Die DGHM prämiert Veröffentlichungen, die sich durch eine große Anwendungsrelevanz auszeichnen. Für diese Auszeichnung können Publikationen vorgschlagen werden, an denen ein DGHM-Mitglied als Erst- oder LetztautorIn beteiligt ist und die in den vorangegangenen 3 Monaten hochrangig publiziert wurden.
Aktuelles Highlight der Infektionsprävention und Klin. Mikrobiologie
Endocarditis associated with contamination of cardiovascular bioprostheses with Mycobacterium chelonae: a collaborative microbiological study
Judith Kikhney1, Inna Friesen2, Solveigh Wiesener3, Laura Kursawe1, Christoph Loddenkemper4, Josef Zündorf 5, Beate Häuser5, Esther P Cónsul Tejero5, Dinah V Schöning6, Kurosh Sarbandi7, Doris Hillemann2, Martin Kuhns2, Miriam S Stegemann8, Frieder Pfäfflin8, Frank-Rainer Klefisch9, Volker Düsterhöft10, Sebastian Haller11, Anja V Laer11, Tim Eckmanns11, Emmanuelle Cambau12, Sarah Tschudin-Sutter13, Barbara Hasse14, Anette Friedrichs15, Bernd Panholzer16, Walter Eichinger17, Petra Gastmeier18, Volkmar Falk1, Annette Moter19
Lancet Microbe 2024 Oct 24:100934. doi: 10.1016/j.lanmic.2024.06.001.
Link zum vollständigen Artikel: https://pubmed.ncbi.nlm.nih.gov/39491876/
Judith Kikhney
Abstract:
Background: Mycobacterium chelonae is a rare cause of infective endocarditis that is difficult to diagnose and treat. After we found M chelonae in a series of patients, we aimed to investigate its role in cardiovascular prosthesis dysfunction and contamination of bioprostheses as a possible cause of infection.
Methods: In this collaborative microbiological study, we report on nine patients treated in three cardiovascular surgical departments in Germany, who were found to have M chelonae infection after receiving BioIntegral bioprostheses. We performed fluorescence in-situ hybridisation (FISH) combined with broad-range 16S rRNA gene amplification and sequencing (FISHseq) on samples of native cardiovascular tissue and explanted bioprosthetic material, as well as on 12 unused BioIntegral prostheses. We confirmed FISHseq findings with histological examination by staining for acid-fast bacilli, and M chelonae was differentiated from M abscessus by molecular techniques.
Findings: Between Dec 1, 2020, and Feb 28, 2022, we identified M chelonae in BioIntegral bioprostheses from three initial patients treated in Berlin that were explanted following dysfunction or suspected endocarditis, visualising morphologically intact FISH-positive mycobacteria. Despite negative mycobacterial culture, we also detected M chelonae in all 12 unused BioIntegral prostheses. The competent authorities in the EU prompted an alert, leading to the identification of six additional patients between March 1, 2022, and July 31, 2023. To find other cases of M chelonae endocarditis, we reviewed the FISHseq results of 1237 cardiovascular samples that were analysed between Jan 1, 2015, and Aug 31, 2022, including 295 samples from 228 bioprostheses supplied by other manufacturers. M chelonae was only detected in six of 41 patients who had received BioIntegral products.
Interpretation: Bioprostheses manufactured by BioIntegral Surgical might be colonised by M chelonae, which can lead to implant dysfunction. These infections are likely to be missed by conventional routine diagnostics and should be considered in patients with BioIntegral implants and suspected infection or dysfunction. Cases should be reported to public health and regulatory authorities. Routine safety testing of bioprostheses during manufacture should be reconsidered.
Funding: German Federal Ministry of Education and Research.
Kommentar:
Mycobacterium chelonae ist ein seltener Erreger kardiovaskulärer Infektionen, der mit kontaminierten Bioprothesen in Verbindung gebracht wurde. Durch eine Kombination von molekularen Techniken (FISHseq, PCR und Sequenzierung) und histopathologischen Färbungen konnten wir erstmals zeigen, dass Bioprothesen der Firma BioIntegral mit M. chelonae kontaminiert waren und dass dies zu Implantatversagen führen kann. Diese Studie führte dazu, dass nach einer Warnung durch die EU die Prothesen des Herstellers auf dem Europäischen Markt nicht mehr verfügbar sind. Diese lebensbedrohlichen Infektionen werden durch kulturelle Routine-Diagnostik nicht nachgewiesen und sollten bei PatientInnen, die Prothesen des Herstellers tragen, in Betracht gezogen werden.
Kontakt:
Dr. phil. nat. Judith Kikhney
Biofilmzentrum
Institut für Mikrobiologie und Infektionsimmunologie
Charité – Universitätsmedizin Berlin
Campus Benjamin Franklin | Hindenburgdamm 30 | 12203 Berlin
T +49 30 450 524 524 or -006
F +49 30 450 7 524 006
judith.kikhney@charite.de
https://imh.charite.de/
Autor:inneninformationen:
1 University of Leipzig Medical Center, Institute of Hygiene, Hospital Epidemiology and Environmental Health, Leipzig, Germany. tiffany.schaumburg@medizin.uni-leipzig.de.
2 Leipzig University, Faculty of Medicine, Clinical Trial Centre (ZKS Leipzig), Leipzig, Germany.
3 University of Leipzig Medical Center, Institute of Hygiene, Hospital Epidemiology and Environmental Health, Leipzig, Germany.
4 Leipzig University, Faculty of Medicine, Institute of Medical Informatics, Statistics and Epidemiology (IMISE), Leipzig, Germany.
5 Kiel University, University Hospital Schleswig-Holstein, Institute of Hospital Epidemiology and Environmental Hygiene, Kiel, Germany.
# Contributed equally.
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