Dataset Information

Identification of Mycobacterium chimaera in heater-cooler units in China.

ABSTRACT: A global outbreak of infections due to Mycobacterium chimaera has been linked to the LivaNova (formerly Sorin) 3 T heater-cooler units (HCUs). We performed a study to investigate M. chimaera from HCUs in China. Water samples were collected from all 3 T HCUs (n = 5) at our hospital in May 2017. Mycobacteria isolates were subjected to genome sequencing using the HiSeq X10 Sequencer. Species were identified based on average nucleotide identity with M. chimaera type strain DSM 44623T. Paired-end reads of all M. chimaera genomes were retrieved from the SRA database and, together with our isolates, were mapped against the chromosome of M. chimaera reference strain ZUERICH-1 to call SNPs. Mycobacteria grew from three HCUs manufactured in 2009 but not from the two in 2016. The three isolates were identified as M. chimaera and differed from each other by 4 to 6 SNPs, and from ZUERICH-1 by 7 to 10 SNPs. The three isolates belonged to the subgroup 1.1 and were most closely related to strains of the subgroup 1.1 from HCUs or patients in Europe, Australia/New Zealand and USA, suggesting the same common source. This is the first report of M. chimaera from HCUs in China.

SUBMITTER: Zhang X

PROVIDER: S-EPMC5959939 | biostudies-literature | 2018 May

REPOSITORIES: biostudies-literature

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Identification of Mycobacterium chimaera in heater-cooler units in China.

Zhang Xiaoxia X Lin Ji J Feng Yu Y Wang Xiaohui X McNally Alan A Zong Zhiyong Z

Scientific reports 20180518 1

A global outbreak of infections due to Mycobacterium chimaera has been linked to the LivaNova (formerly Sorin) 3 T heater-cooler units (HCUs). We performed a study to investigate M. chimaera from HCUs in China. Water samples were collected from all 3 T HCUs (n = 5) at our hospital in May 2017. Mycobacteria isolates were subjected to genome sequencing using the HiSeq X10 Sequencer. Species were identified based on average nucleotide identity with M. chimaera type strain DSM 44623<sup>T</sup>. Pai ...[more]

PMID: 29777159

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Project description:Mycobacterium chimaera is ubiquitously spread in the environment, including factory and hospital water systems. Invasive cases of M. chimaera infection have been associated with aerosols produced by the use of heater-cooler units (HCU) during cardiac surgery. The aim of this study was to evaluate for the first time the performance of IR-Biotyper system on a large number of M. chimaera isolates collected from longitudinal environmental HCUs samples and water sources from hospitals located in three Italian provinces. In addition, IR-Biotyper results were compared with whole-genome sequencing (WGS) analysis, the reference method for molecular epidemiology, to investigate the origin of M. chimaera contamination of HCUs. From November 2018 to May 2021, 417 water samples from 52 HCUs (Stockert 3T, n = 41 and HCU40, n = 11) and 23 hospital taps (used to fill the HCU tanks) were concentrated, decontaminated, and cultured for M. chimaera. Positive cultures (n = 53) were purified by agar plate subcultures and analyzed by IR-Biotyper platform and Ion Torrent sequencing system. IR-Biotyper spectra results were analyzed using a statistical approach of dimensionality reduction by linear discriminant analysis (LDA), generating three separate clusters of M. chimaera, ascribable to each hospital. Furthermore, the only M. chimaera-positive sample from tap water clustered with the isolates from the HCUs of the same hospital, confirming that the plumbing system could represent the source of HCU contamination and, potentially, of patient infection. According to the genome-based phylogenies and following the classification proposed by van Ingen and collaborators in 2017, three distinct M. chimaera groups appear to have contaminated the HCU water systems: subgroups 1.1, 2.1, and branch 2. Most of the strains isolated from HCUs at the same hospital share a highly similar genetic profile. The nonrandom distribution obtained with WGS and IR-Biotyper leads to the hypothesis that M. chimaera subtypes circulating in the local plumbing colonize HCUs through the absolute filter, in addition with the current hypothesis that contamination occurs at the HCU production site. This opens the possibility that other medical equipment, such as endoscope reprocessing device or hemodialysis systems, could be contaminated by M. chimaera. IMPORTANCE Our manuscript focuses on interventions to reduce waterborne disease transmission, improve sanitation, and control infection. Sanitary water can be contaminated by nontuberculous Mycobacteria, including M. chimaera, a causative agent of invasive infections in immunocompromised patients. We found highly similar genetic and phenotypic profiles of M. chimaera isolated from heater-cooler units (HCU) used during surgery to thermo-regulate patients' body temperature, and from the same hospital tap water. These results lead to the hypothesis that M. chimaera subtypes circulating in the local plumbing colonize HCUs through the absolute filter, adding to the current hypothesis that contamination occurs at the HCU production site. In addition, this opens the possibility that other medical equipment using sanitized water, such as endoscope reprocessing devices or hemodialysis systems, could be contaminated by nontuberculous Mycobacteria, suggesting the need for environmental surveillance and associated control measures.

Dataset Information

Identification of Mycobacterium chimaera in heater-cooler units in China.

Publications

Identification of Mycobacterium chimaera in heater-cooler units in China.

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