Invasive Nontuberculous Mycobacterial Infections among Cardiothoracic Surgical Patients Exposed to Heater-Cooler Devices1

Emerg Infect Dis. 2017 May;23(5):796-805. doi: 10.3201/eid2305.161899.


Invasive nontuberculous mycobacteria (NTM) infections may result from a previously unrecognized source of transmission, heater-cooler devices (HCDs) used during cardiac surgery. In July 2015, the Pennsylvania Department of Health notified the Centers for Disease Control and Prevention (CDC) about a cluster of NTM infections among cardiothoracic surgical patients at 1 hospital. We conducted a case-control study to identify exposures causing infection, examining 11 case-patients and 48 control-patients. Eight (73%) case-patients had a clinical specimen identified as Mycobacterium avium complex (MAC). HCD exposure was associated with increased odds of invasive NTM infection; laboratory testing identified patient isolates and HCD samples as closely related strains of M. chimaera, a MAC species. This investigation confirmed a large US outbreak of invasive MAC infections in a previously unaffected patient population and suggested transmission occurred by aerosolization from HCDs. Recommendations have been issued for enhanced surveillance to identify potential infections associated with HCDs and measures to mitigate transmission risk.

Keywords: NTM; bacteria; cardiac surgery; cardiopulmonary bypass; heater–cooler device; nontuberculous mycobacteria; tuberculosis and other mycobacteria.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Cardiac Surgical Procedures / adverse effects*
  • Case-Control Studies
  • Equipment Contamination*
  • Female
  • Health Care Surveys
  • Humans
  • Logistic Models
  • Male
  • Middle Aged
  • Mycobacterium Infections, Nontuberculous / epidemiology*
  • Mycobacterium Infections, Nontuberculous / etiology*
  • Nontuberculous Mycobacteria* / isolation & purification
  • Odds Ratio
  • Risk Factors
  • Thoracic Surgical Procedures / adverse effects*
  • Young Adult