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Epidemiological and Molecular Investigation of the Heater–Cooler Unit (HCU)-Related Outbreak of Invasive Mycobacterium chimaera Infection Occurred in Italy

Background: From 2013 onwards, a large outbreak of Mycobacterium chimaera (MC) invasive infection, which was correlated with the use of contaminated heater–cooler units (HCUs) during open chest surgery, was reported from all over the world. Here, we report the results of the epidemiological and mole...

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Autores principales: Cannas, Angela, Campanale, Antonella, Minella, Daniela, Messina, Francesco, Butera, Ornella, Nisii, Carla, Mazzarelli, Antonio, Fontana, Carla, Lispi, Lucia, Maraglino, Francesco, Di Caro, Antonino, Sabbatucci, Michela
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10536513/
https://www.ncbi.nlm.nih.gov/pubmed/37764096
http://dx.doi.org/10.3390/microorganisms11092251
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author Cannas, Angela
Campanale, Antonella
Minella, Daniela
Messina, Francesco
Butera, Ornella
Nisii, Carla
Mazzarelli, Antonio
Fontana, Carla
Lispi, Lucia
Maraglino, Francesco
Di Caro, Antonino
Sabbatucci, Michela
author_facet Cannas, Angela
Campanale, Antonella
Minella, Daniela
Messina, Francesco
Butera, Ornella
Nisii, Carla
Mazzarelli, Antonio
Fontana, Carla
Lispi, Lucia
Maraglino, Francesco
Di Caro, Antonino
Sabbatucci, Michela
author_sort Cannas, Angela
collection PubMed
description Background: From 2013 onwards, a large outbreak of Mycobacterium chimaera (MC) invasive infection, which was correlated with the use of contaminated heater–cooler units (HCUs) during open chest surgery, was reported from all over the world. Here, we report the results of the epidemiological and molecular investigations conducted in Italy after the alarm raised about this epidemic event. Methods: MC strains isolated from patients or from HCU devices were characterized by genomic sequencing and molecular epidemiological analysis. Results: Through retrospective epidemiological analysis conducted between January 2010 and December 2022, 40 possible cases of patients infected with MC were identified. Thirty-six strains isolated from these patients were analysed by whole genome sequencing (WGS) and were found to belong to the genotypes 1.1 or 1.8, which are the genotypes correlated with the outbreak. Most of the cases presented with prosthetic valve endocarditis, vascular graft infection or disseminated infection. Among the cases found, there were 21 deaths. The same analysis was carried out on HCU devices. A total of 251 HCUs were found to be contaminated by MC; genotypes 1.1 or 1.8 were identified in 28 of those HCUs. Conclusions: To ensure patients’ safety and adequate follow-up, clinicians and general practitioners were made aware of the results and public health measures, and recommendations were issued to prevent further cases in the healthcare settings. The Italian Society of Cardiac Surgery performed a national survey to assess the incidence of HCU-related MC prosthetic infections in cardiac surgery. No cases were reported after HCU replacement or structural modification and disinfection and possibly safe allocation outside surgical rooms.
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spelling pubmed-105365132023-09-29 Epidemiological and Molecular Investigation of the Heater–Cooler Unit (HCU)-Related Outbreak of Invasive Mycobacterium chimaera Infection Occurred in Italy Cannas, Angela Campanale, Antonella Minella, Daniela Messina, Francesco Butera, Ornella Nisii, Carla Mazzarelli, Antonio Fontana, Carla Lispi, Lucia Maraglino, Francesco Di Caro, Antonino Sabbatucci, Michela Microorganisms Article Background: From 2013 onwards, a large outbreak of Mycobacterium chimaera (MC) invasive infection, which was correlated with the use of contaminated heater–cooler units (HCUs) during open chest surgery, was reported from all over the world. Here, we report the results of the epidemiological and molecular investigations conducted in Italy after the alarm raised about this epidemic event. Methods: MC strains isolated from patients or from HCU devices were characterized by genomic sequencing and molecular epidemiological analysis. Results: Through retrospective epidemiological analysis conducted between January 2010 and December 2022, 40 possible cases of patients infected with MC were identified. Thirty-six strains isolated from these patients were analysed by whole genome sequencing (WGS) and were found to belong to the genotypes 1.1 or 1.8, which are the genotypes correlated with the outbreak. Most of the cases presented with prosthetic valve endocarditis, vascular graft infection or disseminated infection. Among the cases found, there were 21 deaths. The same analysis was carried out on HCU devices. A total of 251 HCUs were found to be contaminated by MC; genotypes 1.1 or 1.8 were identified in 28 of those HCUs. Conclusions: To ensure patients’ safety and adequate follow-up, clinicians and general practitioners were made aware of the results and public health measures, and recommendations were issued to prevent further cases in the healthcare settings. The Italian Society of Cardiac Surgery performed a national survey to assess the incidence of HCU-related MC prosthetic infections in cardiac surgery. No cases were reported after HCU replacement or structural modification and disinfection and possibly safe allocation outside surgical rooms. MDPI 2023-09-07 /pmc/articles/PMC10536513/ /pubmed/37764096 http://dx.doi.org/10.3390/microorganisms11092251 Text en © 2023 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Cannas, Angela
Campanale, Antonella
Minella, Daniela
Messina, Francesco
Butera, Ornella
Nisii, Carla
Mazzarelli, Antonio
Fontana, Carla
Lispi, Lucia
Maraglino, Francesco
Di Caro, Antonino
Sabbatucci, Michela
Epidemiological and Molecular Investigation of the Heater–Cooler Unit (HCU)-Related Outbreak of Invasive Mycobacterium chimaera Infection Occurred in Italy
title Epidemiological and Molecular Investigation of the Heater–Cooler Unit (HCU)-Related Outbreak of Invasive Mycobacterium chimaera Infection Occurred in Italy
title_full Epidemiological and Molecular Investigation of the Heater–Cooler Unit (HCU)-Related Outbreak of Invasive Mycobacterium chimaera Infection Occurred in Italy
title_fullStr Epidemiological and Molecular Investigation of the Heater–Cooler Unit (HCU)-Related Outbreak of Invasive Mycobacterium chimaera Infection Occurred in Italy
title_full_unstemmed Epidemiological and Molecular Investigation of the Heater–Cooler Unit (HCU)-Related Outbreak of Invasive Mycobacterium chimaera Infection Occurred in Italy
title_short Epidemiological and Molecular Investigation of the Heater–Cooler Unit (HCU)-Related Outbreak of Invasive Mycobacterium chimaera Infection Occurred in Italy
title_sort epidemiological and molecular investigation of the heater–cooler unit (hcu)-related outbreak of invasive mycobacterium chimaera infection occurred in italy
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10536513/
https://www.ncbi.nlm.nih.gov/pubmed/37764096
http://dx.doi.org/10.3390/microorganisms11092251
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