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Epidemiology, management, and clinical outcomes of extrapulmonary Mycobacterium abscessus complex infections in heart transplant and ventricular assist device recipients.

Publication ,  Journal Article
Friedland, AE; Maziarz, EK; Wolfe, CR; Patel, CB; Patel, P; Milano, CA; Schroder, JN; Daneshmand, MA; Wallace, RJ; Alexander, BD; Baker, AW
Published in: Am J Transplant
July 2023

Nontuberculous mycobacteria are emerging pathogens, yet data on the epidemiology and management of extrapulmonary nontuberculous mycobacteria infections in orthotopic heart transplantation (OHT) and ventricular assist device (VAD) recipients are scarce. We retrospectively reviewed records of OHT and VAD recipients who underwent cardiac surgery at our hospital and developed Mycobacterium abscessus complex (MABC) infection from 2013 to 2016 during a hospital outbreak of MABC linked to heater-cooler units. We analyzed patient characteristics, medical and surgical management, and long-term outcomes. Ten OHT patients and 7 patients with VAD developed extrapulmonary M. abscessus subspecies abscessus infection. The median time from presumed inoculation during cardiac surgery to the first positive culture was 106 days in OHT and 29 days in VAD recipients. The most common sites of positive cultures were blood (n = 12), sternum/mediastinum (n = 8), and the VAD driveline exit site (n = 7). The 14 patients diagnosed when alive received combination antimicrobial therapy for a median of 21 weeks, developed 28 antibiotic-related adverse events, and underwent 27 surgeries. Only 8 (47%) patients survived longer than 12 weeks after diagnosis, including 2 patients with VAD who experienced long-term survival after an explantation of infected VADs and OHT. Despite aggressive medical and surgical management, OHT and VAD patients with MABC infection experienced substantial morbidity and mortality.

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Published In

Am J Transplant

DOI

EISSN

1600-6143

Publication Date

July 2023

Volume

23

Issue

7

Start / End Page

1048 / 1057

Location

United States

Related Subject Headings

  • Surgery
  • Retrospective Studies
  • Mycobacterium abscessus
  • Mycobacterium Infections, Nontuberculous
  • Humans
  • Heart-Assist Devices
  • Heart Transplantation
  • 3204 Immunology
  • 3202 Clinical sciences
  • 11 Medical and Health Sciences
 

Citation

APA
Chicago
ICMJE
MLA
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Friedland, A. E., Maziarz, E. K., Wolfe, C. R., Patel, C. B., Patel, P., Milano, C. A., … Baker, A. W. (2023). Epidemiology, management, and clinical outcomes of extrapulmonary Mycobacterium abscessus complex infections in heart transplant and ventricular assist device recipients. Am J Transplant, 23(7), 1048–1057. https://doi.org/10.1016/j.ajt.2023.04.009
Friedland, Anne E., Eileen K. Maziarz, Cameron R. Wolfe, Chetan B. Patel, Priyesh Patel, Carmelo A. Milano, Jacob N. Schroder, et al. “Epidemiology, management, and clinical outcomes of extrapulmonary Mycobacterium abscessus complex infections in heart transplant and ventricular assist device recipients.Am J Transplant 23, no. 7 (July 2023): 1048–57. https://doi.org/10.1016/j.ajt.2023.04.009.
Friedland AE, Maziarz EK, Wolfe CR, Patel CB, Patel P, Milano CA, et al. Epidemiology, management, and clinical outcomes of extrapulmonary Mycobacterium abscessus complex infections in heart transplant and ventricular assist device recipients. Am J Transplant. 2023 Jul;23(7):1048–57.
Friedland, Anne E., et al. “Epidemiology, management, and clinical outcomes of extrapulmonary Mycobacterium abscessus complex infections in heart transplant and ventricular assist device recipients.Am J Transplant, vol. 23, no. 7, July 2023, pp. 1048–57. Pubmed, doi:10.1016/j.ajt.2023.04.009.
Friedland AE, Maziarz EK, Wolfe CR, Patel CB, Patel P, Milano CA, Schroder JN, Daneshmand MA, Wallace RJ, Alexander BD, Baker AW. Epidemiology, management, and clinical outcomes of extrapulmonary Mycobacterium abscessus complex infections in heart transplant and ventricular assist device recipients. Am J Transplant. 2023 Jul;23(7):1048–1057.
Journal cover image

Published In

Am J Transplant

DOI

EISSN

1600-6143

Publication Date

July 2023

Volume

23

Issue

7

Start / End Page

1048 / 1057

Location

United States

Related Subject Headings

  • Surgery
  • Retrospective Studies
  • Mycobacterium abscessus
  • Mycobacterium Infections, Nontuberculous
  • Humans
  • Heart-Assist Devices
  • Heart Transplantation
  • 3204 Immunology
  • 3202 Clinical sciences
  • 11 Medical and Health Sciences