Mycobacterium chimaera – information for open-heart surgery patients
The Australian Commission on Safety and Quality in Health Care (ACSQHC) recently issued the National Infection Control Guidance: Non-tuberculosis Mycobacterium alert associated with heater-cooler devices (HCDs). Heater-cooler devices are often used in cardiac surgery procedures such as heart valve replacement. RHDAustralia is communicating this alert so that patients who have previously undergone these procedures are aware of the small risk of infection from M. chimaera. If you develop any symptoms of fever, coughing which is persistent or with blood, fatigue, night sweats, nausea, abdominal, joint or muscle pain, difficulty breathing, redness, heat or pus at the surgical incision site, weight loss or vomiting please contact your health professional and advise them that you have had open-heart surgery. The M. chimaera infection is slow growing and may take many months to develop. It can be treated with combinations of specific antibiotics or occasionally additional surgery.
The Commission has updated the National Infection Guidance on Non-tuberculous Mycobacterium Associated with Heater-Cooler Devices. A key change to the National Guidance is the stratification of risk based on date of device manufacture (i.e. before September 2014). This updated advice is consistent with advice provided by the Therapeutic Goods Administration.
The Commission’s updated National Infection Control Guidance is available online here: https://www.safetyandquality.gov.au/publications/national-infection-cont...
What is the issue?
Heater-cooler devices (HCDs) used in cardiac surgery may have been contaminated with a rare bacterium called Mycobacterium chimaera (or M. chimaera), and that exposure of patients to these devices in the operating theatre may lead to infections that can appear months after the surgery. Infection of cardiac surgery patients with M. chimaera is associated with a particular heater-cooler device type (made by Sorin) and was first recognised in 2012 in Switzerland. These devices, which are widely used around the world including Australia, are thought to have been contaminated during manufacture. At least 50 patients worldwide have been identified with M. chimaera infections after cardiac surgery. The Therapeutic Goods Administration (TGA) has recently provided an update on this issue which noted a report of a possible patient infection with M. chimaera following open cardiac surgery in 2015. If confirmed, this would be the first case reported in Australia linked to exposure to heater-cooler units.
Information for patients who have had open heart/valve surgery
Slow growing M. chimaera can take several months to more than a year for an infection to develop.
Signs of possible M. chimaera infection may include:
Advice to clinicians
For clinicians involved in the care of patients potentially exposed to contaminated HCDs including all cardiothoracic surgeons, infectious disease physicians, cardiologists, perfusionists, general practitioners and other relevant specialists should be aware of the general risk of M. chimaera infection post-operatively, and any specific risks impacting patients. These may include the location and potential time period where any HCDs with known contamination were used in their jurisdiction.
Communicating with patients who had surgery involving a contaminated HCD
Organisations may choose to proactively communicate with all patients who had surgery where a contaminated HCD was used, or with a subset of those patients. If a decision is taken to identify and contact patients, the patient notification exercise should initially focus on patients who had the highest risk procedures, which are open cardiac procedures where medical devices have been implanted, such as cardiac valves. The purpose of the patient notification exercise should also be carefully agreed and stated. Only if cases are identified amongst those patient groups should a patient notification exercise be extended to all patients who had surgery involving a contaminated HCD.
State/Territory communication and more information:
- NSW information
- Queensland information
- Victoria information
- Science Direct - Infection, Disease & Health Publication (subscription or institutional licence required)