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Invasive Mycobacterium abscessus Complex Infection After Cardiac Surgery: Epidemiology, Management, and Clinical Outcomes

Authors :
Jason E. Stout
Peter K. Smith
Barbara D. Alexander
Eileen K Maziarz
Arthur W. Baker
Jacob N. Schroder
Daniel J. Sexton
Deverick J. Anderson
Mani A. Daneshmand
Sarah S. Lewis
Cameron R. Wolfe
Richard J. Wallace
Source :
Clin Infect Dis
Publication Year :
2020
Publisher :
Oxford University Press (OUP), 2020.

Abstract

Background We recently mitigated a clonal outbreak of hospital-acquired Mycobacterium abscessus complex (MABC), which included a large cluster of adult patients who developed invasive infection after exposure to heater-cooler units during cardiac surgery. Recent studies have detailed Mycobacterium chimaera infections acquired during cardiac surgery; however, little is known about the epidemiology and clinical courses of cardiac surgery patients with invasive MABC infection. Methods We retrospectively collected clinical data on all patients who underwent cardiac surgery at our hospital and subsequently had positive cultures for MABC from 2013 through 2016. Patients with ventricular assist devices or heart transplants were excluded. We analyzed patient characteristics, antimicrobial therapy, surgical interventions, and clinical outcomes. Results Ten cardiac surgery patients developed invasive, extrapulmonary infection from M. abscessus subspecies abscessus in an outbreak setting. Median time from presumed inoculation in the operating room to first positive culture was 53 days (interquartile range [IQR], 38–139 days). Disseminated infection was common, and the most frequent culture-positive sites were mediastinum (n = 7) and blood (n = 7). Patients received a median of 24 weeks (IQR, 5–33 weeks) of combination antimicrobial therapy that included multiple intravenous agents. Six patients required antibiotic changes due to adverse events attributed to amikacin, linezolid, or tigecycline. Eight patients underwent surgical management, and 6 patients required multiple sternal debridements. Eight patients died within 2 years of diagnosis, including 4 deaths directly attributable to MABC infection. Conclusions Despite aggressive medical and surgical management, invasive MABC infection after cardiac surgery caused substantial morbidity and mortality. New treatment strategies are needed, and compliance with infection prevention guidelines remains critical.

Details

ISSN :
15376591 and 10584838
Volume :
72
Database :
OpenAIRE
Journal :
Clinical Infectious Diseases
Accession number :
edsair.doi.dedup.....73b7ffa35c1e640cd82a9c9deb5eb7bb
Full Text :
https://doi.org/10.1093/cid/ciaa215