Global outbreak of severe Mycobacterium chimaera disease after cardiac surgery: a molecular epidemiological study

Jakko van Ingen, Thomas A. Kohl, Katharina Kranzer, Barbara Hasse, Peter M. Keller, Anna Katarzyna Szafrańska, Doris Hillemann, Meera Chand, Peter Werner Schreiber, Rami Sommerstein, Christoph Berger, Michele Genoni, Christian Rüegg, Nicolas Troillet, Andreas F. Widmer, Sören L. Becker, Mathias Herrmann, Tim Eckmanns, Sebastian Haller, Christiane Höller & 30 others Sylvia B. Debast, Maurice J. Wolfhagen, Joost Hopman, Jan Kluytmans, Merel Langelaar, Daan W. Notermans, Jaap ten Oever, Peter van den Barselaar, Alexander B.A. Vonk, Margreet C. Vos, Nada Ahmed, Timothy Brown, Derrick Crook, Theresa Lamagni, Nick Phin, E. Grace Smith, Maria Zambon, Annerose Serr, Tim Götting, Winfried Ebner, Alexander Thürmer, Christian Utpatel, Cathrin Spröer, Boyke Bunk, Ulrich Nübel, Guido V. Bloemberg, Erik C. Böttger, Stefan Niemann, Dirk Wagner, Hugo Sax

Research output: Contribution to journalArticleAcademicpeer-review

Abstract

Background Since 2013, over 100 cases of Mycobacterium chimaera prosthetic valve endocarditis and disseminated disease were notified in Europe and the USA, linked to contaminated heater–cooler units (HCUs) used during cardiac surgery. We did a molecular epidemiological investigation to establish the source of these patients' disease. Methods We included 24 M chimaera isolates from 21 cardiac surgery-related patients in Switzerland, Germany, the Netherlands, and the UK, 218 M chimaera isolates from various types of HCUs in hospitals, from LivaNova (formerly Sorin; London, UK) and Maquet (Rastatt, Germany) brand HCU production sites, and unrelated environmental sources and patients, as well as eight Mycobacterium intracellulare isolates. Isolates were analysed by next-generation whole-genome sequencing using Illumina and Pacific Biosciences technologies, and compared with published M chimaera genomes. Findings Phylogenetic analysis based on whole-genome sequencing of 250 isolates revealed two major M chimaera groups. Cardiac surgery-related patient isolates were all classified into group 1, in which all, except one, formed a distinct subgroup. This subgroup also comprised isolates from 11 cardiac surgery-related patients reported from the USA, most isolates from LivaNova HCUs, and one from their production site. Isolates from other HCUs and unrelated patients were more widely distributed in the phylogenetic tree. Interpretation HCU contamination with M chimaera at the LivaNova factory seems a likely source for cardiothoracic surgery-related severe M chimaera infections diagnosed in Switzerland, Germany, the Netherlands, the UK, the USA, and Australia. Protective measures and heightened clinician awareness are essential to guarantee patient safety. Funding Partly funded by the EU Horizon 2020 programme, its FP7 programme, the German Center for Infection Research (DZIF), the Swiss National Science Foundation, the Swiss Federal Office of Public Health, and National Institute of Health Research Oxford Health Protection Research Units on Healthcare Associated Infection and Antimicrobial Resistance.

Original languageEnglish
Pages (from-to)1033-1041
Number of pages9
JournalThe Lancet Infectious Diseases
Volume17
Issue number10
DOIs
Publication statusPublished - 1 Oct 2017

