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Long-term follow-up of post-cardiac surgery Mycobacterium chimaera infections: A 5-center case series.
Journal of Infection ( IF 14.3 ) Pub Date : 2019-12-19 , DOI: 10.1016/j.jinf.2019.12.007
Kathleen G Julian 1 , Tonya Crook 1 , Eugene Curley 2 , A Ben Appenheimer 3 , Catharine I Paules 1 , Barbara Hasse 4 , Daniel J Diekema 3 , Charles L Daley 5 , Jorgelina de Sanctis 6 , Walter C Hellinger 7 , Adrah Levin 5 , George McSherry 1 , Carol Freer 1 , Cynthia J Whitener 1
Affiliation  

OBJECTIVES In multiple countries, endovascular/disseminated Mycobacterium chimaera infections have occurred in post-cardiac surgery patients in association with contaminated, widely-distributed cardiac bypass heater-cooler devices. To contribute to long-term characterization of this recently recognized infection, we describe the clinical course of 28 patients with 3-7 years of follow-up for survivors. METHODS Identified at five hospitals in the United States 2010-2016, post-cardiac surgery patients in the cohort had growth of Mycobacterium avium complex (MAC)/M. chimaera from a sterile site or surgical wound, or a clinically compatible febrile illness with granulomatous inflammation on biopsy. Case follow-up was conducted in May 2019. RESULTS Of 28 patients, infection appeared to be localized to the sternum in four patients. Among 18 with endovascular/disseminated infection who received combination anti-mycobacterial treatment and had sufficient follow-up, 39% appeared to have controlled infection (>12 months), 56% died, and one patient is alive with relapsed bacteremia. While the number of patients is small and interpretation is limited, four (67%) of six patients who had cardiac prosthesis removal/replacement appeared to have controlled infection compared to three (25%) of 12 with retained cardiac prosthesis (p >0.14; Fisher's exact test). CONCLUSIONS Given poor response to treatment and potential for delayed relapses, post-cardiac surgery M. chimaera infection warrants aggressive treatment and long-term monitoring.

中文翻译:

心脏术后外科手术的长期随访分支杆菌感染:5个中心病例系列。

目标在多个国家,与受污染的,分布广泛的心脏旁路加热器冷却器设备相关联,在心脏手术后患者中发生了血管内/弥散性的分枝杆菌感染。为了对这种新近识别的感染进行长期表征,我们描述了28例患者的临床病程,并对幸存者进行了3-7年的随访。方法2010年至2016年在美国的五家医院中鉴定出该队列中的心脏手术后患者生长了鸟分枝杆菌复合物(MAC)/ M。来自无菌部位或手术伤口的嵌合体,或在活检时临床上相容的发热性疾病伴肉芽肿性炎症。病例随访于2019年5月进行。结果28例患者中,有4例感染似乎局限于胸骨。在接受抗分枝杆菌治疗联合治疗且随访充分的18名血管内/弥散性感染患者中,有39%的患者似乎已控制感染(> 12个月),有56%的患者死亡,其中一名患者存活并复发了菌血症。尽管患者人数很少且解释有限,但有心脏假体移除/置换的六名患者中有四名(67%)表现出受控制的感染,而保留心脏假体的12名患者中有三名(25%)(p> 0.14; Fisher的精确测试)。结论鉴于对治疗的反应较差以及延迟复发的可能性,心脏手术后的M. chimaera感染值得积极治疗和长期监测。39%的患者似乎已控制了感染(> 12个月),有56%的患者死亡,一名患者存活并复发了菌血症。尽管患者人数很少且解释有限,但有心脏假体移除/置换的六名患者中有四名(67%)表现出受控制的感染,而保留心脏假体的12名患者中有三名(25%)(p> 0.14; Fisher的精确测试)。结论鉴于对治疗的反应较差以及延迟复发的可能性,心脏手术后的M. chimaera感染值得积极治疗和长期监测。39%的患者似乎已控制了感染(> 12个月),有56%的患者死亡,并且有1例存活的细菌血症复发。尽管患者人数很少且解释有限,但有心脏假体移除/置换的六名患者中有四名(67%)表现出受控制的感染,而保留心脏假体的12名患者中有三名(25%)(p> 0.14; Fisher的精确测试)。结论鉴于对治疗的反应较差以及延迟复发的可能性,心脏手术后的M. chimaera感染值得积极治疗和长期监测。在有心脏假体切除/更换的6例患者中,有4例(67%)似乎具有受控的感染,而在保留心脏假体的12例中有3例(25%)(p> 0.14; Fisher精确检验)。结论鉴于对治疗的反应较差以及延迟复发的可能性,心脏手术后的M. chimaera感染值得积极治疗和长期监测。在有心脏假体切除/更换的6例患者中,有4例(67%)似乎具有受控的感染,而在保留心脏假体的12例中有3例(25%)(p> 0.14; Fisher精确检验)。结论鉴于对治疗的反应较差以及延迟复发的可能性,心脏手术后的M. chimaera感染值得积极治疗和长期监测。
更新日期:2019-12-19
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