Special Session to Examine Heater-Cooler-Induced Infections

HEATER-COOLER-INDUCED INFECTIONS

Sunday

7:00 a.m. – 8:00 a.m.

Room 310ABC

Nontuberculous mycobacterium (NTM) forming in heater-cooler devices commonly used in operating rooms have been linked to deadly infections that are difficult to detect and may not manifest themselves for years following surgery.

“This is considered by both the CDC and FDA as an emerging public health concern that has generated multiple medical alerts,” said Keith B. Allen, MD, of St. Luke’s Mid American Heart Institute and the University of Missouri–Kansas City.

Dr. Allen will present an abstract on these infections associated with the use of heater-cooler devices in patients who have undergone cardiothoracic surgeries. A panel discussion featuring cardiothoracic surgeons and infectious disease experts also is part of the Sunday session.

Contamination can be seen in the dark area of a heater-cooler device tube. Photo provided by Keith Allen, MD.

Contamination can be seen in the dark area of a heater-cooler device tube. Photo provided by Keith Allen, MD.

Mycobacterium chimaera infections have been reported in at least six countries in North America and Europe. Of great concern is that the infections have a long latency period of up to 60 months, Dr. Allen said. Specific culturing techniques are required to detect NTM.

“NTM is a ubiquitous organism that can contaminate these heater-cooler devices,” he said. “Even though the devices do not come into direct contact with the patient’s blood or body fluids, they have the potential to aerosolize these bacteria into the surgical field, which then contaminate devices that are implanted into the patient or the surgical wound itself.

“What makes these infections so problematic is that they are difficult to grow. If you have somebody who presents with fevers and you are doing normal cultures, you would never culture NTM. It can take up to 8 weeks to grow, so you have to be aware of the problem and have it be part of your differential to make the appropriate diagnosis.”

Keith B. Allen, MD

Keith B. Allen, MD

Dr. Allen, lead author of the abstract, worked with other experts at the request of the FDA, which organized a Circulatory Device Panel meeting last summer to address the problem.

“This is a problem that is not going to go away,” Dr. Allen said. “Patients can be exposed to this in an open heart operation, and they might not manifest symptoms for 3 years or more.

“We are looking at the tip of the iceberg. There probably have been a lot of patients who had issues that were never diagnosed because we were not aware of it as a problem. That’s why this session is so important.”

Learn What You Can Do

In November, STS and several other societies issued a joint statement to the worldwide cardiothoracic community offering resources and other information from government entities and health care providers. To learn more about the heater-cooler situation, go to sts.org/heater-cooler.

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