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Global Mycobacterium chimaera Outbreak in Cardiac Surgery
Hugo Sax and Barbara Hasse, University of Zurich Hospital
Sponsored by the World Health OrganizaBon
A Webber Training Teleclass
Hosted by Julie Storr, World Health OrganizaBon
www.webbertraining.com
1
Hugo Sax, MD Barbara Hasse, MD
Division of Infectious Diseases and Hospital Epidemiology University Hospital of Zurich
University of Zurich Zurich, Switzerland
Global Mycobacterium chimaera outbreak in cardiac surgery
Hosted by Julie Storr World Health Organization, Geneva
Thanks'to'Teleclass'Educa0on'
Patron Sponsors
www.who.int/gpsc/en.www.sealedair.com. www.virox.com.
Sponsored by
www.webbertraining.com March 16, 2016
hugo.sax@usz.ch HumanLabZ.org
Global Mycobacterium chimaera Outbreak in Cardiac Surgery
Hugo Sax and Barbara Hasse, University of Zurich Hospital
Sponsored by the World Health OrganizaBon
A Webber Training Teleclass
Hosted by Julie Storr, World Health OrganizaBon
www.webbertraining.com
2
hugo.sax@usz.ch HumanLabZ.org
hugo.sax@usz.ch HumanLabZ.org
Global Mycobacterium chimaera Outbreak in Cardiac Surgery
Hugo Sax and Barbara Hasse, University of Zurich Hospital
Sponsored by the World Health OrganizaBon
A Webber Training Teleclass
Hosted by Julie Storr, World Health OrganizaBon
www.webbertraining.com
3
hugo.sax@usz.ch HumanLabZ.org
hugo.sax@usz.ch HumanLabZ.org
Global Mycobacterium chimaera Outbreak in Cardiac Surgery
Hugo Sax and Barbara Hasse, University of Zurich Hospital
Sponsored by the World Health OrganizaBon
A Webber Training Teleclass
Hosted by Julie Storr, World Health OrganizaBon
www.webbertraining.com
4
hugo.sax@usz.ch HumanLabZ.org Achermann Y, et al. J Clin Microbiol. 2013 Jun;51(6):1769–73.
hugo.sax@usz.ch HumanLabZ.org
Global Mycobacterium chimaera Outbreak in Cardiac Surgery
Hugo Sax and Barbara Hasse, University of Zurich Hospital
Sponsored by the World Health OrganizaBon
A Webber Training Teleclass
Hosted by Julie Storr, World Health OrganizaBon
www.webbertraining.com
5
hugo.sax@usz.ch HumanLabZ.org
hugo.sax@usz.ch HumanLabZ.org
Global Mycobacterium chimaera Outbreak in Cardiac Surgery
Hugo Sax and Barbara Hasse, University of Zurich Hospital
Sponsored by the World Health OrganizaBon
A Webber Training Teleclass
Hosted by Julie Storr, World Health OrganizaBon
www.webbertraining.com
6
hugo.sax@usz.ch HumanLabZ.org
hugo.sax@usz.ch HumanLabZ.org
Global Mycobacterium chimaera Outbreak in Cardiac Surgery
Hugo Sax and Barbara Hasse, University of Zurich Hospital
Sponsored by the World Health OrganizaBon
A Webber Training Teleclass
Hosted by Julie Storr, World Health OrganizaBon
www.webbertraining.com
7
hugo.sax@usz.ch HumanLabZ.org
hugo.sax@usz.ch HumanLabZ.org
Global Mycobacterium chimaera Outbreak in Cardiac Surgery
Hugo Sax and Barbara Hasse, University of Zurich Hospital
Sponsored by the World Health OrganizaBon
A Webber Training Teleclass
Hosted by Julie Storr, World Health OrganizaBon
www.webbertraining.com
8
hugo.sax@usz.ch HumanLabZ.org
hugo.sax@usz.ch HumanLabZ.org
Global Mycobacterium chimaera Outbreak in Cardiac Surgery
Hugo Sax and Barbara Hasse, University of Zurich Hospital
Sponsored by the World Health OrganizaBon
A Webber Training Teleclass
Hosted by Julie Storr, World Health OrganizaBon
www.webbertraining.com
9
hugo.sax@usz.ch HumanLabZ.org
hugo.sax@usz.ch HumanLabZ.org
Global Mycobacterium chimaera Outbreak in Cardiac Surgery
