CCMS Medicine Winter 2017 - 8
www.CHESTERCMS.org
M. chimera, A Recently Recognized
Post-Cardiac Surgery Epidemic
BY: JOHN P. MAHER, MD, MPH
I
s it really possible, in the twenty-first century, that health care
providers can be unaware that an epidemic of nosocomial
infections has been ongoing for a number of years, without
significant reaction and interventions by the health care profession
- especially when the infections are linked to our modern, hightech, facility-based surgical care?
That such a situation not only could, but does, exist raises
the specter of significant liability for physicians, hospitals and
manufacturers of technological equipment used in such surgical
treatment procedures. There are already a number of websites
on the internet where lawyers are "trolling" for cases to generate
litigation.
In medicine, we are more used to the profession's historically
successful pattern of identification and interruption of such issues.
For example, the history of the medical profession is studded
with those heroes such as Semmelweiss (puerperal fever), Lister
(surgical sepsis), Snow (water-borne cholera), Pasteur (rabies),
and Salk and Sabin (Polio). Yet at the same time we tend to forget
that it was not that long ago when Great Britain experienced an
epidemic of Bovine Spongiform Encephalopathy (BSE, or "Mad
Cow Disease") in which the early identification of the causative
prion agent in cattle in 1986 and its potential public health effects
were ignored, resulting in just under a half million infected cattle
"entering the food chain" and resulting in a decade-long outbreak
of fatal human cases in several countries, which lasted to the end of
that millennium.
And now we come to the present time: According to the U.S.
Centers for Disease Control and Prevention (CDC), "an outbreak
of invasive Mycobacterium chimera has now affected patients in
several countries on different continents."
A November 21st email posting on ProMED quotes a
8 CHESTER COUNTY Medicine | WINTER 2017
Cambridge Core Abstract of an IC&HE (Infection Control &
Hospital Epidemiology) article, saying the recently-identified
problem is now "a global epidemic of M. chimera, an invasive,
slow-growing bacterium, linked to heater-cooler devices (HCDs)
used in cardiac surgery." As a result, English public health
authorities launched a series of investigations to assess the risk in
the U.K.
Much of the research which initially identified, and then
characterized, the epidemiology of the problem originated with
researchers at Inselspital, Bern University Hospital, Switzerland.
Two heart patients on extra-corporeal circulation there were
diagnosed in 2012 with invasive M. chimera infections, causing
them to launch an outbreak investigation to identify the source
and extent of the potential outbreak and implement preventive
measures (CID, online, 3/11/15). Their study, published 11/14/16
in IC&HE, also provided precautionary recommendations to
hospitals and health systems to reduce the risk of infections.
Their investigation had identified six male patients, between
the ages of 49 and 64, with prosthetic valve endocarditis or
vascular graft infections due to M. chimera, which - amazingly
- only became clinically manifest after latency periods of 1.5
to 3.6 years. The M. chimera was isolated from cardiac tissue
specimens, blood cultures, or other biopsy specimens. They also
obtained the same organism from water circuits of heater-cooler
units connected to the cardio-pulmonary bypass, and air samples
collected when the HCDs were in use. All samples demonstrated
identical RAPD-PCR patterns, and the authors concluded that
"the epidemiological and microbiological features of this prolonged
outbreak provided evidence for the aerosolized transmission of
M. chimera from contaminated heater-cooler units to patients
during open heart surgery"....(and) "Results of the whole
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Table of Contents for the Digital Edition of CCMS Medicine Winter 2017
CCMS Medicine Winter 2017 - 1
CCMS Medicine Winter 2017 - 2
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