TY - JOUR
T1 - Long-term follow-up of post-cardiac surgery Mycobacterium chimaera infections
T2 - A 5-center case series
AU - Julian, Kathleen G.
AU - Crook, Tonya
AU - Curley, Eugene
AU - Appenheimer, A. Ben
AU - Paules, Catharine I.
AU - Hasse, Barbara
AU - Diekema, Daniel J.
AU - Daley, Charles L.
AU - de Sanctis, Jorgelina
AU - Hellinger, Walter C.
AU - Levin, Adrah
AU - McSherry, George
AU - Freer, Carol
AU - Whitener, Cynthia J.
N1 - Publisher Copyright:
© 2019
PY - 2020/2
Y1 - 2020/2
N2 - Objectives: In multiple countries, endovascular/disseminated Mycobacterium chimaera infections have occurred in post-cardiac surgery patients in association with contaminated, widely-distributed cardiac bypass heater-cooler devices. To contribute to long-term characterization of this recently recognized infection, we describe the clinical course of 28 patients with 3–7 years of follow-up for survivors. Methods: Identified at five hospitals in the United States 2010–2016, post-cardiac surgery patients in the cohort had growth of Mycobacterium avium complex (MAC)/M. chimaera from a sterile site or surgical wound, or a clinically compatible febrile illness with granulomatous inflammation on biopsy. Case follow-up was conducted in May 2019. Results: Of 28 patients, infection appeared to be localized to the sternum in four patients. Among 18 with endovascular/disseminated infection who received combination anti-mycobacterial treatment and had sufficient follow-up, 39% appeared to have controlled infection (>12 months), 56% died, and one patient is alive with relapsed bacteremia. While the number of patients is small and interpretation is limited, four (67%) of six patients who had cardiac prosthesis removal/replacement appeared to have controlled infection compared to three (25%) of 12 with retained cardiac prosthesis (p >0.14; Fisher's exact test). Conclusions: Given poor response to treatment and potential for delayed relapses, post-cardiac surgery M. chimaera infection warrants aggressive treatment and long-term monitoring.
AB - Objectives: In multiple countries, endovascular/disseminated Mycobacterium chimaera infections have occurred in post-cardiac surgery patients in association with contaminated, widely-distributed cardiac bypass heater-cooler devices. To contribute to long-term characterization of this recently recognized infection, we describe the clinical course of 28 patients with 3–7 years of follow-up for survivors. Methods: Identified at five hospitals in the United States 2010–2016, post-cardiac surgery patients in the cohort had growth of Mycobacterium avium complex (MAC)/M. chimaera from a sterile site or surgical wound, or a clinically compatible febrile illness with granulomatous inflammation on biopsy. Case follow-up was conducted in May 2019. Results: Of 28 patients, infection appeared to be localized to the sternum in four patients. Among 18 with endovascular/disseminated infection who received combination anti-mycobacterial treatment and had sufficient follow-up, 39% appeared to have controlled infection (>12 months), 56% died, and one patient is alive with relapsed bacteremia. While the number of patients is small and interpretation is limited, four (67%) of six patients who had cardiac prosthesis removal/replacement appeared to have controlled infection compared to three (25%) of 12 with retained cardiac prosthesis (p >0.14; Fisher's exact test). Conclusions: Given poor response to treatment and potential for delayed relapses, post-cardiac surgery M. chimaera infection warrants aggressive treatment and long-term monitoring.
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U2 - 10.1016/j.jinf.2019.12.007
DO - 10.1016/j.jinf.2019.12.007
M3 - Article
C2 - 31863789
AN - SCOPUS:85077396534
SN - 0163-4453
VL - 80
SP - 197
EP - 203
JO - Journal of Infection
JF - Journal of Infection
IS - 2
ER -