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Scriven, James E, Scobie, Antonia, Verlander, Neville Q, Houston, Angela, Collyns, Tim, Cajic, Vjeran, Kon, Onn Min, Mitchell, Tamara, Rahama, Omar, Robinson, Amy, Withama, Shirmila, Wilson, Peter, Maxwell, David, Agranoff, Daniel, Davies, Eleri, Llewelyn, Meirion, Soo, Shiu-Shing, Sahota, Amandip, Cooper, Mike, Hunter, Michael, Tomlins, Jennifer, Tiberi, Simon, Kendall, Simon, Dedicoat, Martin, Alexander, Eliza, Fenech, Teresa, Zambon, Maria, Lamagni, Theresa, Smith, E Grace and Chand, Meera (2018) Mycobacterium chimaera infection following cardiac surgery in the United Kingdom: clinical features and outcome of the first 30 cases. Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases. ISSN 1469-0691. This article is available to all HEFT staff and students via ASK Discovery tool http://tinyurl.com/z795c8c by using their HEFT Athens login IDs
Full text not available from this repository.Abstract
OBJECTIVES
Mycobacterium chimaera infection following cardiac surgery, due to contaminated cardiopulmonary bypass heater-cooler units, has been reported worldwide. However, the spectrum of clinical disease remains poorly understood. To address this, we report the clinical and laboratory features, treatment and outcome of the first 30 UK cases.
METHODS
Case note review was performed for cases identified retrospectively through outbreak investigations and prospectively through on-going surveillance. Case definition was Mycobacterium chimaera detected in any clinical specimen, history of cardiothoracic surgery with cardiopulmonary bypass, and compatible clinical presentation.
RESULTS
Thirty patients were identified (28 with prosthetic material) exhibiting a spectrum of disease including prosthetic valve endocarditis (14/30), sternal wound infection (2/30), aortic graft infection (4/30), and disseminated (non-cardiac) disease (10/30). Patients presented a median of 14 months post surgery (maximum 5 years) most commonly complaining of fever and weight loss. Investigations frequently revealed lymphopenia, thrombocytopenia, liver cholestasis and non-necrotising granulomatous inflammation. Diagnostic sensitivity for a single mycobacterial blood culture was 68% but increased if multiple samples were sent. 27 patients started macrolide-based combination treatment and 14 had further surgery. To date, 18 patients have died (60%) a median of 30 months (IQR 20-39) after initial surgery. Survival analysis identified younger age, mitral valve surgery, mechanical valve replacement, higher serum sodium concentration and lower CRP as factors associated with better survival.
CONCLUSIONS
Mycobacterium chimaera infection following cardiac surgery is associated with a wide spectrum of disease. The diagnosis should be considered in all patients who develop an unexplained illness following cardiac surgery.
| Item Type: | Article |
|---|---|
| Additional Information: | This article is available to all HEFT staff and students via ASK Discovery tool http://tinyurl.com/z795c8c by using their HEFT Athens login IDs |
| Subjects: | WC Communicabable diseases |
| Divisions: | Clinical Support > Infection Control |
| Related URLs: | |
| Depositing User: | Mrs Semanti Chakraborty |
| Date Deposited: | 12 Jun 2018 15:37 |
| Last Modified: | 12 Jun 2018 15:38 |
| URI: | http://www.repository.uhblibrary.co.uk/id/eprint/1667 |
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