By Ethan Covey
A cluster of three extrapulmonary healthcare-associated Mycobacterium abscessus infections identified among cardiothoracic surgery patients at Duke University Hospital has been linked to water-based heater–cooler devices (HCDs).
The study highlights the importance of rigorous surveillance for healthcare-associated M. abscessus, as well as ongoing issues regarding the use of HCDs for patients undergoing cardiothoracic procedures (Infect Cont Hosp Epidemiol 2024;45[5]:644-650).
“In our study, we directly linked this new line of heater–cooler devices to three M. abscessus infections,” said Jessica Seidelman, MD, an associate professor of medicine in the Division of Infectious Diseases at Duke University School of Medicine, in Durham, N.C. “I think this addresses the ongoing challenges of using these devices for cardiothoracic surgery, particularly as they are used in patients who are transplant recipients and are immunocompromised.”
The three patient cases all had surgery at Duke from October to December 2020. A subsequent epidemiological investigation found that despite adherence to manufacturer-recommended disinfection protocols, M. abscessus was identified on 83% of tested HCDs. The investigation determined that the M. abscessus subspecies abscessus responsible for the cluster likely originated from the municipal water supply.
A mitigation strategy was implemented, which included replacement of all HCDs. No additional cases were identified.
Dr. Seidelman noted that new HCDs, which are in development, may help prevent such contamination from occurring.
“There are some newer heater–cooler devices that are waterless and may mitigate the risk of mycobacterial infections,” she said. “Some centers have also completely sequestered the heater–cooler devices from the operating rooms with the hopes that this would also eliminate the infection risk.”
