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Ann Thorac Surg 1988;46:703-710
© 1988 The Society of Thoracic Surgeons

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Articles

Rapidly Growing Nontuberculous Mycobacteria: A New Enemy of the Cardiac Surgeon

Carolinas Heart Institute and the Heineman Medical Research Laboratory at Charlotte Memorial Hospital and Medical Center, Charlotte, NC, and the Section of Hematology/Oncology, The University of Chicago, The Pritzker School of Medicine, Chicago, IL

^* Address reprint requests to Dr. Robicsek, Heineman Medical Research Center, PO Box 35457, Charlotte, NC 28235

A review of atypical mycobacterial infections complicating cardiac operations is presented. Proven sources of infections at different institutions include contaminated porcine valves and municipal water supply, but the mode of transmission in the great majority of patients remains unclear. There are two principal clinical forms of atypical mycobacterial infections after cardiac operations—endocarditis and sternal osteomyelitis. The latter has characteristics resembling tuberculotic "cold abscess." Specialized laboratory testing is necessary to confirm the diagnosis, and surgeons may have to take the initiative to request special microbiological investigation in cases where infection is clinically suspected but routine cultures are reported as "negative." The prognosis for patients who have any atypical mycobacterial infection after a heart operation is severe. Those infected with the strain chelonei and those whose cardiac chambers were entered during operation fare worse. This dim clinical prognosis may be improved by appropriate and aggressive antibiotic and surgical therapy. Awareness of the urgency of special bacteriological studies is the key to successful management.

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