720  PMID: 22087681 
  16. Aokage T, Palmér K, Ichiba S, Takeda S. Extracorporeal membrane oxygenation for acute respiratory distress syndrome. J Intensive Care. 2015;3(1):17.  https://doi.org/10.1186/s40560-015-0082-7  PMID: 27408728 
  17. Bakhtiary F, Keller H, Dogan S, Dzemali O, Oezaslan F, Meininger D, et al. Venoarterial extracorporeal membrane oxygenation for treatment of cardiogenic shock: clinical experiences in 45 adult patients. J Thorac Cardiovasc Surg. 2008;135(2):382-8.  https://doi.org/10.1016/j.jtcvs.2007.08.007  PMID: 18242273 
  18. Rastan AJ, Dege A, Mohr M, Doll N, Falk V, Walther T, et al. Early and late outcomes of 517 consecutive adult patients treated with extracorporeal membrane oxygenation for refractory postcardiotomy cardiogenic shock. J Thorac Cardiovasc Surg. 2010;139(2):302-11, 311.e1.  https://doi.org/10.1016/j.jtcvs.2009.10.043  PMID: 20106393 
  19. Mirabel M, Luyt CE, Leprince P, Trouillet JL, Léger P, Pavie A, et al. Outcomes, long-term quality of life, and psychologic assessment of fulminant myocarditis patients rescued by mechanical circulatory support. Crit Care Med. 2011;39(5):1029-35.  https://doi.org/10.1097/CCM.0b013e31820ead45  PMID: 21336134 
  20. Werdan K, Gielen S, Ebelt H, Hochman JS. Mechanical circulatory support in cardiogenic shock. Eur Heart J. 2014;35(3):156-67.  https://doi.org/10.1093/eurheartj/eht248  PMID: 24014384 
  21. Squiers JJ, Lima B, DiMaio JM. Contemporary extracorporeal membrane oxygenation therapy in adults: Fundamental principles and systematic review of the evidence. J Thorac Cardiovasc Surg. 2016;152(1):20-32.  https://doi.org/10.1016/j.jtcvs.2016.02.067  PMID: 27060027 
  22. Hoopes CW, Kukreja J, Golden J, Davenport DL, Diaz-Guzman E, Zwischenberger JB. Extracorporeal membrane oxygenation as a bridge to pulmonary transplantation. J Thorac Cardiovasc Surg. 2013;145(3):862-7, discussion 867-8.  https://doi.org/10.1016/j.jtcvs.2012.12.022  PMID: 23312979 
  23. Kon ZN, Wehman PB, Gibber M, Rabin J, Evans CF, Rajagopal K, et al. Venovenous extracorporeal membrane oxygenation as a bridge to lung transplantation: successful transplantation after 155 days of support. Ann Thorac Surg. 2015;99(2):704-7.  https://doi.org/10.1016/j.athoracsur.2014.04.097  PMID: 25639416 
  24. European Centre for Disease Prevention and Control (ECDC). ECDC Technical Document. 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. 2015. [Accessed 17 Oct 2016]. Available from: http://ecdc.europa.eu/en/publications/Publications/EU-protocol-for-M-chimaera.pdf
  25. Verordnung über die Qualität von Wasser für den menschlichen Gebrauch (Trinkwasserverordnung – TrinkwV 2001), Neufassung vom 10. März 2016. 2016. [German ordinance on the quality of water intended for human consumption (Trinkwasserverordnung – TrinkwV 2001) as published on 10 March 2016]. [Accessed 1 Nov 2016]. German. Available from: http://www.bgbl.de/xaver/bgbl/start.xav?startbk=Bundesanzeiger_BGBl&jumpTo=bgbl116s0459.pdf#__bgbl__%2F%2F*%5B%40attr_id%3D%27bgbl116s0459.pdf%27%5D__1478020685560 [in German]
  26. Moon SM, Kim SY, Jhun BW, Lee H, Park HY, Jeon K, et al. Clinical characteristics and treatment outcomes of pulmonary disease caused by Mycobacterium chimaera. Diagn Microbiol Infect Dis. 2016;S0732-8893(16)30315-7. PMID: 27720208 
  27. Alhanna J, Purucker M, Steppert C, Grigull-Daborn A, Schiffel G, Gruber H, et al. Mycobacterium chimaera causes tuberculosis-like infection in a male patient with anorexia nervosa. Int J Eat Disord. 2012;45(3):450-2.  https://doi.org/10.1002/eat.20942  PMID: 21656541 
  28. Bills ND, Hinrichs SH, Aden TA, Wickert RS, Iwen PC. Molecular identification of Mycobacterium chimaera as a cause of infection in a patient with chronic obstructive pulmonary disease. Diagn Microbiol Infect Dis. 2009;63(3):292-5.  https://doi.org/10.1016/j.diagmicrobio.2008.12.002  PMID: 19216940 
  29. Cohen-Bacrie S, David M, Stremler N, Dubus JC, Rolain JM, Drancourt M. Mycobacterium chimaera pulmonary infection complicating cystic fibrosis: a case report. J Med Case Reports. 2011;5(1):473.  https://doi.org/10.1186/1752-1947-5-473  PMID: 21939536 
  30. Perkins KM, Lawsin A, Hasan NA, Strong M, Halpin AL, Rodger RR, et al. Notes from the field: Mycobacterium chimaera contamination of heater-cooler devices used in cardiac surgery – United States. MMWR Morb Mortal Wkly Rep. 2016;65(40):1117-8.  https://doi.org/10.15585/mmwr.mm6540a6  PMID: 27740609 
  31. Schreiber PW, Küster SP, Hasse B, Bayard C, Rüegg C, Kohler P, et al. Reemergence of Mycobacterium chimaera in heater-cooler units despite intensified cleaning and disinfection protocol. Emerg Infect Dis. 2016;22(10):1830-3.  https://doi.org/10.3201/eid2210.160925  PMID: 27649345 
  32. van Ingen J. Microbiological diagnosis of nontuberculous mycobacterial pulmonary disease. Clin Chest Med. 2015;36(1):43-54.  https://doi.org/10.1016/j.ccm.2014.11.005  PMID: 25676518 
  33. Peek GJ, Mugford M, Tiruvoipati R, Wilson A, Allen E, Thalanany MM, et al. CESAR trial collaboration. Efficacy and economic assessment of conventional ventilatory support versus extracorporeal membrane oxygenation for severe adult respiratory failure (CESAR): a multicentre randomised controlled trial. Lancet. 2009;374(9698):1351-63.  https://doi.org/10.1016/S0140-6736(09)61069-2  PMID: 19762075 
  34. Noah MA, Peek GJ, Finney SJ, Griffiths MJ, Harrison DA, Grieve R, et al. Referral to an extracorporeal membrane oxygenation center and mortality among patients with severe 2009 influenza A(H1N1). JAMA. 2011;306(15):1659-68.  https://doi.org/10.1001/jama.2011.1471  PMID: 21976615 

Data & Media loading...

Submit comment
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