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Mycobacterium chimaera infections associated with heater–cooler units in cardiac surgery

机译:心脏手术中与加热器-制冷器单元相关的Chimaera分支杆菌感染

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摘要

Purpose of review: Mycobacterium chimaera infections following cardiac surgery have been reported from an increasing number of countries. These infections are characterized by a poor prognosis with a case fatality rate around 50% despite treatment. Since the first description in 2013, our understanding has grown steadily. Several outbreak investigations, case series, and experiments with heater–cooler units (HCUs) have been published. This review summarizes the current knowledge.\udRecent findings: M. chimaera transmission occurs during cardiopulmonary bypass via bioaerosols emitted from contaminated HCU water systems. Manifestations of M. chimaera infection comprise endocarditis, vascular graft infections, surgical site infections, and dissemination. So far, all cases were exposed to a single HCU brand. Samples from the manufacturing site as well as clonality of M. chimaera strains isolated from HCUs and patients suggest a contamination already at time of delivery representing the main source for the outbreak. Nevertheless, HCU contamination in hospitals cannot be excluded. \udSummary: Improved awareness of physicians of M. chimaera infection is crucial to prompt adequate diagnostic workup in patients that have been exposed to HCU presenting with compatible symptoms. For risk mitigation, strict separation between the air volume in contact with HCUs and critical clinical areas such as operating rooms is essential.
机译:审查目的:越来越多的国家报告了心脏手术后的Chimaera分支杆菌感染。这些感染的特点是预后差,尽管经过治疗,病死率仍约为50%。自2013年首次描述以来,我们的理解稳步增长。已经发布了一些爆发调查,案例系列以及使用加热器-冷却器单元(HCU)的实验。这篇综述总结了当前的知识。\ ud最近的发现:在体外循环期间,通过污染的HCU水系统排放的生物气溶胶,发生了M. chimaera传播。 Chimaera感染的表现包括心内膜炎,血管移植物感染,手术部位感染和传播。到目前为止,所有案例都暴露于单个HCU品牌。从生产现场采集的样本以及从HCU和患者中分离出的M. chimaera菌株的克隆性表明,分娩时已经存在污染,这是暴发的主要来源。但是,不能排除医院的HCU污染。 \ udSummary:提高对M. chimaera感染的医师的认识,对于迅速暴露出具有相适应症状的HCU的患者,进行充分的诊断检查至关重要。为了降低风险,与HCU接触的空气量与关键的临床区域(例如手术室)之间必须严格分开。

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