title: Clinical implications of Mycobacterium chimaera detection in thermoregulatory devices used for extracorporeal membrane oxygenation (ECMO), Germany, 2015 to 2016.
abstract: Mycobacterium chimaera, a non-tuberculous mycobacterium, was recently identified as causative agent of deep-seated infections in patients who had previously undergone open-chest cardiac surgery. Outbreak investigations suggested an aerosol-borne pathogen transmission originating from water contained in heater-cooler units (HCUs) used during cardiac surgery. Similar thermoregulatory devices are used for extracorporeal membrane oxygenation (ECMO) and M. chimaera might also be detectable in ECMO treatment settings. We performed a prospective microbiological study investigating the occurrence of M. chimaera in water from ECMO systems and in environmental samples, and a retrospective clinical review of possible ECMO-related mycobacterial infections among patients in a pneumological intensive care unit. We detected M. chimaera in 9 of 18 water samples from 10 different thermoregulatory ECMO devices; no mycobacteria were found in the nine room air samples and other environmental samples. Among 118 ECMO patients, 76 had bronchial specimens analysed for mycobacteria and M. chimaera was found in three individuals without signs of mycobacterial infection at the time of sampling. We conclude that M. chimaera can be detected in water samples from ECMO-associated thermoregulatory devices and might potentially pose patients at risk of infection. Further research is warranted to elucidate the clinical significance of M. chimaera in ECMO treatment settings.
authors.affiliation: Department of Medicine V - Pneumology, Allergology and Critical Care Medicine, ECLS Center Saar, Saarland University, Homburg/Saar, Germany.
authors.forename: Franziska C
authors.initials: FC
authors.lastname: Trudzinski
authors.affiliation: Institute of Medical Microbiology and Hygiene, Saarland University, Homburg/Saar, Germany.
authors.forename: Uwe
authors.initials: U
authors.lastname: Schlotthauer
authors.affiliation: Department of Medicine V - Pneumology, Allergology and Critical Care Medicine, ECLS Center Saar, Saarland University, Homburg/Saar, Germany.
authors.forename: Annegret
authors.initials: A
authors.lastname: Kamp
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Saarland University, Homburg/Saar, Germany.
authors.forename: Kai
authors.initials: K
authors.lastname: Hennemann
authors.affiliation: Department of Anaesthesiology and Critical Care, Campus Kassel of the University Hospital of Southampton, Kassel, Germany.
authors.forename: Ralf M
authors.initials: RM
authors.lastname: Muellenbach
authors.affiliation: Institute of Clinical Microbiology and Hygiene, University Hospital Regensburg, University of Regensburg, Regensburg, Germany.
authors.forename: Udo
authors.initials: U
authors.lastname: Reischl
authors.affiliation: Institute of Medical Microbiology and Hygiene, Saarland University, Homburg/Saar, Germany.
authors.forename: Barbara
authors.initials: B
authors.lastname: Gärtner
authors.affiliation: Department of Medicine V - Pneumology, Allergology and Critical Care Medicine, ECLS Center Saar, Saarland University, Homburg/Saar, Germany.
authors.forename: Heinrike
authors.initials: H
authors.lastname: Wilkens
authors.affiliation: Department of Medicine V - Pneumology, Allergology and Critical Care Medicine, ECLS Center Saar, Saarland University, Homburg/Saar, Germany.
authors.forename: Robert
authors.initials: R
authors.lastname: Bals
authors.affiliation: Institute of Medical Microbiology and Hygiene, Saarland University, Homburg/Saar, Germany.|Faculty of Medicine, University of Münster, Münster, Germany.
authors.forename: Mathias
authors.initials: M
authors.lastname: Herrmann
authors.affiliation: Department of Medicine V - Pneumology, Allergology and Critical Care Medicine, ECLS Center Saar, Saarland University, Homburg/Saar, Germany.
authors.forename: Philipp M
authors.initials: PM
authors.lastname: Lepper
authors.affiliation: Institute of Medical Microbiology and Hygiene, Saarland University, Homburg/Saar, Germany.|Swiss Tropical and Public Health Institute, Basel, Switzerland.|University of Basel, Basel, Switzerland.
authors.forename: Sören L
authors.initials: SL
authors.lastname: Becker
mesh_terms: D000328:Adult; D000368:Aged; D001833:Body Temperature Regulation; D003428:Cross Infection / Q000209:etiology* / Q000382:microbiology; D004866:Equipment Contamination; D015199:Extracorporeal Membrane Oxygenation / Q000295:instrumentation*; D006801:Humans; D008875:Middle Aged; D009161:Mycobacterium / Q000145:classification / Q000302:isolation & purification*; D009165:Mycobacterium Infections, Nontuberculous / Q000209:etiology* / Q000382:microbiology; D009170:Nontuberculous Mycobacteria / Q000145:classification / Q000302:isolation & purification*; D009894:Opportunistic Infections / Q000382:microbiology*; D011446:Prospective Studies; D012189:Retrospective Studies; D014871:Water Microbiology
keywords: Mycobacterium chimaera; atypical mycobacteria; diagnosis; extracorporeal membrane oxygenation (ECMO); heater-cooler unit; infection