TY - JOUR
T1 - Global outbreak of severe Mycobacterium chimaera disease after cardiac surgery
T2 - a molecular epidemiological study
AU - van Ingen, Jakko
AU - Kohl, Thomas A.
AU - Kranzer, Katharina
AU - Hasse, Barbara
AU - Keller, Peter M.
AU - Katarzyna Szafrańska, Anna
AU - Hillemann, Doris
AU - Chand, Meera
AU - Schreiber, Peter Werner
AU - Sommerstein, Rami
AU - Berger, Christoph
AU - Genoni, Michele
AU - Rüegg, Christian
AU - Troillet, Nicolas
AU - Widmer, Andreas F.
AU - Becker, Sören L.
AU - Herrmann, Mathias
AU - Eckmanns, Tim
AU - Haller, Sebastian
AU - Höller, Christiane
AU - Debast, Sylvia B.
AU - Wolfhagen, Maurice J.
AU - Hopman, Joost
AU - Kluytmans, Jan
AU - Langelaar, Merel
AU - Notermans, Daan W.
AU - ten Oever, Jaap
AU - van den Barselaar, Peter
AU - Vonk, Alexander B.A.
AU - Vos, Margreet C.
AU - Ahmed, Nada
AU - Brown, Timothy
AU - Crook, Derrick
AU - Lamagni, Theresa
AU - Phin, Nick
AU - Smith, E. Grace
AU - Zambon, Maria
AU - Serr, Annerose
AU - Götting, Tim
AU - Ebner, Winfried
AU - Thürmer, Alexander
AU - Utpatel, Christian
AU - Spröer, Cathrin
AU - Bunk, Boyke
AU - Nübel, Ulrich
AU - Bloemberg, Guido V.
AU - Böttger, Erik C.
AU - Niemann, Stefan
AU - Wagner, Dirk
AU - Sax, Hugo
PY - 2017/10/1
Y1 - 2017/10/1
N2 - Background Since 2013, over 100 cases of Mycobacterium chimaera prosthetic valve endocarditis and disseminated disease were notified in Europe and the USA, linked to contaminated heater–cooler units (HCUs) used during cardiac surgery. We did a molecular epidemiological investigation to establish the source of these patients' disease. Methods We included 24 M chimaera isolates from 21 cardiac surgery-related patients in Switzerland, Germany, the Netherlands, and the UK, 218 M chimaera isolates from various types of HCUs in hospitals, from LivaNova (formerly Sorin; London, UK) and Maquet (Rastatt, Germany) brand HCU production sites, and unrelated environmental sources and patients, as well as eight Mycobacterium intracellulare isolates. Isolates were analysed by next-generation whole-genome sequencing using Illumina and Pacific Biosciences technologies, and compared with published M chimaera genomes. Findings Phylogenetic analysis based on whole-genome sequencing of 250 isolates revealed two major M chimaera groups. Cardiac surgery-related patient isolates were all classified into group 1, in which all, except one, formed a distinct subgroup. This subgroup also comprised isolates from 11 cardiac surgery-related patients reported from the USA, most isolates from LivaNova HCUs, and one from their production site. Isolates from other HCUs and unrelated patients were more widely distributed in the phylogenetic tree. Interpretation HCU contamination with M chimaera at the LivaNova factory seems a likely source for cardiothoracic surgery-related severe M chimaera infections diagnosed in Switzerland, Germany, the Netherlands, the UK, the USA, and Australia. Protective measures and heightened clinician awareness are essential to guarantee patient safety. Funding Partly funded by the EU Horizon 2020 programme, its FP7 programme, the German Center for Infection Research (DZIF), the Swiss National Science Foundation, the Swiss Federal Office of Public Health, and National Institute of Health Research Oxford Health Protection Research Units on Healthcare Associated Infection and Antimicrobial Resistance.
AB - Background Since 2013, over 100 cases of Mycobacterium chimaera prosthetic valve endocarditis and disseminated disease were notified in Europe and the USA, linked to contaminated heater–cooler units (HCUs) used during cardiac surgery. We did a molecular epidemiological investigation to establish the source of these patients' disease. Methods We included 24 M chimaera isolates from 21 cardiac surgery-related patients in Switzerland, Germany, the Netherlands, and the UK, 218 M chimaera isolates from various types of HCUs in hospitals, from LivaNova (formerly Sorin; London, UK) and Maquet (Rastatt, Germany) brand HCU production sites, and unrelated environmental sources and patients, as well as eight Mycobacterium intracellulare isolates. Isolates were analysed by next-generation whole-genome sequencing using Illumina and Pacific Biosciences technologies, and compared with published M chimaera genomes. Findings Phylogenetic analysis based on whole-genome sequencing of 250 isolates revealed two major M chimaera groups. Cardiac surgery-related patient isolates were all classified into group 1, in which all, except one, formed a distinct subgroup. This subgroup also comprised isolates from 11 cardiac surgery-related patients reported from the USA, most isolates from LivaNova HCUs, and one from their production site. Isolates from other HCUs and unrelated patients were more widely distributed in the phylogenetic tree. Interpretation HCU contamination with M chimaera at the LivaNova factory seems a likely source for cardiothoracic surgery-related severe M chimaera infections diagnosed in Switzerland, Germany, the Netherlands, the UK, the USA, and Australia. Protective measures and heightened clinician awareness are essential to guarantee patient safety. Funding Partly funded by the EU Horizon 2020 programme, its FP7 programme, the German Center for Infection Research (DZIF), the Swiss National Science Foundation, the Swiss Federal Office of Public Health, and National Institute of Health Research Oxford Health Protection Research Units on Healthcare Associated Infection and Antimicrobial Resistance.
UR - http://www.scopus.com/inward/record.url?scp=85023763788&partnerID=8YFLogxK
U2 - https://doi.org/10.1016/S1473-3099(17)30324-9
DO - https://doi.org/10.1016/S1473-3099(17)30324-9
M3 - Article
C2 - 28711585
SN - 1473-3099
VL - 17
SP - 1033
EP - 1041
JO - The Lancet Infectious Diseases
JF - The Lancet Infectious Diseases
IS - 10
ER -