Cardiac Surgery Reseach Centre, Insubria University, Circolo Hospital, Varese.
Santa Maria Hospital, GVM Care & Research, University of Bari Aldo Moro, Department of Emergency and Organ Transplant, Bari.
J Cardiovasc Med (Hagerstown). 2018 Dec;19(12):748-755. doi: 10.2459/JCM.0000000000000717.
A global outbreak of Mycobacterium chimaera infections following cardiac surgery and linked to contaminated heater-cooler units (HCUs) is currently ongoing. Neither the status of this outbreak in Italy nor the mitigation strategies adopted by adult cardiac surgery units (ACSUs) are currently known. In 2017, the Italian Society of Cardiac Surgery launched a national survey among the Italian ACSU to shed some light on this issue.
In Italy, there are 90 ACSUs across 20 regions. From May to November 2017, these ACSUs were surveyed collecting data on patients diagnosed with MC infections, ACSU workload, HCU models in use and control measures adopted in the operatory room.
The response rate was 87.8%. The median number of cardiac procedures at each ACSU was 450/year [interquartile range (IQR) 350-650 procedures/year], and nationally, the number of procedures/year exceeded 40k. In Italy, seven patients with M. chimaera infections following cardiac procedures have been reported since 2015: all had aortic or valvular surgery as the first procedure; the median latency between the first operation and the infection was 2 years (IQR 2-3.25). Mortality for patients requiring redo cardiac surgery was 50%. M. chimaera infections risk was 0.4-1 patient every 1000 cardiac procedures. The most common HCU model in Italy is the 3T HCU (70.9%). The most common control measures adopted included implementing new HCU disinfection protocols, using sterile or filtrated water in the HCU and displacing HCU fans away from the patient: HCU replacement and microbiology testing were instead infrequent.
In Italy, the risk of contracting M. chimaera infections and the mortality reported are in line with other European countries, but significant heterogeneity exists on the mitigation strategies adopted to prevent further M. chimaera inoculations, suggesting the development of national guidelines.
目前正在发生与受污染的热交换器（HCU）相关的心脏手术后感染奇异分枝杆菌的全球疫情。目前尚不清楚意大利疫情的现状以及成人心脏手术单位（ACSU）所采取的缓解策略。2017 年，意大利心脏外科学会对意大利的 ACSU 进行了一项全国性调查，以了解这个问题。
意大利共有 90 个 ACSU 分布在 20 个地区。2017 年 5 月至 11 月，对这些 ACSU 进行了调查，收集了诊断为 MC 感染的患者、ACSU 工作量、使用的 HCU 型号以及手术室中采取的控制措施的数据。
回复率为 87.8%。每个 ACSU 的中位数心脏手术数量为 450/年[四分位距（IQR）350-650 例/年]，全国每年的手术数量超过 4 万例。在意大利，自 2015 年以来已有 7 例心脏手术后感染奇异分枝杆菌的患者报告：所有患者均接受过主动脉或瓣膜手术作为首次手术；第一次手术和感染之间的潜伏期中位数为 2 年（IQR 2-3.25）。需要再次心脏手术的患者死亡率为 50%。每个 1000 例心脏手术中，奇异分枝杆菌感染的风险为 0.4-1 例。意大利最常见的 HCU 型号是 3T HCU（70.9%）。最常见的控制措施包括实施新的 HCU 消毒方案、在 HCU 中使用无菌或过滤水以及将 HCU 风扇移离患者：而 HCU 更换和微生物学测试则很少见。
在意大利，感染奇异分枝杆菌的风险和报告的死亡率与其他欧洲国家一致，但为防止进一步的奇异分枝杆菌接种而采取的缓解策略存在显著差异，表明需要制定国家指南。
