Volume 23, Number 5—May 2017
Research
Invasive Nontuberculous Mycobacterial Infections among Cardiothoracic Surgical Patients Exposed to Heater–Cooler Devices1
, Cheri Grigg, Cara Bicking Kinsey, M. Shannon Keckler, Heather Moulton-Meissner, Emily Cooper, Minn M. Soe, Judith Noble-Wang, Allison Longenberger, Shane R. Walker, Jeffrey R. Miller, Joseph F. Perz, and Kiran M. Perkins
Table 3
Surgical exposures of case-patients with invasive extrapulmonary NTM infections and control-patients among patients who underwent cardiothoracic surgery, York, Pennsylvania, USA, 2015*
| Exposures | Case-patients, n = 11 | Control-patients, n = 48 | Odds ratio (95% CI) | p value† |
|---|---|---|---|---|
| No. surgeries per patient | ||||
| All surgeries, median (IQR) | 1 (1–4) | 2 (1–3) | 0.90 | |
| Cardiothoracic surgeries, median (IQR) |
1 (1–3) |
1 (1–2) |
0.86 |
|
| Type of procedure‡ | ||||
| Major cardiothoracic procedure | 11 (100) | 31 (65) | 12.8 (1.5–>999.9) | 0.09 |
| Major cardiac procedure | 9 (82) | 21 (44) | 4.9 (1.2–27.5) | 0.04 |
| Coronary artery bypass grafting surgery | 6 (55) | 17 (35) | 2.1 (0.6–7.9) | 0.25 |
| Cardiac valve surgery | 4 (436) | 8 (67) | 2.9 (0.7–11.4) | 0.15 |
| Aortic surgery | 5 (45) | 0 (0) | 82.1 (7.9–>999.9) | 0.008 |
| Pericardial window | 0 (0) | 2 (4) | 0.8 (0.01–10.9) | 0.91 |
| Major thoracic procedure |
2 (18) |
11 (23) |
0.9 (0.1–3.6) |
0.85 |
| Perioperative exposures§ | ||||
| Central line¶ | 10 (91) | 27 (56) | 5.5 (1.1–53.5) | 0.07 |
| Chest tube | 10 (91) | 31 (65) | 3.9 (0.8–38.2) | 0.15 |
| Shower during hospitalization | 7 (64) | 20 (42) | 2.3 (0.7–9.2) | 0.21 |
| Artificial valve or graft | 8 (73) | 9 (19) | 10.1 (2.6–48.1) | 0.002 |
| Topical medication | 10 (91) | 37 (77) | 2.1 (0.4–21.4) | 0.43 |
| Topical antibiotic | 10 (91) | 31 (65) | 3.9 (0.8–38.2) | 0.15 |
| Topical anticoagulant | 5 (45) | 15 (31) | 1.8 (0.5–6.7) | 0.37 |
| Use of cardiopulmonary bypass with HCD exposure |
9 (82) |
20 (42) |
5.3 (1.3–29.9) |
0.03 |
| Length of HCD-related exposures# | ||||
| Surgical time with HCD, min, median (IQR) | 328 (164–360) | 0 (0–222) | 0.003 | |
| Time on bypass, min, median (IQR) | 147 (46–175) | 0 (0–74) | 0.002 |
*Any surgery that occurred 30 d to 3.5 y before first NTM-positive specimen for cases or index date for controls. Values are no. (%) patients except as indicated. NTM, nontuberculous mycobacteria.
†Fisher exact test for categorical variables or Wilcoxon 2-sample test for continuous variables.
‡Major cardiac surgery: coronary artery bypass grafting, valve replacement, aortic graft, pericardial window; major thoracic surgery: lung removal, thoracotomy, esophagectomy.
§Exposure was considered present if any of the surgeries (>1) had the exposure.
¶Present at any time during hospital stay. Did not include chronic indwelling lines, such as PICC lines or dialysis catheters.
#If a patient had multiple cardiothoracic surgeries, the time for the longest operative time was included.
1Preliminary results from this study were presented at the Epidemic Intelligence Service conference, May 2–5, 2016, Atlanta, Georgia, USA; and the American Society for Microbiology Microbe conference, June 16–20, 2016, Boston, Massachusetts, USA.