Division of Infectious Diseases, Duke University School of Medicine, Durham, North Carolina, USA.
Duke Center for Antimicrobial Stewardship and Infection Prevention, Durham, North Carolina, USA.
Clin Infect Dis. 2021 Apr 8;72(7):1232-1240. doi: 10.1093/cid/ciaa215.
We recently mitigated a clonal outbreak of hospital-acquired Mycobacterium abscessus complex (MABC), which included a large cluster of adult patients who developed invasive infection after exposure to heater-cooler units during cardiac surgery. Recent studies have detailed Mycobacterium chimaera infections acquired during cardiac surgery; however, little is known about the epidemiology and clinical courses of cardiac surgery patients with invasive MABC infection.
We retrospectively collected clinical data on all patients who underwent cardiac surgery at our hospital and subsequently had positive cultures for MABC from 2013 through 2016. Patients with ventricular assist devices or heart transplants were excluded. We analyzed patient characteristics, antimicrobial therapy, surgical interventions, and clinical outcomes.
Ten cardiac surgery patients developed invasive, extrapulmonary infection from M. abscessus subspecies abscessus in an outbreak setting. Median time from presumed inoculation in the operating room to first positive culture was 53 days (interquartile range [IQR], 38-139 days). Disseminated infection was common, and the most frequent culture-positive sites were mediastinum (n = 7) and blood (n = 7). Patients received a median of 24 weeks (IQR, 5-33 weeks) of combination antimicrobial therapy that included multiple intravenous agents. Six patients required antibiotic changes due to adverse events attributed to amikacin, linezolid, or tigecycline. Eight patients underwent surgical management, and 6 patients required multiple sternal debridements. Eight patients died within 2 years of diagnosis, including 4 deaths directly attributable to MABC infection.
Despite aggressive medical and surgical management, invasive MABC infection after cardiac surgery caused substantial morbidity and mortality. New treatment strategies are needed, and compliance with infection prevention guidelines remains critical.
我们最近减轻了一次医院获得性脓肿分枝杆菌复合群（MABC）的克隆爆发，其中包括一大群成年患者，他们在心脏手术后暴露于热交换器单元后发生了侵袭性感染。最近的研究详细描述了心脏手术期间获得的分枝杆菌拟态感染；然而，对于心脏手术患者侵袭性 MABC 感染的流行病学和临床过程知之甚少。
我们回顾性收集了 2013 年至 2016 年期间在我院接受心脏手术且随后 MABC 阳性培养的所有患者的临床数据。排除了心室辅助装置或心脏移植患者。我们分析了患者特征、抗菌治疗、手术干预和临床结果。
在一次暴发环境中，10 名心脏手术患者发生了脓肿分枝杆菌亚种脓肿引起的侵袭性、肺外感染。从手术室推测接种到首次阳性培养的中位时间为 53 天（四分位距 [IQR]，38-139 天）。播散性感染很常见，最常培养阳性的部位是纵隔（n=7）和血液（n=7）。患者接受了中位 24 周（IQR，5-33 周）的联合抗菌治疗，包括多种静脉内药物。由于阿米卡星、利奈唑胺或替加环素引起的不良反应，6 名患者需要改变抗生素。8 名患者接受了手术治疗，6 名患者需要多次胸骨清创术。8 名患者在诊断后 2 年内死亡，包括 4 例直接归因于 MABC 感染的死亡。
尽管进行了积极的医疗和手术治疗，但心脏手术后侵袭性 MABC 感染仍导致了大量的发病率和死亡率。需要新的治疗策略，并且遵守感染预防指南仍然至关重要。