Cite this

van Ingen, J., Kohl, T. A., Kranzer, K., Hasse, B., Keller, P. M., Katarzyna Szafrańska, A., ... Sax, H. (2017). Global outbreak of severe Mycobacterium chimaera disease after cardiac surgery: a molecular epidemiological study. The Lancet Infectious Diseases, 17(10), 1033-1041. https://doi.org/10.1016/S1473-3099(17)30324-9
van Ingen, Jakko ; Kohl, Thomas A. ; Kranzer, Katharina ; Hasse, Barbara ; Keller, Peter M. ; Katarzyna Szafrańska, Anna ; Hillemann, Doris ; Chand, Meera ; Schreiber, Peter Werner ; Sommerstein, Rami ; Berger, Christoph ; Genoni, Michele ; Rüegg, Christian ; Troillet, Nicolas ; Widmer, Andreas F. ; Becker, Sören L. ; Herrmann, Mathias ; Eckmanns, Tim ; Haller, Sebastian ; Höller, Christiane ; Debast, Sylvia B. ; Wolfhagen, Maurice J. ; Hopman, Joost ; Kluytmans, Jan ; Langelaar, Merel ; Notermans, Daan W. ; ten Oever, Jaap ; van den Barselaar, Peter ; Vonk, Alexander B.A. ; Vos, Margreet C. ; Ahmed, Nada ; Brown, Timothy ; Crook, Derrick ; Lamagni, Theresa ; Phin, Nick ; Smith, E. Grace ; Zambon, Maria ; Serr, Annerose ; Götting, Tim ; Ebner, Winfried ; Thürmer, Alexander ; Utpatel, Christian ; Spröer, Cathrin ; Bunk, Boyke ; Nübel, Ulrich ; Bloemberg, Guido V. ; Böttger, Erik C. ; Niemann, Stefan ; Wagner, Dirk ; Sax, Hugo. / Global outbreak of severe Mycobacterium chimaera disease after cardiac surgery : a molecular epidemiological study. In: The Lancet Infectious Diseases. 2017 ; Vol. 17, No. 10. pp. 1033-1041.
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abstract = "Background Since 2013, over 100 cases of Mycobacterium chimaera prosthetic valve endocarditis and disseminated disease were notified in Europe and the USA, linked to contaminated heater–cooler units (HCUs) used during cardiac surgery. We did a molecular epidemiological investigation to establish the source of these patients' disease. Methods We included 24 M chimaera isolates from 21 cardiac surgery-related patients in Switzerland, Germany, the Netherlands, and the UK, 218 M chimaera isolates from various types of HCUs in hospitals, from LivaNova (formerly Sorin; London, UK) and Maquet (Rastatt, Germany) brand HCU production sites, and unrelated environmental sources and patients, as well as eight Mycobacterium intracellulare isolates. Isolates were analysed by next-generation whole-genome sequencing using Illumina and Pacific Biosciences technologies, and compared with published M chimaera genomes. Findings Phylogenetic analysis based on whole-genome sequencing of 250 isolates revealed two major M chimaera groups. Cardiac surgery-related patient isolates were all classified into group 1, in which all, except one, formed a distinct subgroup. This subgroup also comprised isolates from 11 cardiac surgery-related patients reported from the USA, most isolates from LivaNova HCUs, and one from their production site. Isolates from other HCUs and unrelated patients were more widely distributed in the phylogenetic tree. Interpretation HCU contamination with M chimaera at the LivaNova factory seems a likely source for cardiothoracic surgery-related severe M chimaera infections diagnosed in Switzerland, Germany, the Netherlands, the UK, the USA, and Australia. Protective measures and heightened clinician awareness are essential to guarantee patient safety. Funding Partly funded by the EU Horizon 2020 programme, its FP7 programme, the German Center for Infection Research (DZIF), the Swiss National Science Foundation, the Swiss Federal Office of Public Health, and National Institute of Health Research Oxford Health Protection Research Units on Healthcare Associated Infection and Antimicrobial Resistance.",
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van Ingen, J, Kohl, TA, Kranzer, K, Hasse, B, Keller, PM, Katarzyna Szafrańska, A, Hillemann, D, Chand, M, Schreiber, PW, Sommerstein, R, Berger, C, Genoni, M, Rüegg, C, Troillet, N, Widmer, AF, Becker, SL, Herrmann, M, Eckmanns, T, Haller, S, Höller, C, Debast, SB, Wolfhagen, MJ, Hopman, J, Kluytmans, J, Langelaar, M, Notermans, DW, ten Oever, J, van den Barselaar, P, Vonk, ABA, Vos, MC, Ahmed, N, Brown, T, Crook, D, Lamagni, T, Phin, N, Smith, EG, Zambon, M, Serr, A, Götting, T, Ebner, W, Thürmer, A, Utpatel, C, Spröer, C, Bunk, B, Nübel, U, Bloemberg, GV, Böttger, EC, Niemann, S, Wagner, D & Sax, H 2017, 'Global outbreak of severe Mycobacterium chimaera disease after cardiac surgery: a molecular epidemiological study' The Lancet Infectious Diseases, vol. 17, no. 10, pp. 1033-1041. https://doi.org/10.1016/S1473-3099(17)30324-9

