2392. Mycobacterium chimaera outbreak response: Experience from four US healthcare systems
Session: Oral Abstract Session: Featured Oral Abstract
Saturday, October 29, 2016: 4:30 PM
Room: La Nouvelle Orleans Ballroom
Background: There is an ongoing multinational outbreak of invasive M. chimaera(Mc) infections linked to heater-cooler devices (HCDs) used during cardiopulmonary bypass (CPB). We report the experience of 4 US centers.

Methods:  Cases were persons with a positive culture for Mc (or M. aviumcomplex if species ID not done) from normally sterile sites after exposure to a HCD during CPB. Clinical information was obtained from treating physicians and outbreak response information was obtained via survey. Mc isolates from patients and HCD water were sent to National Jewish for species ID, susceptibility, and whole genome sequencing (WGS).

Results: As of 7/28/16, 24 cases have been identified, all of which had HCD exposure. Surgeries included prosthetic valve and/or ring (46%), vascular graft (29%), LVAD (21%), heart transplant (13%), and CABG only (4%). The mean age was 60 y, 88% were male, and mean time from exposure to diagnosis was 1.6 y [range 0.1-6.3 y]. Most infections (83%) were deep-seated (e.g. endocarditis, graft infection), often with evidence for extracardiac dissemination. Four (17%) were localized (3 sternal wound and 1 LVAD pocket infection). Crude mortality as of 7/28/16 was 46%. Mc was detected in HCD water (all were LivaNova-Sorin 3T). Initial WGS from 1 center reveals a mean SNP difference of 2.7 within cluster (3 cases + 6 HCD), vs 867 between unrelated Mc isolates; WGS from other sites is ongoing. Centers where HCD exposure occurred performed case finding using lookback (lab, path, and/or medical records) plus patient and provider notification. 9917 HCD-exposed patients were notified, 1672 were evaluated in clinics established for outbreak response, and over 1300 AFB blood cultures were obtained. 8 cases were detected via lookback (4) and provider notification (4). None were detected via patient notification.

Conclusions:  The ongoing outbreak of HCD-associated invasive Mc infection presents several challenges including delayed presentation, protean clinical manifestations, and high associated mortality. Engineering solutions that prevent bioaerosols from reaching the operative field are needed. Heightened awareness of Mc infection following HCD exposure as well as nationwide lookback and provider notifications may assist in case finding.

A Ben Appenheimer, MD1, Daniel J. Diekema, MD, FIDSA, FSHEA1, Dorine Berriel-Cass, MABSN, RN, CIC2, Tonya Crook, MD, MS, DTM&H3, Charles L. Daley, MD4, David Dobbie, MD2, Michael Edmond, MD, MPH, MPA, FIDSA, FSHEA1, Walter Hellinger, MD, FSHEA5, Dilek Ince, MD1, Kathleen G. Julian, MD3, Russell Lampen, DO2, Ricardo Arbulu, MD6, Emily Cooper, RN MS ACNS-BC CIC7, Eugene Curley III, MD7, Jorgelina De Sanctis, MD2, Carol Freer, MD MS FACP3, Michael Strong, PhD4, Kiran Gajurel, MD1, Nabeeh Hasan, PhD4, Shane Walker, CIC7 and Cynthia Whitener, MD, FSHEA3, (1)University of Iowa Carver College of Medicine, Iowa City, IA, (2)Spectrum Health, Grand Rapids, MI, (3)Penn State Hershey Medical Center, Hershey, PA, (4)National Jewish Medical and Research Center, Denver, CO, (5)Mayo Clinic Jacksonville, Jacksonville, FL, (6)McFarland Clinic, Ames, IA, (7)Wellspan Health, York, PA

Disclosures:

A. B. Appenheimer, None

D. J. Diekema, None

D. Berriel-Cass, None

T. Crook, None

C. L. Daley, None

D. Dobbie, None

M. Edmond, None

W. Hellinger, None

D. Ince, None

K. G. Julian, None

R. Lampen, None

R. Arbulu, None

E. Cooper, None

E. Curley III, None

J. De Sanctis, None

C. Freer, None

M. Strong, None

K. Gajurel, None

N. Hasan, None

S. Walker, None

C. Whitener, None

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