Mycobacterium chimaera: A silent threat in the cardiac operating room.

Abstract

Mycobacterium chimaera infection is a serious complication caused by contamination of the surgical wound or entry into the respiratory tract of aerosols from the CSUs used in cardiac surgery. The incubation period can take from months to six years before symptoms of infection appear. The infection is difficult to treat and has a mortality rate of 50–60%. Occasionally, the similarity of the clinical picture can lead to misdiagnosis as sarcoidosis, in which case the use of steroids can worsen the prognosis of the infection. Pharmacological treatment requires at least 12 months for both respiratory and extra-respiratory infections. There is a risk of complications due to cumulative toxicity and adverse drug effects. Current European perfusion guidelines recommend the placement of CSUs outside the operating room as the most effective measure to prevent aerosol dissemination. It is known that despite proper disinfection protocols and following manufacturers' recommendations, MC contamination may not be completely eradicated in CTUs. Another option is the use of units that do not use water as a thermal vehicle. Units that use ethylene glycol are already commercially available; however, evidence of their use is still scarce, and their use is limited. Furthermore, ethylene glycol is lethal at high doses, so an accident could result in death.