Mycobacterium chimaera Genomics With Regard to Epidemiological and Clinical Investigations Conducted for an Open Chest Postsurgical Mycobacterium chimaera Infection Outbreak

Emmanuel Lecorche; Côme Daniau; Kevin La; Faiza Mougari; Hanaa Benmansour; Sylvain Kumanski; Jérôme Robert; Sandra Fournier; Guillaume Lebreton; Anne Carbonne; Emmanuelle Cambau; CNR-MyRMA

doi:10.1093/ofid/ofab192

Mycobacterium chimaera Genomics With Regard to Epidemiological and Clinical Investigations Conducted for an Open Chest Postsurgical Mycobacterium chimaera Infection Outbreak

Open Forum Infect Dis. 2021 Apr 16;8(6):ofab192. doi: 10.1093/ofid/ofab192. eCollection 2021 Jun.

Authors

Emmanuel Lecorche^{1

2

3}, Côme Daniau⁴, Kevin La^{1

3}, Faiza Mougari^{2

3}, Hanaa Benmansour^{2

3}, Sylvain Kumanski³, Jérôme Robert^{3

5

6}, Sandra Fournier⁷, Guillaume Lebreton⁸, Anne Carbonne⁴, Emmanuelle Cambau^{1

2

3}; CNR-MyRMA

Collaborators

CNR-MyRMA:
Corentine Alauzet, Laurent Cavalié, Christine Chefson-Girault, Olivier Belmonte, Catherine Bounhiol Colin, Anne Bourgoin, Anne Bousseau, Lucien Brasme, Céline Cépoulain, Florence Cizeau, Christophe De Champs, Jean-Winoc Decousser, David Ducellier, Marguerite Fines Guyon, Sandra Fournier, Karine Gambarotto, Marion Grare, Hélène Guet-Revillet, Chloe Jansen, Frederic Janvier, Najiby Kassis-Chikhani, Valerie Lalande, Philippe Lanotte, Annick Lefebvre, Claire Lesteven, Marc Levy, Thomas Maitre, Sandra Malavaud, Stéphanie Morel, Isabelle Podglajen, Elodie Poisnel, Cécile Poulain, Marie-Fleur Rafidiarisoa, Jean Ringeval, Alexandre Rivier, Jerome Robert, Christine Roques-Ceschin, Soumaya Skalli, Ousmane Traore, Celine Vauterin, Charlotte Verdet

Affiliations

¹ Université de Paris, INSERM, IAME, Paris, France.
² APHP-GHU Nord, Service de Mycobactériologie Spécialisée et de Référence, Paris, France.
³ Centre National de Référence des Mycobactéries et de la Résistance des Mycobactéries aux Antituberculeux (CNR-MyRMA), Paris, France.
⁴ Santé Publique France, Saint-Maurice, France.
⁵ Centre d'Immunologie et des Maladies Infectieuses-CIMI-Paris, Sorbonne-Université, INSERM, Paris, France.
⁶ Bactériologie-Hygiène, AP-HP, Sorbonne Université, Site Pitié, Paris, France.
⁷ Centre d'Immunologie et des Maladies Infectieuses, Sorbonne - Université, INSERM (U1135 - E2), Paris, France.
⁸ Service de Chirurgie Cardiaque et Thoracique, Hôpital La Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France.

Abstract

Background: Postsurgical infections due to Mycobacterium chimaera appeared as a novel nosocomial threat in 2015, with a worldwide outbreak due to contaminated heater-cooler units used in open chest surgery. We report the results of investigations conducted in France including whole-genome sequencing comparison of patient and heater-cooler unit isolates.

Methods: We sought M. chimaera infection cases from 2010 onwards through national epidemiological investigations in health care facilities performing cardiopulmonary bypass, together with a survey on good practices and systematic heater-cooler unit microbial analyses. Clinical and heater-cooler unit isolates were subjected to whole-genome sequencing analyzed with regard to the reference outbreak strain Zuerich-1.

Results: Only 2 clinical cases were shown to be related to the outbreak, although 23% (41/175) of heater-cooler units were declared positive for M. avium complex. Specific measures to prevent infection were applied in 89% (50/56) of health care facilities, although only 14% (8/56) of them followed the manufacturer maintenance recommendations. Whole-genome sequencing comparison showed that the clinical isolates and 72% (26/36) of heater-cooler unit isolates belonged to the epidemic cluster. Within clinical isolates, 5-9 nonsynonymous single nucleotide polymorphisms were observed, among which an in vivo mutation in a putative efflux pump gene was observed in a clinical isolate obtained for 1 patient on antimicrobial treatment.

Conclusions: Cases of postsurgical M. chimaera infections have been declared to be rare in France, although heater-cooler units were contaminated, as in other countries. Genomic analyses confirmed the connection to the outbreak and identified specific single nucleotide polymorphisms, including 1 suggesting fitness evolution in vivo.

Keywords: heater-cooler units (HCUs); mmpL; molecular epidemiology; nontuberculous mycobacteria (NTM).