Patient lookback post cardiac surgery
SA Health is about to contact, by mail, people who have undergone certain cardiothoracic surgical procedures in recent years, due to a small risk that they may have been exposed to Mycobacterium chimaera from heater-cooler devices used to regulate blood temperature during the procedure. About 70 cases have been reported worldwide so far, including one in Australia, linked to one brand of heater cooler device manufactured in Germany and believed to have been contaminated in the factory, at time of manufacture. This brand of machine has been used in South Australia at: Flinders Medical Centre, Flinders Private Hospital, and Ashford Hospital. Patients who have had surgery at other hospitals are at no increased risk and will not be contacted by the Department.
M. chimaera, a non-tuberculous mycobacterium (NTM), is a slow-growing environmental organism of usually low pathogenicity, and infections acquired from heater-cooler devices have sometimes taken several years before symptoms have developed. In the reported surgically acquired infections, clinical manifestations have included prosthetic valve endocarditis, prosthetic vascular graft infection, surgical site infection, abscesses or bacteraemia, pyrexia of unknown origin, joint or muscle pains, weight loss and fatigue. Less common manifestations have included hepatitis, renal insufficiency, pancytopaenia due to bone marrow involvement, and osteomyelitis.
Diagnosis can be difficult due to the nonspecific presentation and slow-growing nature of the bacteria. Referral back to their cardiac surgeon and consultation with an infectious diseases physician is recommended if caring for patients who have undergone an open-chest cardiac procedure at one of the hospitals mentioned above and who present with unexplained signs of infection.
Treatment of NTM infections is complicated and of long duration, so empirical treatment is not appropriate. A diagnosis must be established by culture of appropriate specimens and this should be done in consultation with an infectious diseases physician or clinical microbiologist.
Testing of asymptomatic patients is strongly discouraged. There is no simple test to exclude infection, and the best management for asymptomatic patients is ongoing monitoring for symptoms for up to 5 years post-surgery. The risk of infection is extremely low and the large majority of people will not be affected.
Detailed information is available on the SA Health website at www.sahealth.sa.gov.au/infectionprevention