Spagnolo Anna Maria, De Giglio Osvalda, Caggiano Giuseppina, D'Agostini Francesco, Martini Mariano, Orsini Davide, La Maestra Sebastiano
Department of Health Sciences, University of Genova, Via Pastore 1, 16132 Genova, Italy.
Interdisciplinary Department of Medicine, Hygiene Section, University of Bari Aldo Moro, Piazza G. Cesare 11, 70124 Bari, Italy.
Pathogens. 2024 Sep 10;13(9):781. doi: 10.3390/pathogens13090781.
(MC), a member of the complex, can cause infections in patients after open-heart surgery due to contaminated heater-cooler units (HCUs). The transmission route of HCU-related MC infection is non-inhalational, and infection can occur in patients without previously known immune deficiency. Patients may develop endocarditis of the prosthetic valve, infection of the vascular graft, and/or manifestations of disseminated mycobacterial infection (splenomegaly, arthritis, hepatitis, nephritis, myocarditis, etc.). MC infections have serious outcomes (30-50% recurrence rate, 20-67% mortality rate). In 2015, an international outbreak of infections among patients undergoing cardiothoracic surgeries was associated with exposure to contaminated LivaNova 3T HCUs (formerly Stöckert 3T heater-cooler system, London, United Kingdom). In response to the global outbreak, many international agencies have issued directives and recommendations in order to reduce the risk of MC infection in cardiac surgery. Whole-genome sequencing (WGS) technology can be used to describe the global spread and dynamics of MC infections, to characterize local outbreaks, and also to identify sources of infection in hospital settings. In order to minimize the risk of contamination of HCUs and reduce the risk of patient infection, it is imperative that healthcare facilities establish a program of regular cleaning and disinfection maintenance procedures as well as monitoring of the water used and the air in the operating room, in accordance with the manufacturer's procedure.
分枝杆菌属（Mycobacterium chelonae，MC）是复合菌属的一员，因心脏手术中使用的加热器 - 冷却器装置（HCUs）受污染，可导致心脏直视手术后患者感染。与HCU相关的MC感染传播途径并非通过吸入，且在先前无已知免疫缺陷的患者中也可能发生感染。患者可能会出现人工瓣膜心内膜炎、血管移植物感染和/或播散性分枝杆菌感染的表现（脾肿大、关节炎、肝炎、肾炎、心肌炎等）。MC感染会导致严重后果（复发率为30 - 50%，死亡率为20 - 67%）。2015年，心胸外科手术患者中发生的一次国际性分枝杆菌感染暴发与接触受污染的LivaNova 3T HCU（原英国伦敦的Stöckert 3T加热器 - 冷却器系统）有关。为应对全球疫情，许多国际机构已发布指令和建议，以降低心脏手术中MC感染的风险。全基因组测序（WGS）技术可用于描述MC感染的全球传播和动态，确定局部暴发特征，还可在医院环境中识别感染源。为尽量减少HCU污染风险并降低患者感染风险，医疗保健机构必须按照制造商的程序，制定定期清洁和消毒维护程序以及监测手术室用水和空气的计划。
