title: Mycobacterium chimaera Outbreak Associated With Heater-Cooler Devices: Piecing the Puzzle Together.
abstract: An outbreak of invasive Mycobacterium chimaera infections associated with heater-cooler devices (HCDs) has now affected patients in several countries on different continents. Clinical infections are characterized by delayed diagnosis, inadequate treatment response to antimicrobial agents, and poor prognosis. Outbreak investigators found M. chimaera in HCD water circuits and air samples while HCDs were running, suggesting that transmission from the HCD to the surgical site occurs via the airborne route. New HCDs at the manufacturing site were also contaminated with M. chimaera, and recent whole-genome sequencing data suggest a point source. Some guidance on screening for M. chimaera colonization in HCD water and exhaust air is available. In contrast, reliable disinfection procedures are not well described, and it is not yet known whether eradication of M. chimaera from a contaminated HCD can be achieved. Meanwhile, strict separation of the HCD from operating room air is necessary to ensure patient safety, and these efforts may require engineering solutions. While our understanding of the causes and the extent of the M. chimaera outbreak is growing, several aspects of patient management, device handling, and risk mitigation still require clarification. Infect Control Hosp Epidemiol 2016;1-6.
authors.affiliation: 1Department of Infectious Diseases,Bern University Hospital,University of Bern,Switzerland.
authors.forename: Rami
authors.initials: R
authors.lastname: Sommerstein
authors.affiliation: 2Division of Infectious Diseases and Hospital Epidemiology,University Hospital Zurich,University of Zurich,Switzerland.
authors.forename: Peter W
authors.initials: PW
authors.lastname: Schreiber
authors.affiliation: 3Division of Infectious Diseases,University of Iowa Carver College of Medicine,Iowa.
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Diekema
authors.affiliation: 3Division of Infectious Diseases,University of Iowa Carver College of Medicine,Iowa.
authors.forename: Michael B
authors.initials: MB
authors.lastname: Edmond
authors.affiliation: 2Division of Infectious Diseases and Hospital Epidemiology,University Hospital Zurich,University of Zurich,Switzerland.
authors.forename: Barbara
authors.initials: B
authors.lastname: Hasse
authors.affiliation: 1Department of Infectious Diseases,Bern University Hospital,University of Bern,Switzerland.
authors.forename: Jonas
authors.initials: J
authors.lastname: Marschall
authors.affiliation: 2Division of Infectious Diseases and Hospital Epidemiology,University Hospital Zurich,University of Zurich,Switzerland.
authors.forename: Hugo
authors.initials: H
authors.lastname: Sax
mesh_terms: D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D003428:Cross Infection / Q000635:transmission*; D004196:Disease Outbreaks; D004866:Equipment Contamination; D006801:Humans; D017053:Infection Control / Q000379:methods; D009165:Mycobacterium Infections, Nontuberculous / Q000635:transmission*; D009170:Nontuberculous Mycobacteria