Long-term follow-up of post-cardiac surgery Mycobacterium chimaera infections: A 5-center case series - 05/02/20
, Tonya Crook a, Eugene Curley b, A. Ben Appenheimer c, Catharine I. Paules a, Barbara Hasse d, Daniel J. Diekema c, Charles L. Daley e, Jorgelina de Sanctis f, Walter C. Hellinger g, Adrah Levin e, George McSherry a, Carol Freer a, Cynthia J. Whitener aHighlights |
• | Indolent symptoms of endovascular M. chimaera do not portend a benign course. |
• | Despite antimicrobials, mortality was high for post-surgery patients with M. chimaera. |
• | Relapses of M. chimaera may also manifest minimal or indolent symptoms. |
• | Only 3 of 12 with infected, retained cardiac prosthesis achieved control of infection. |
• | This infection warrants aggressive treatment and long-term monitoring. |
Abstract |
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.
Le texte complet de cet article est disponible en PDF.Keywords : Nontuberculous mycobacteria, Mycobacterium avium complex, Endocarditis, Cardiopulmonary bypass, Cardiovascular surgical procedures
Plan
Vol 80 - N° 2
P. 197-203 - février 2020 Retour au numéro
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