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In 2011, invasive cardiovascular and disseminated infections by a slowly-growing non-tuberculous mycobacterium, Mycobacterium chimaera, were detected in patients who had undergone cardiothoracic surgery in Switzerland. M. chimaera was subsequently detected in the water tanks of heater-cooler units (HCUs) used to regulate the temperature of patients’ blood in the cardiopulmonary bypass circuit, and in air samples from the operating room when the HCUs were running [1]. This report led investigators in other countries to look for similar cases among cardiothoracic surgery patients exposed to such devices. From 2014 onwards up to April 2015, cases of invasive cardiovascular infection by M. chimaera potentially linked to HCUs were consecutively detected in the Netherlands, Germany and the United Kingdom (UK) [2] and hereafter in the United States (US) [3]. An epidemiological link with use of a specific model of HCUs, the 3T device (LivaNova, UK; formerly Sorin, Germany), was confirmed by the detection of M. chimaera in these devices across affected cardiothoracic surgery centres [4]. Observational and experimental studies showed that exhaust air from contaminated HCUs can transmit aerosols with M. chimaera to the operating field under ultraclean laminar air flow ventilation [5,6].

Mycobacterium chimaera infections associated with heater-cooler units (HCU): closing another loophole in patient safety