Hugo Sax and Barbara Hasse, University of Zurich Hospital
Sponsored by the World Health OrganizaBon
A Webber Training Teleclass
Hosted by Julie Storr, World Health OrganizaBon
www.webbertraining.com
10
hugo.sax@usz.ch HumanLabZ.org
hugo.sax@usz.ch HumanLabZ.org
Global Mycobacterium chimaera Outbreak in Cardiac Surgery
Hugo Sax and Barbara Hasse, University of Zurich Hospital
Sponsored by the World Health OrganizaBon
A Webber Training Teleclass
Hosted by Julie Storr, World Health OrganizaBon
www.webbertraining.com
11
hugo.sax@usz.ch HumanLabZ.org
hugo.sax@usz.ch HumanLabZ.org
Global Mycobacterium chimaera Outbreak in Cardiac Surgery
Hugo Sax and Barbara Hasse, University of Zurich Hospital
Sponsored by the World Health OrganizaBon
A Webber Training Teleclass
Hosted by Julie Storr, World Health OrganizaBon
www.webbertraining.com
12
hugo.sax@usz.ch HumanLabZ.org
hugo.sax@usz.ch HumanLabZ.org
Global Mycobacterium chimaera Outbreak in Cardiac Surgery
Hugo Sax and Barbara Hasse, University of Zurich Hospital
Sponsored by the World Health OrganizaBon
A Webber Training Teleclass
Hosted by Julie Storr, World Health OrganizaBon
www.webbertraining.com
13
hugo.sax@usz.ch HumanLabZ.org
hugo.sax@usz.ch HumanLabZ.org
Global Mycobacterium chimaera Outbreak in Cardiac Surgery
Hugo Sax and Barbara Hasse, University of Zurich Hospital
Sponsored by the World Health OrganizaBon
A Webber Training Teleclass
Hosted by Julie Storr, World Health OrganizaBon
www.webbertraining.com
14
hugo.sax@usz.ch HumanLabZ.org
hugo.sax@usz.ch HumanLabZ.org
Global Mycobacterium chimaera Outbreak in Cardiac Surgery
Hugo Sax and Barbara Hasse, University of Zurich Hospital
Sponsored by the World Health OrganizaBon
A Webber Training Teleclass
Hosted by Julie Storr, World Health OrganizaBon
www.webbertraining.com
15
hugo.sax@usz.ch HumanLabZ.org
hugo.sax@usz.ch HumanLabZ.org
Global Mycobacterium chimaera Outbreak in Cardiac Surgery
Hugo Sax and Barbara Hasse, University of Zurich Hospital
Sponsored by the World Health OrganizaBon
A Webber Training Teleclass
Hosted by Julie Storr, World Health OrganizaBon
www.webbertraining.com
16
hugo.sax@usz.ch HumanLabZ.org
hugo.sax@usz.ch HumanLabZ.org
Global Mycobacterium chimaera Outbreak in Cardiac Surgery
Hugo Sax and Barbara Hasse, University of Zurich Hospital
Sponsored by the World Health OrganizaBon
A Webber Training Teleclass
Hosted by Julie Storr, World Health OrganizaBon
www.webbertraining.com
17
hugo.sax@usz.ch HumanLabZ.org
hugo.sax@usz.ch HumanLabZ.org
Global Mycobacterium chimaera Outbreak in Cardiac Surgery
Hugo Sax and Barbara Hasse, University of Zurich Hospital
Sponsored by the World Health OrganizaBon
A Webber Training Teleclass
Hosted by Julie Storr, World Health OrganizaBon
www.webbertraining.com
18
hugo.sax@usz.ch HumanLabZ.org
hugo.sax@usz.ch HumanLabZ.org
Global Mycobacterium chimaera Outbreak in Cardiac Surgery
Hugo Sax and Barbara Hasse, University of Zurich Hospital
Sponsored by the World Health OrganizaBon
A Webber Training Teleclass
Hosted by Julie Storr, World Health OrganizaBon
www.webbertraining.com
19
hugo.sax@usz.ch HumanLabZ.org
hugo.sax@usz.ch HumanLabZ.org
Global Mycobacterium chimaera Outbreak in Cardiac Surgery
Hugo Sax and Barbara Hasse, University of Zurich Hospital
Sponsored by the World Health OrganizaBon
A Webber Training Teleclass
Hosted by Julie Storr, World Health OrganizaBon
www.webbertraining.com
20
hugo.sax@usz.ch HumanLabZ.org