Global outbreak of severe Mycobacterium chimaera disease after cardiac surgery : a molecular epidemiological study. / van Ingen, Jakko; Kohl, Thomas A.; Kranzer, Katharina; Hasse, Barbara; Keller, Peter M.; Katarzyna Szafrańska, Anna; Hillemann, Doris; Chand, Meera; Schreiber, Peter Werner; Sommerstein, Rami; Berger, Christoph; Genoni, Michele; Rüegg, Christian; Troillet, Nicolas; Widmer, Andreas F.; Becker, Sören L.; Herrmann, Mathias; Eckmanns, Tim; Haller, Sebastian; Höller, Christiane; Debast, Sylvia B.; Wolfhagen, Maurice J.; Hopman, Joost; Kluytmans, Jan; Langelaar, Merel; Notermans, Daan W.; ten Oever, Jaap; van den Barselaar, Peter; Vonk, Alexander B.A.; Vos, Margreet C.; Ahmed, Nada; Brown, Timothy; Crook, Derrick; Lamagni, Theresa; Phin, Nick; Smith, E. Grace; Zambon, Maria; Serr, Annerose; Götting, Tim; Ebner, Winfried; Thürmer, Alexander; Utpatel, Christian; Spröer, Cathrin; Bunk, Boyke; Nübel, Ulrich; Bloemberg, Guido V.; Böttger, Erik C.; Niemann, Stefan; Wagner, Dirk; Sax, Hugo.

In: The Lancet Infectious Diseases, Vol. 17, No. 10, 01.10.2017, p. 1033-1041.

Research output: Contribution to journalArticleAcademicpeer-review

TY - JOUR

T1 - Global outbreak of severe Mycobacterium chimaera disease after cardiac surgery

T2 - a molecular epidemiological study

AU - van Ingen, Jakko

AU - Kohl, Thomas A.

AU - Kranzer, Katharina

AU - Hasse, Barbara

AU - Keller, Peter M.

AU - Katarzyna Szafrańska, Anna

AU - Hillemann, Doris

AU - Chand, Meera

AU - Schreiber, Peter Werner

AU - Sommerstein, Rami

AU - Berger, Christoph

AU - Genoni, Michele

AU - Rüegg, Christian

AU - Troillet, Nicolas

AU - Widmer, Andreas F.

AU - Becker, Sören L.

AU - Herrmann, Mathias

AU - Eckmanns, Tim

AU - Haller, Sebastian

AU - Höller, Christiane

AU - Debast, Sylvia B.

AU - Wolfhagen, Maurice J.

AU - Hopman, Joost

AU - Kluytmans, Jan

AU - Langelaar, Merel

AU - Notermans, Daan W.

AU - ten Oever, Jaap

AU - van den Barselaar, Peter

AU - Vonk, Alexander B.A.

AU - Vos, Margreet C.

AU - Ahmed, Nada

AU - Brown, Timothy

AU - Crook, Derrick

AU - Lamagni, Theresa

AU - Phin, Nick

AU - Smith, E. Grace

AU - Zambon, Maria

AU - Serr, Annerose

AU - Götting, Tim

AU - Ebner, Winfried

AU - Thürmer, Alexander

AU - Utpatel, Christian

AU - Spröer, Cathrin

AU - Bunk, Boyke

AU - Nübel, Ulrich

AU - Bloemberg, Guido V.

AU - Böttger, Erik C.

