The effect of sodium thiosulfate on the recovery of Mycobacterium chimaera from heater–cooler unit water samples

• Published in: The Journal of hospital infection 2020-06, Vol.105 (2), p.252-257
• Main Authors: Mak, E.E.H., Sng, L.H., Lee, B.W.M., Peh, J.W.L., Colman, R.E., Seifert, M.
• Format: Article
• Language: English
• Subjects: Cardiac Surgical Procedures - adverse effects; Colony Count, Microbial; Disease Outbreaks - prevention & control; Equipment Contamination; Heater–cooler unit; Heating - instrumentation; Humans; Mycobacterium - drug effects; Mycobacterium - isolation & purification; Mycobacterium chimaera; Mycobacterium Infections - prevention & control; Sampling; Selection Bias; Sodium thiosulfate; Thiosulfates - pharmacology; Water; Water Microbiology; Water Supply
• ISSN: 0195-6701; 1532-2939
• DOI: 10.1016/j.jhin.2020.02.015

Heater–cooler units (HCUs) have been implicated in the recent global outbreak of invasive Mycobacterium chimaera infection among patients following cardiothoracic surgery. Because infected patients tend to remain asymptomatic for extended periods, detection of M. chimaera from HCUs in real time is essential to halting the ongoing M. chimaera HCU-associated outbreak. Sample collection protocols to evaluate the presence of M. chimaera offer conflicting recommendations regarding the addition of sodium thiosulfate (NaT) during the collection process. To study the effect of NaT on M. chimaera recovery and culture contamination. Seventy-six paired HCU water samples (with and without NaT) were collected, processed and cultured simultaneously into Lowenstein–Jensen slants, Middlebrook 7H10 agar plates, and mycobacterial growth indicator tubes (MGITs), and incubated at 37°C. A subset of 31 paired samples was additionally cultured on MGITs and incubated at 30°C. Of 76 samples incubated at 37°C in each of the three media, with and without NaT, M. chimaera was identified in at least one aliquot of 21 samples. The presence of NaT did not significantly increase the probability of recovering M. chimaera in a multi-variable conditional logistic model and culture contamination rates were similar between aliquots with and without NaT. In the subset of samples cultured on MGITs at both 30°C and 37°C, the presence of NaT again was not associated with M. chimaera recovery, but was significantly associated with reduced culture contamination.