hugo.sax@usz.ch HumanLabZ.org
Switzerland 7 patients Netherlands 4 patients Germany 5 patients UK 20 patients Spain 1 patients US 11 patients France 2 patients Irland 2 patients
And counting…
40
To our best knowledge
Global Mycobacterium chimaera Outbreak in Cardiac Surgery
Hugo Sax and Barbara Hasse, University of Zurich Hospital
Sponsored by the World Health OrganizaBon
A Webber Training Teleclass
Hosted by Julie Storr, World Health OrganizaBon
www.webbertraining.com
21
hugo.sax@usz.ch HumanLabZ.org
Now the work starts for clinicians…
41
hugo.sax@usz.ch HumanLabZ.org
Global Mycobacterium chimaera Outbreak in Cardiac Surgery
Hugo Sax and Barbara Hasse, University of Zurich Hospital
Sponsored by the World Health OrganizaBon
A Webber Training Teleclass
Hosted by Julie Storr, World Health OrganizaBon
www.webbertraining.com
22
hugo.sax@usz.ch HumanLabZ.org
hugo.sax@usz.ch HumanLabZ.org
Global Mycobacterium chimaera Outbreak in Cardiac Surgery
Hugo Sax and Barbara Hasse, University of Zurich Hospital
Sponsored by the World Health OrganizaBon
A Webber Training Teleclass
Hosted by Julie Storr, World Health OrganizaBon
www.webbertraining.com
23
hugo.sax@usz.ch HumanLabZ.org
hugo.sax@usz.ch HumanLabZ.org
Global Mycobacterium chimaera Outbreak in Cardiac Surgery
Hugo Sax and Barbara Hasse, University of Zurich Hospital
Sponsored by the World Health OrganizaBon
A Webber Training Teleclass
Hosted by Julie Storr, World Health OrganizaBon
www.webbertraining.com
24
hugo.sax@usz.ch HumanLabZ.org
Treatment
Multidisciplinary approach!
• Infectious disease specialist • Microbiologist • Cardiovascular surgeon • Cardiologist • Cardiac anesthesia • Nucelar imaging specialists • Opthalmologist
47
hugo.sax@usz.ch HumanLabZ.org
Global Mycobacterium chimaera Outbreak in Cardiac Surgery
Hugo Sax and Barbara Hasse, University of Zurich Hospital
Sponsored by the World Health OrganizaBon
A Webber Training Teleclass
Hosted by Julie Storr, World Health OrganizaBon
www.webbertraining.com
25
hugo.sax@usz.ch HumanLabZ.org
hugo.sax@usz.ch HumanLabZ.org
Global Mycobacterium chimaera Outbreak in Cardiac Surgery
Hugo Sax and Barbara Hasse, University of Zurich Hospital
Sponsored by the World Health OrganizaBon
A Webber Training Teleclass
Hosted by Julie Storr, World Health OrganizaBon
www.webbertraining.com
26
hugo.sax@usz.ch HumanLabZ.org
hugo.sax@usz.ch HumanLabZ.org
Prevention
52
Global Mycobacterium chimaera Outbreak in Cardiac Surgery
Hugo Sax and Barbara Hasse, University of Zurich Hospital
Sponsored by the World Health OrganizaBon
A Webber Training Teleclass
Hosted by Julie Storr, World Health OrganizaBon
www.webbertraining.com
27
hugo.sax@usz.ch HumanLabZ.org
hugo.sax@usz.ch HumanLabZ.org
Global Mycobacterium chimaera Outbreak in Cardiac Surgery
Hugo Sax and Barbara Hasse, University of Zurich Hospital
Sponsored by the World Health OrganizaBon
A Webber Training Teleclass
Hosted by Julie Storr, World Health OrganizaBon
www.webbertraining.com
28
hugo.sax@usz.ch HumanLabZ.org
hugo.sax@usz.ch HumanLabZ.org
Global Mycobacterium chimaera Outbreak in Cardiac Surgery
Hugo Sax and Barbara Hasse, University of Zurich Hospital
Sponsored by the World Health OrganizaBon
A Webber Training Teleclass
Hosted by Julie Storr, World Health OrganizaBon
www.webbertraining.com
29
hugo.sax@usz.ch HumanLabZ.org
Early diagnosis Screening
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hugo.sax@usz.ch HumanLabZ.org
Screening tools
Look for it !
