Volume 26, Number 3—March 2020
Invasive Mycobacterium chimaera Infections and Heater–Cooler Devices in Cardiac Surgery
To the Editor: In their recent assessment of Mycobacterium chimaera risk in patients undergoing heart valve surgery, Sommerstein et al. compare their findings to our prior risk assessment for UK patients (1,2). In their article, the authors note their assessed risk as “4 to 7” times higher than our risk estimate and suggest this relates to differences in case-finding methodology. Our study reported incidence density (cases per 10,000 person-years) to account for the differing lengths of postoperative follow-up in each successive annual cohort of surgical patients. In contrast, Sommerstein et al. calculated crude risk based on annual procedure numbers. Since our published assessment was undertaken some years before the authors’ assessment, additional cases have been diagnosed, in keeping with the long incubation period for these infections, a median of 15 months but up to 5 years (3). Recalculation of risk and 95% (binomial) CIs, limited to 2008–2014 to match the authors’ assessment, would yield a crude risk estimate of 0.24 (0.15–0.35) per 1,000 procedures (24/102,234); the risk in Switzerland (11/14,054) would be estimated at 0.78 (0.39–1.40), just over 3 times higher.
Whether the observed differences between the United Kingdom and Switzerland represent a true difference in M. chimaera risk in patients undergoing heart valve surgery is subject to debate. Both countries based case finding on results from routine diagnostic investigation; however, awareness of the risk in Switzerland predates that in other countries, potentially increasing the likelihood of investigation for mycobacterial infection. We have observed considerable variation in risk between cardiac centers, from 0 cases rising to 1 per 100 patients for 1 center in their year of highest estimated risk (4). Our pooled estimate covering 33 centers may encompass a wider selection of risk profiles, compared with the smaller number of centers in Switzerland.
- Sommerstein R, Hasse B, Marschall J, Sax H, Genoni M, Schlegel M, et al.; Swiss Chimaera Taskforce. Swiss Chimaera Taskforce. Global health estimate of invasive Mycobacterium chimaera infections associated with heater-cooler devices in cardiac surgery. Emerg Infect Dis. 2018;24:576–8.
- Chand M, Lamagni T, Kranzer K, Hedge J, Moore G, Parks S, et al. Insidious risk of severe Mycobacterium chimaera infection in cardiac surgery patients. Clin Infect Dis. 2017;64:335–42.
- Scriven JE, Scobie A, Verlander NQ, Houston A, Collyns T, Cajic V, et al. Mycobacterium chimaera infection following cardiac surgery in the United Kingdom: clinical features and outcome of the first 30 cases. Clin Microbiol Infect. 2018;24:1164–70.
- Public Health England. Infections associated with heater cooler units used in cardiopulmonary bypass and ECMO. Information for healthcare providers in the UK. 2017 [cited 2018 Mar 13]. https://www.gov.uk/government/publications/infections-associated-with-heater-cooler-units-used-in-cardiopulmonary-bypass-and-ecmo
Original Publication Date: February 04, 2020