Failure to eradicate non-tuberculous mycobacteria upon disinfection of heater–cooler units: results of a microbiological investigation in northwestern Italy

Ditommaso, Savina; Giacomuzzi, Monica; Memoli, Gabriele; Zotti, Carla Maria

doi:10.1016/j.jhin.2020.08.023

Cited by 7 publications

(7 citation statements)

References 37 publications

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“…Our findings are in line with previous reports from, for example, Italy 9 and Singapore, 10 and they underscore the difficulty to eradicate M. chimaera -induced biofilms. Recently, an experimental study showed that M. chimaera effectively colonizes various materials such as surfaces made of titanium and stainless steel in less than 24 hours, and that the bacterium is rapidly surrounded by an extracellular, protective biofilm matrix.…”

Section: Discussionsupporting

confidence: 93%

Microbiological Surveillance of Heater-Cooler Units Used in Cardiothoracic Surgery for Detection of Mycobacterium chimaera

Schlotthauer

Hennemann

Гартнер

et al. 2022

Thorac Cardiovasc Surg

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Mycobacterium chimaera is a nontuberculous mycobacterium that was identified as causative agent in a global outbreak of severe infections following open-chest cardiothoracic surgery. Heater-cooler units (HCUs), which were contaminated during the manufacturing process, were elucidated as the origin of this outbreak. Regular surveillance of water-containing HCUs used for cardiac surgery was recommended as one preventive measure. We present data on the occurrence of M. chimaera and other mycobacterial pathogens in different HCUs from one surgical center in Germany over a 42-month period. Water samples and swabs from seven different HCUs were taken between 2015 and 2018, and mycobacteria were detected in 50.6% (78/154) of water samples and 21.1% (4/19) of swabs. M. chimaera accounted for the majority of detected pathogens (77/83 isolates in water samples), but other species such as Mycobacterium gordonae were also found. Despite strict adherence to an intensified, regular disinfection procedure, the majority of HCUs remained positive for mycobacteria until the end of the study. In conclusion, additional measures are needed to reduce the risk of intraoperative transmission of M. chimaera, and our observations underscore the inherent infections risks associated with water-containing medical devices.

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Section: Discussionsupporting

confidence: 93%

Microbiological Surveillance of Heater-Cooler Units Used in Cardiothoracic Surgery for Detection of Mycobacterium chimaera

Schlotthauer

Hennemann

Гартнер

et al. 2022

Thorac Cardiovasc Surg

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“…On 25 February 2020 LivaNova received FDA clearance for 3T heater–cooler device modification [ 55 ]. Although regular and effective decontamination and microbiological surveillance is crucial to mitigate the risk of infection due to M. chimaera [ 32 , 56 , 57 ] and other opportunistic pathogens, such as Legionella , the theoretical risk of aerosolization remains high when these devices are decontaminated [ 58 , 59 ] or emptied, or when their circuits are damaged.…”

Section: Discussionmentioning

confidence: 99%

Persistence of Legionella in Routinely Disinfected Heater-Cooler Units and Heater Units assessed by Propidium Monoazide qPCR

et al. 2020

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Background: Evidence to date indicates that heater–cooler units (HCUs) and heater units (HUs) can generate potentially infectious aerosols containing a range of opportunistic pathogens such as Mycobacterium chimaera, other non-tuberculous mycobacterial (NTM) species, Pseudomonas aeruginosa and Legionella spp. Our purpose was to determine the extent of Legionella contamination and total viable count (TVC) in HCUs and HUs and to analyze the relationship by water system design of devices of two different brands (LivaNova vs. Maquet). Methods: Legionella spp. were detected and quantified by our optimized PMA-qPCR protocol; TVCs were assessed according to ISO protocol 6222. Analyses were performed in the first sampling round and after six months of surveillance. Results: Overall, Legionella spp. was detected in 65.7% of devices. In the second sampling round, Legionella positivity rates were significantly lower in water samples from the Maquet devices compared to the LivaNova ones (27.3% vs. 61.5%). LivaNova HCUs also yielded more Legionella, and aquatic bacteria counts than Maquet in both first and second-round samples. Conclusions: We recommend that all surgical patients and staff exposed to aerosols from thermoregulatory devices should be followed up for Legionella infection and that microbiological surveillance on such devices should be conducted regularly as precautionary principle.

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“…These HCUs, also known as heaterecooler devices (HCDs), consist of a closed circuit with water tanks and use water as a heat-transfer medium to regulate the body temperature of the patient. In these HCUs, M. chimaera and other NTM can be present [4]. Due to the presence of fans and the bioaerosol-forming capacity of M. chimaera, transmission of this mycobacterium from the HCU to the surgical field can occur, with subsequent infection of the patient.…”

Section: Introductionmentioning

confidence: 99%

“…Several disinfectants are recommended by the manufacturers, including peracetic acid and chlorine (in fact hypochlorite). However, NTM colonization of the HCUs can persist even when these measures are strictly followed, which is thought to be due to the formation of biofilms [4,5]. To prevent infections of the patients, the HCUs used in cardiothoracic surgery in our hospital were placed outside the operating theatre, in a dedicated space, although this solution requires extra tubing and renovation of the operating theatre.…”

Section: Introductionmentioning

confidence: 99%

Vermamoeba vermiformis resides in water-based heater–cooler units and can enhance Mycobacterium chimaera survival after chlorine exposure

Sarink

Cappellen

Tielens

et al. 2023

Journal of Hospital Infection

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Failure to eradicate non-tuberculous mycobacteria upon disinfection of heater–cooler units: results of a microbiological investigation in northwestern Italy

Cited by 7 publications

References 37 publications

Microbiological Surveillance of Heater-Cooler Units Used in Cardiothoracic Surgery for Detection of Mycobacterium chimaera

Microbiological Surveillance of Heater-Cooler Units Used in Cardiothoracic Surgery for Detection of Mycobacterium chimaera

Persistence of Legionella in Routinely Disinfected Heater-Cooler Units and Heater Units assessed by Propidium Monoazide qPCR

Vermamoeba vermiformis resides in water-based heater–cooler units and can enhance Mycobacterium chimaera survival after chlorine exposure

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