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Volume 23, Number 5—May 2017
Research

Invasive Nontuberculous Mycobacterial Infections among Cardiothoracic Surgical Patients Exposed to Heater–Cooler Devices1

Meghan M. LymanComments to Author , Cheri Grigg, Cara Bicking Kinsey, M. Shannon Keckler, Heather Moulton-Meissner, Emily Cooper, Minn M. Soe, Judith Noble-Wang, Allison Longenberger, Shane R. Walker, Jeffrey R. Miller, Joseph F. Perz, and Kiran M. Perkins
Author affiliations: Centers for Disease Control and Prevention, Atlanta, Georgia, USA (M.M. Lyman, C. Grigg, C. Bicking Kinsey, M.S. Keckler, H. Moulton-Meissner, M.M. Soe, J. Noble-Wang, J.R. Miller, J.F. Perz, K.M. Perkins); Pennsylvania Department of Health, Harrisburg, Pennsylvania, USA (C. Bicking Kinsey, A. Longenberger, J.R. Miller); WellSpan York Hospital, York, Pennsylvania, USA (E. Cooper, S.R. Walker)

Main Article

Table 3

Surgical exposures of case-patients with invasive extrapulmonary NTM infections and control-patients among patients who underwent cardiothoracic surgery, York, Pennsylvania, USA, 2015*

Exposures Case-patients, 
n = 11 Control-patients, 
n = 48 Odds ratio (95% CI) p value†
No. surgeries per patient
  All surgeries, median (IQR) 1 (1–4) 2 (1–3) 0.90
  Cardiothoracic surgeries, median (IQR)
1 (1–3)
1 (1–2)

0.86
Type of procedure‡
  Major cardiothoracic procedure 11 (100) 31 (65) 12.8 (1.5–>999.9) 0.09
  Major cardiac procedure 9 (82) 21 (44) 4.9 (1.2–27.5) 0.04
    Coronary artery bypass grafting surgery 6 (55) 17 (35) 2.1 (0.6–7.9) 0.25
    Cardiac valve surgery 4 (436) 8 (67) 2.9 (0.7–11.4) 0.15
    Aortic surgery 5 (45) 0 (0) 82.1 (7.9–>999.9) 0.008
    Pericardial window 0 (0) 2 (4) 0.8 (0.01–10.9) 0.91
  Major thoracic procedure
2 (18)
11 (23)
0.9 (0.1–3.6)
0.85
Perioperative exposures§
  Central line¶ 10 (91) 27 (56) 5.5 (1.1–53.5) 0.07
  Chest tube 10 (91) 31 (65) 3.9 (0.8–38.2) 0.15
  Shower during hospitalization 7 (64) 20 (42) 2.3 (0.7–9.2) 0.21
  Artificial valve or graft 8 (73) 9 (19) 10.1 (2.6–48.1) 0.002
  Topical medication 10 (91) 37 (77) 2.1 (0.4–21.4) 0.43
  Topical antibiotic 10 (91) 31 (65) 3.9 (0.8–38.2) 0.15
  Topical anticoagulant 5 (45) 15 (31) 1.8 (0.5–6.7) 0.37
  Use of cardiopulmonary bypass with HCD exposure
9 (82)
20 (42)
5.3 (1.3–29.9)
0.03
Length of HCD-related exposures#
  Surgical time with HCD, min, median (IQR) 328 (164–360) 0 (0–222) 0.003
  Time on bypass, min, median (IQR) 147 (46–175) 0 (0–74) 0.002

*Any surgery that occurred 30 d to 3.5 y before first NTM-positive specimen for cases or index date for controls. Values are no. (%) patients except as indicated. NTM, nontuberculous mycobacteria.
†Fisher exact test for categorical variables or Wilcoxon 2-sample test for continuous variables.
‡Major cardiac surgery: coronary artery bypass grafting, valve replacement, aortic graft, pericardial window; major thoracic surgery: lung removal, thoracotomy, esophagectomy.
§Exposure was considered present if any of the surgeries (>1) had the exposure.
¶Present at any time during hospital stay. Did not include chronic indwelling lines, such as PICC lines or dialysis catheters.
#If a patient had multiple cardiothoracic surgeries, the time for the longest operative time was included.

Main Article

1Preliminary results from this study were presented at the Epidemic Intelligence Service conference, May 2–5, 2016, Atlanta, Georgia, USA; and the American Society for Microbiology Microbe conference, June 16–20, 2016, Boston, Massachusetts, USA.

Page created: April 17, 2017
Page updated: April 17, 2017
Page reviewed: April 17, 2017
The conclusions, findings, and opinions expressed by authors contributing to this journal do not necessarily reflect the official position of the U.S. Department of Health and Human Services, the Public Health Service, the Centers for Disease Control and Prevention, or the authors' affiliated institutions. Use of trade names is for identification only and does not imply endorsement by any of the groups named above.
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