569. Epidemiologic Review of Department of Veterans Affairs Patients with Isolation of Non-Tuberculous Mycobacteria after Cardiopulmonary Bypass Procedures
Session: Poster Abstract Session: Non-Tuberculosis Mycobacterial
Thursday, October 27, 2016
Room: Poster Hall
Posters
  • G Oda ID Week 2016 poster final.pdf (8.0 MB)

    • Background:  In October 2015, the Centers for Disease Control and Prevention and United States Food and Drug Administration issued communications regarding possible association between non-tuberculous mycobacteria (NTM) infections and heater-cooler units (HCUs) used during cardiopulmonary bypass (CPB). We conducted a national review to identify and characterize NTM clinical isolates in Veterans who underwent CPB.

    Methods: VA databases were queried for CPB procedure codes between 1/1/2010 -9/30/2015 and NTM isolates recovered by standard methods from 1/1/2010 - 10/31/2015.  NTM were further characterized by species and anatomic site. Patients with NTM isolated after CPB underwent detailed health record review for presence of infection, CPB procedure details and risk factors.

    Results: Figure 1 details the review process and results. Table 1 shows patient characteristics undergoing CPB and NTM isolates.  Median number of days between CPB and first NTM isolate was 397 days (range: 2 – 2,035).  Of 5 patients with NTM isolated from wound, tissue or blood, 2/5 had non-healing foot ulcers and 3/5 had M. fortuitum sternal wound infections.  The latter 3 surgeries were performed at different facilities on separate dates using Sorin/Livanova™ (2) and Terumo™ (1) HCUs.  All 3 patients received targeted antimicrobial therapy and recovered.

    Table 1:  Characteristics of patients undergoing CPB and their NTM isolates, 2010-2015

    Pre-disposing condition (n=72 patients)

    n (%)

    Diabetes diagnosis

    26 (36%)

    Immunosuppressive disease

    6 (8%)

    Immunosuppressive treatment

    5 (7%)

    Surgical risk factor

    Median (range) in minutes

    Time in Operating Room (n=61)

    400 (245-1050)

    Cardiopulmonary bypass time (n = 53)

    118 (47-371)

    Aortic cross clamp time (n=43)

    81 (0-217)

    NTM recovered (n = 91)

    # isolates

    avium/avium-intracellulare

    41

    gordonae

    19

    fortuitum/smegmatis

    10

    chelonae/abscessus

    6

    unspeciated

    4

    mucogenicum

    3

    simiae

    2

    boletti, bovis, immunogenum, kansasii, lentiflavum, szulgai

    1 each

    Site (n = 91)

    # isolates

    Respiratory

    80

    Wound/tissue/blood

    5

    Urine

    4

    Stool

    2

    Conclusion:  We did not find clustering of NTM infections related to CPB.  However, we cannot exclude the possibility of HCUs as a source of M. fortuitum in the 3 sternal wound infections identified in this review.

    Gina Oda, MS1, Cynthia Lucero-Obusan, MD1, Russell Ryono, Pharm. D.1, Patricia Schirmer, MD1, Hasan Shanawani, MPH, MD2, Katrina Jacobs, MS2 and Mark Holodniy, MD, FIDSA, FSHEA1, (1)Public Health Surveillance and Research, Department of Veterans Affairs, Palo Alto, CA, (2)National Center for Patient Safety, Department of Veterans Affairs, Ann Arbor, MI

    Disclosures:

    G. Oda, None

    C. Lucero-Obusan, None

    R. Ryono, None

    P. Schirmer, None

    H. Shanawani, None

    K. Jacobs, None

    M. Holodniy, None

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