Physical examination Medical history Heparin blood cultures, Perform mycobacterial cultures or Mycobacterial specific PCR in case of biopsy Histopathological work up (presence of granulomas)
Scrutinze Sarcodosis, vasculitis or unknown systemic diseases
58
Global Mycobacterium chimaera Outbreak in Cardiac Surgery
Hugo Sax and Barbara Hasse, University of Zurich Hospital
Sponsored by the World Health OrganizaBon
A Webber Training Teleclass
Hosted by Julie Storr, World Health OrganizaBon
www.webbertraining.com
30
hugo.sax@usz.ch HumanLabZ.org
Look carefully at fever of unknow origin or vasculitis with former cardiopulmonary bypass surgery
63 year-old lady 2008 History of aortic valve replacement Fatigue, fevers, and weight loss. 2011 Unknown vasculitis with 4/10 blood cultures positive for MAC
Retrospective review of echocardiography: Endocarditis with strains
59
hugo.sax@usz.ch HumanLabZ.org
Global Mycobacterium chimaera Outbreak in Cardiac Surgery
Hugo Sax and Barbara Hasse, University of Zurich Hospital
Sponsored by the World Health OrganizaBon
A Webber Training Teleclass
Hosted by Julie Storr, World Health OrganizaBon
www.webbertraining.com
31
hugo.sax@usz.ch HumanLabZ.org
Missed diagnosis….
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hugo.sax@usz.ch HumanLabZ.org
Look back for MAC/ M. avium cases Look back for culture-negative PVE, aortic graft infection
Investigation of Mycobacterium chimaera infection associated with cardiopulmonary bypass. Public Health England. https://www.gov.uk/government/ publications/health-protection-report-volume-9-2015/hpr-volume-9-issue-15-news-30-april (19 May 2015, update 29. December 2015
Look back at University Hospital Zurich yielded no cases Look back Switzerland: ongoing
Look back yielded around 20 cases of presumptive cardiac infections with MAC with fatal outcome
62
Global Mycobacterium chimaera Outbreak in Cardiac Surgery
Hugo Sax and Barbara Hasse, University of Zurich Hospital
Sponsored by the World Health OrganizaBon
A Webber Training Teleclass
Hosted by Julie Storr, World Health OrganizaBon
www.webbertraining.com
32
hugo.sax@usz.ch HumanLabZ.org
The story is still ongoing…
63
hugo.sax@usz.ch HumanLabZ.org
Conclusions
When a system can fail, it will fail (Murphy) A note on common sense Medical devices are not grounded such as airplanes Outbreak investigation on an international level is slow We don’t know yet how big this is
64
Global Mycobacterium chimaera Outbreak in Cardiac Surgery
Hugo Sax and Barbara Hasse, University of Zurich Hospital
Sponsored by the World Health OrganizaBon
A Webber Training Teleclass
Hosted by Julie Storr, World Health OrganizaBon
www.webbertraining.com
33
hugo.sax@usz.ch HumanLabZ.org
Take-home message:
Look for it!
65
hugo.sax@usz.ch HumanLabZ.org
Yvonne Achermann Cornelia Bayard Guido Bloemberg Erik C Böttger Leo Eberl Carlotta Fabbri Volkmar Falk Barbara Hasse Philipp Kohler Francesco Maisano Christian Rüegg Peter Schreiber Rami Sommerstein Rainer Weber
Swiss Chimaera Collaborative
Meera Chand, UK Thomas Kohl, D Katharina Krantzer, D Stefan Niemann, D Jakko van Ingen, NL Dirk Wagener, D Diamantis Plachouras, ECDC
Zürich Collaboration
European Collaboration
Daniele Genoni Matthias Schlegel Andreas Widmer Many infection control supervisors
66
Global Mycobacterium chimaera Outbreak in Cardiac Surgery
Hugo Sax and Barbara Hasse, University of Zurich Hospital
Sponsored by the World Health OrganizaBon
A Webber Training Teleclass
Hosted by Julie Storr, World Health OrganizaBon
www.webbertraining.com
34
hugo.sax@usz.ch HumanLabZ.org 67
Objectives: - Outline the background and rationale - Summarise the two-pronged approach - Explore how the core components will contribute to the global knowledge - Describe next steps and highlight how this work will strengthen approaches to IPC improvement and implementation across all countries
hugo.sax@usz.ch HumanLabZ.org 68
Thanks'to'Teleclass'Educa0on'
Patron Sponsors
www.who.int/gpsc/en.www.sealedair.com. www.virox.com.
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