Wetzstein Nils, Kohl Thomas A, Diricks Margo, Mas-Peiro Silvia, Holubec Tomas, Kessel Johanna, Graf Christiana, Koch Benjamin, Herrmann Eva, Vehreschild Maria J G T, Hogardt Michael, Niemann Stefan, Stephan Christoph, Wichelhaus Thomas A
Department of Internal Medicine, Infectious Diseases, University Hospital Frankfurt, Goethe University, Frankfurt am Main, Germany.
The German Centre for Infection Research (DZIF), partner site Hamburg-Lübeck-Borstel-Riems, Germany; Molecular and Experimental Mycobacteriology, Research Centre Borstel, Borstel, Germany.
Clin Microbiol Infect. 2023 Aug;29(8):1008-1014. doi: 10.1016/j.cmi.2023.03.005. Epub 2023 Mar 12.
Since 2013, heater-cooler unit (HCU) associated Mycobacterium chimaera infections linked to a global outbreak have been described. These infections were characterised by high morbidity and mortality due to delayed diagnosis, as well as challenges in antimycobacterial and surgical therapy. This study aimed to investigate the clinical characteristics and outcome of published cases of HCU-associated M. chimaera infections.
We searched PubMed and the Web of Science until 15 June 2022 for case reports, case series, and cohort studies, without language restriction, on patients with M. chimaera infection and a prior history of cardiac surgery. In this systematic review of case reports, no risk of bias assessment could be performed. Clinical, microbiological, and radiological features were recorded. Logistic regression and time-to-event analyses were performed to identify the potential factors associated with better survival.
One hundred eighty patients from 54 publications were included. Most patients underwent surgical aortic valve (67.0%; 118/176 of patients with available data) or combined aortic valve and root replacement (15.3%; 27/176). The median period between the time point of surgery and the first symptoms was 17 months (interquartile range 13-26 months). The overall case fatality rate was 45.5% (80/176), with a median survival of 24 months after the initiation of antimycobacterial therapy or diagnosis. A reoperation (including the removal or exchange of foreign material) was associated with better survival in multivariate logistic regression (OR 0.32 for lethal events; 95% CI 0.12-0.79; p 0.015) and in time-to-event analysis (p 0.0094).
This systematic review and meta-analysis confirm the high overall mortality of HCU -associated disseminated M. chimaera infections after cardiac surgery. A reoperation seems to be associated with better survival. Physicians have to stay aware of this infection, as patients might still be present today due to the long latency period.
自2013年以来，已报道了与全球疫情相关的加热器-冷却器单元（HCU）所致的嵌合体分枝杆菌感染。这些感染的特点是由于诊断延迟导致高发病率和死亡率，以及抗分枝杆菌治疗和手术治疗面临挑战。本研究旨在调查已发表的HCU相关嵌合体分枝杆菌感染病例的临床特征和结局。
我们在PubMed和Web of Science上检索至2022年6月15日，以查找关于嵌合体分枝杆菌感染且有心脏手术史患者的病例报告、病例系列和队列研究，无语言限制。在对病例报告的这项系统评价中，无法进行偏倚风险评估。记录临床、微生物学和放射学特征。进行逻辑回归和事件发生时间分析，以确定与更好生存相关的潜在因素。
纳入了来自54篇出版物的180例患者。大多数患者接受了主动脉瓣手术（67.0%；有可用数据的患者中118/176）或主动脉瓣与根部联合置换手术（15.3%；176例中27例）。手术时间点与首次出现症状之间的中位时间为17个月（四分位间距13 - 26个月）。总体病死率为45.5%（80/176），抗分枝杆菌治疗开始或诊断后中位生存期为24个月。再次手术（包括取出或更换异物）在多因素逻辑回归（致死事件的OR为0.32；95%CI 0.12 - 0.79；p = 0.015）和事件发生时间分析中（p = 0.0094）与更好的生存相关。
这项系统评价和荟萃分析证实了心脏手术后HCU相关播散性嵌合体分枝杆菌感染的总体高死亡率。再次手术似乎与更好的生存相关。医生必须对这种感染保持警惕，因为由于潜伏期长，如今可能仍有患者存在。
