Global outbreak of severe Mycobacterium chimaera disease after cardiac surgery: a molecular epidemiological study
Global outbreak of severe Mycobacterium chimaera disease after cardiac surgery: a molecular epidemiological study
复制标题
DOI：
10.1016/s1473-3099(17)30324-9
复制
发表时间：
2017-10-01
影响因子：
56.3
通讯作者：
Sax, Hugo
中科院分区：
文献类型：
--
作者：
van Ingen, Jakko;Kohl, Thomas A.;Sax, Hugo
背景自2013年以来，欧洲和美国报告了100多例分枝杆菌嵌合型人工瓣膜心内膜炎和播散性疾病，与心脏手术中使用的受污染的加热器-冷却器(HCU)有关。方法从瑞士、德国、荷兰和英国的21例心脏手术相关患者中分离出24株嵌合体，从医院不同类型的HCU中分离出218株嵌合体，分别来自LivaNova(前索林；英国伦敦)和Maquet(德国拉斯特特)品牌HCU生产基地，以及与环境无关的来源和患者，以及8株胞内分枝杆菌。使用Illumina和Pacific Biosciences技术对分离株进行下一代全基因组测序，并与已发表的M嵌合体基因组进行比较。基于全基因组测序的250株分离物的系统发育分析揭示了两个主要的M嵌合体群。与心脏手术相关的患者分离株都被归入组1，在组1中，除一株外，所有株都形成了一个独特的亚群。该亚组还包括来自美国报告的11名心脏手术相关患者的分离株，大多数来自Liva Nova HCU的分离株，以及来自其生产地点的1株分离株。来自其他HCU和无关患者的分离株在系统发育树中分布更广泛。LivaNova工厂的M嵌合体解释HCU污染似乎是瑞士、德国、荷兰、英国、美国和澳大利亚诊断的心胸外科手术相关严重M嵌合体感染的一个可能来源。保护措施和提高临床医生的意识是确保患者安全的关键。
Background Since 2013, over 100 cases of Mycobacterium chimaera prosthetic valve endocarditis and disseminated disease were notified in Europe and the USA, linked to contaminated heater-cooler units (HCUs) used during cardiac surgery. We did a molecular epidemiological investigation to establish the source of these patients' disease.Methods We included 24 M chimaera isolates from 21 cardiac surgery-related patients in Switzerland, Germany, the Netherlands, and the UK, 218 M chimaera isolates from various types of HCUs in hospitals, from LivaNova (formerly Sorin; London, UK) and Maquet (Rastatt, Germany) brand HCU production sites, and unrelated environmental sources and patients, as well as eight Mycobacterium intracellulare isolates. Isolates were analysed by next-generation whole-genome sequencing using Illumina and Pacific Biosciences technologies, and compared with published M chimaera genomes.Findings Phylogenetic analysis based on whole-genome sequencing of 250 isolates revealed two major M chimaera groups. Cardiac surgery-related patient isolates were all classified into group 1, in which all, except one, formed a distinct subgroup. This subgroup also comprised isolates from 11 cardiac surgery-related patients reported from the USA, most isolates from LivaNova HCUs, and one from their production site. Isolates from other HCUs and unrelated patients were more widely distributed in the phylogenetic tree.Interpretation HCU contamination with M chimaera at the LivaNova factory seems a likely source for cardiothoracic surgery-related severe M chimaera infections diagnosed in Switzerland, Germany, the Netherlands, the UK, the USA, and Australia. Protective measures and heightened clinician awareness are essential to guarantee patient safety.