AU - Niemann, Stefan

AU - Wagner, Dirk

AU - Sax, Hugo

PY - 2017/10/1

Y1 - 2017/10/1

N2 - Background Since 2013, over 100 cases of Mycobacterium chimaera prosthetic valve endocarditis and disseminated disease were notified in Europe and the USA, linked to contaminated heater–cooler units (HCUs) used during cardiac surgery. We did a molecular epidemiological investigation to establish the source of these patients' disease. Methods We included 24 M chimaera isolates from 21 cardiac surgery-related patients in Switzerland, Germany, the Netherlands, and the UK, 218 M chimaera isolates from various types of HCUs in hospitals, from LivaNova (formerly Sorin; London, UK) and Maquet (Rastatt, Germany) brand HCU production sites, and unrelated environmental sources and patients, as well as eight Mycobacterium intracellulare isolates. Isolates were analysed by next-generation whole-genome sequencing using Illumina and Pacific Biosciences technologies, and compared with published M chimaera genomes. Findings Phylogenetic analysis based on whole-genome sequencing of 250 isolates revealed two major M chimaera groups. Cardiac surgery-related patient isolates were all classified into group 1, in which all, except one, formed a distinct subgroup. This subgroup also comprised isolates from 11 cardiac surgery-related patients reported from the USA, most isolates from LivaNova HCUs, and one from their production site. Isolates from other HCUs and unrelated patients were more widely distributed in the phylogenetic tree. Interpretation HCU contamination with M chimaera at the LivaNova factory seems a likely source for cardiothoracic surgery-related severe M chimaera infections diagnosed in Switzerland, Germany, the Netherlands, the UK, the USA, and Australia. Protective measures and heightened clinician awareness are essential to guarantee patient safety. Funding Partly funded by the EU Horizon 2020 programme, its FP7 programme, the German Center for Infection Research (DZIF), the Swiss National Science Foundation, the Swiss Federal Office of Public Health, and National Institute of Health Research Oxford Health Protection Research Units on Healthcare Associated Infection and Antimicrobial Resistance.

AB - Background Since 2013, over 100 cases of Mycobacterium chimaera prosthetic valve endocarditis and disseminated disease were notified in Europe and the USA, linked to contaminated heater–cooler units (HCUs) used during cardiac surgery. We did a molecular epidemiological investigation to establish the source of these patients' disease. Methods We included 24 M chimaera isolates from 21 cardiac surgery-related patients in Switzerland, Germany, the Netherlands, and the UK, 218 M chimaera isolates from various types of HCUs in hospitals, from LivaNova (formerly Sorin; London, UK) and Maquet (Rastatt, Germany) brand HCU production sites, and unrelated environmental sources and patients, as well as eight Mycobacterium intracellulare isolates. Isolates were analysed by next-generation whole-genome sequencing using Illumina and Pacific Biosciences technologies, and compared with published M chimaera genomes. Findings Phylogenetic analysis based on whole-genome sequencing of 250 isolates revealed two major M chimaera groups. Cardiac surgery-related patient isolates were all classified into group 1, in which all, except one, formed a distinct subgroup. This subgroup also comprised isolates from 11 cardiac surgery-related patients reported from the USA, most isolates from LivaNova HCUs, and one from their production site. Isolates from other HCUs and unrelated patients were more widely distributed in the phylogenetic tree. Interpretation HCU contamination with M chimaera at the LivaNova factory seems a likely source for cardiothoracic surgery-related severe M chimaera infections diagnosed in Switzerland, Germany, the Netherlands, the UK, the USA, and Australia. Protective measures and heightened clinician awareness are essential to guarantee patient safety. Funding Partly funded by the EU Horizon 2020 programme, its FP7 programme, the German Center for Infection Research (DZIF), the Swiss National Science Foundation, the Swiss Federal Office of Public Health, and National Institute of Health Research Oxford Health Protection Research Units on Healthcare Associated Infection and Antimicrobial Resistance.

UR - http://www.scopus.com/inward/record.url?scp=85023763788&partnerID=8YFLogxK

U2 - 10.1016/S1473-3099(17)30324-9

DO - 10.1016/S1473-3099(17)30324-9

M3 - Article

VL - 17

SP - 1033

EP - 1041

JO - Lancet Infectious Diseases

JF - Lancet Infectious Diseases

SN - 1473-3099

IS - 10

ER -