870. <i>Mycobacterium chimaera</i> Outbreak: Infection Control and Clinical Experiences in Edmonton, Alberta
Bibliographic record
Abstract
Abstract Background Mycobacterium chimaera is responsible for a global outbreak due to contaminated heater-cooler units (HCUs) used in cardiothoracic surgery and has been associated with high mortality. Optimal treatment is not known. The objectives of this study were to describe the Infection Control strategies utilized by the University of Alberta hospital and Mazankowski Heart Institute (MAZ) prior to availability of new HCUs, and outline the clinical course of locally acquired M. chimaera infection. Methods We reviewed interventions undertaken to mitigate the risk of M. chimaera infection. Any MAZ patient with M. chimaera isolated at an anatomic site with a history of cardiothoracic surgery from 2012-present were identified. Charts were reviewed for patient and infection characteristics. Results All manufacturer’s instructions for HCU cleaning-disinfection were followed. The MAZ was compliant with CDC recommendations for directing HCU ventilation exhaust away from the surgical field and to the use of filtered water. M. chimaera was isolated in 3/8 local HCUs. After decontamination procedure, 1 HCU grew M. chimaera but cleared after a second attempt. Smoke studies demonstrated aerosolization of HCU exhaust in October 2016 therefore the laminar air curtains were manipulated for increased flow in October and November 2016. By June 2017, HCUs were retro-fitted and in late 2017 all pre-2014 Sorin HCUs were replaced. 10 patients have been diagnosed with M. chimaera infection post-cardiothoracic surgery performed at the MAZ. None occurred after manipulation of the laminar air curtain. Mean patient age at time of cardiothoracic surgery was 62.3 years and 6 were male. All had implantation of prosthetic material. The most common culture-positive sites were blood in 9/10, urine in 5/10 and prosthetic material or surgical site in 3/10. 6/10 have died due to infection and mean life expectancy of those deceased from first positive culture is 123 days. An additional survivor has been transitioned to comfort care and lost to follow-up. Conclusion M. chimaera post cardiothoracic surgery has been challenging from an infection control perspective but the risk appears to have been mitigated through manipulation of the laminar air curtain. Locally, M. chimaera has been associated with significant (60%) mortality. Disclosures All Authors: No reported disclosures
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.001 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".