Via The Lancet Respiratory Medicine: Nosocomial nontuberculous mycobacteria infections associated with heater-cooler devices. Excerpt:
The July, 2013, opening of a new wing at Duke University Hospital (Durham, NC, USA) was shortly followed by a two-phased outbreak of nosocomial nontuberculous mycobacteria (NTM) infections, investigators recently reported.
All 95 affected patients tested positive for Mycobacterium abscessus, a fast-growing NTM found in the Durham municipal water supply and concentrated in the high-efficiency water distribution system of the new wing. 13 (54%) of 24 affected patients from the second phase were patients who had had cardiac surgery. The mortality reached 41% for infected cardiothoracic patients from both phases combined (nine of 22 patients).
The outbreak of NTM infections among patients who had undergone open-chest cardiac surgery was terminated by instituting changes to the way that heater-cooler devices were used during cardiopulmonary bypass. First author of the study Arthur Baker, of the Duke Division of Infectious Diseases, explains, “Our primary heater-cooler device-related interventions were the use of sterile water in these devices, intensification of the heater-cooler device disinfection protocol, and purchase of new heater-cooler devices”.
This study is the latest in a series of international reports on the outbreak of life-threatening NTM infections in patients who had cardiothoracic surgery during which contaminated heater-cooler devices were used. A 2013 report from Switzerland described the first two observed cases of disseminated Mycobacterium chimaera infection following cardiothoracic surgery. Since then, more cases have been reported in The Netherlands, Germany, the USA, the UK, Denmark, and Australia.
The origin of these M chimaera infections was linked to heater-cooler devices by German investigators, who isolated nearly identical strains of M chimaera from three sources: infected cardiothoracic patients (n=5) who underwent cardiopulmonary bypass with heater-cooler devices from one manufacturer; heater-cooler devices from this manufacturer used in operating rooms in Germany, The Netherlands, and Switzerland; and new heater-cooler devices and environmental samples from the production line at the manufacturer's facility.