{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,13]],"date-time":"2026-02-13T09:33:58Z","timestamp":1770975238233,"version":"3.50.1"},"reference-count":35,"publisher":"MDPI AG","issue":"10","license":[{"start":{"date-parts":[[2025,9,24]],"date-time":"2025-09-24T00:00:00Z","timestamp":1758672000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"EU funding within the MUR PNRR Extended Partnership initiative on Emerging Infectious Diseases Project","award":["PE00000007, INF-ACT."],"award-info":[{"award-number":["PE00000007, INF-ACT."]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Pathogens"],"abstract":"<jats:p>Invasive cases of Mycobacterium chimaera have been found in Europe, and beyond, and have been associated with the use of heater\u2013cooler units necessary to regulate the temperature of blood in extracorporeal circulation during cardiac surgery, mostly due to contamination of patients by aerosol coming from the water in the tanks of the devices. An outbreak of five cases of M. chimaera infection associated with heater\u2013cooler units Stockert 3T (LivaNova) was also identified in the Piedmont region (Italy). M. chimaera strains isolated from 10 Stockert 3T heater\u2013cooler units used in 3 regional cardiac surgery operating rooms were subjected to whole-genome sequencing. The results were analysed according to van Ingen\u2019s criteria. M. chimaera was isolated from 59% of heater\u2013cooler units Stockert 3T (LivaNova) monitored. By whole-genome sequencing analysis performed on M. chimaera strains obtained from 10 heater\u2013cooler units, four strains were classified as subgroup 1.1 or 1.8, which are the two subgroups associated with the HCU-related outbreak worldwide. Our data and their comparisons with global heater\u2013cooler unit isolates provide further evidence of the hypothesis that contamination occurs at the production site of LivaNova following exposure to M. chimaera-contaminated factory plumbing systems.<\/jats:p>","DOI":"10.3390\/pathogens14100964","type":"journal-article","created":{"date-parts":[[2025,9,24]],"date-time":"2025-09-24T09:43:12Z","timestamp":1758706992000},"page":"964","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["The Global Outbreak of M. chimaera Infection Following Cardiac Surgery: Another Piece of the Puzzle"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1590-9009","authenticated-orcid":false,"given":"Savina","family":"Ditommaso","sequence":"first","affiliation":[{"name":"Department of Public Health and Paediatrics, University of Turin, 10124 Torino, TO, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7211-079X","authenticated-orcid":false,"given":"Gabriele","family":"Memoli","sequence":"additional","affiliation":[{"name":"Department of Public Health and Paediatrics, University of Turin, 10124 Torino, TO, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Francesca","family":"Anselmi","sequence":"additional","affiliation":[{"name":"Department of Life Sciences and Systems Biology, University of Turin, 10124 Torino, TO, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ivan","family":"Molineris","sequence":"additional","affiliation":[{"name":"Department of Life Sciences and Systems Biology, University of Turin, 10124 Torino, TO, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Carla Maria","family":"Zotti","sequence":"additional","affiliation":[{"name":"Department of Public Health and Paediatrics, University of Turin, 10124 Torino, TO, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9722-6334","authenticated-orcid":false,"given":"Monica","family":"Giacomuzzi","sequence":"additional","affiliation":[{"name":"Department of Public Health and Paediatrics, University of Turin, 10124 Torino, TO, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,9,24]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"35","DOI":"10.1016\/j.ccm.2014.10.003","article-title":"Environmental Sources of Nontuberculous Mycobacteria","volume":"36","author":"Falkinham","year":"2015","journal-title":"Clin. Chest Med."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"749","DOI":"10.1289\/ehp.1408692","article-title":"Epidemiology and Ecology of Opportunistic Premise Plumbing Pathogens: Legionella Pneumophila, Mycobacterium Avium, and Pseudomonas Aeruginosa","volume":"123","author":"Falkinham","year":"2015","journal-title":"Environ. Health Perspect."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"e01180-19","DOI":"10.1128\/AEM.01180-19","article-title":"A Global Survey of Mycobacterial Diversity in Soil","volume":"85","author":"Walsh","year":"2019","journal-title":"Appl. Environ. Microbiol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"e01614-18","DOI":"10.1128\/mBio.01614-18","article-title":"Ecological Analyses of Mycobacteria in Showerhead Biofilms and Their Relevance to Human Health","volume":"9","author":"Gebert","year":"2018","journal-title":"mBio"},{"key":"ref_5","unstructured":"(2025, September 01). CDC Clinical Overview of Nontuberculous Mycobacteria (NTM), Available online: https:\/\/www.cdc.gov\/nontuberculous-mycobacteria\/hcp\/clinical-overview\/index.html."},{"key":"ref_6","unstructured":"U.S. Environmental Protection Agency (2025, September 01). Legionella in the Indoor Environment, Available online: https:\/\/www.epa.gov\/indoor-air-quality-iaq\/legionella-indoor-environment."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"611","DOI":"10.1016\/j.ijheh.2016.12.002","article-title":"A Systematic Review of Waterborne Infections from Nontuberculous Mycobacteria in Health Care Facility Water Systems","volume":"220","author":"Li","year":"2017","journal-title":"Int. J. Environ. Health"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"66","DOI":"10.1016\/j.coi.2018.06.001","article-title":"Acquired and Genetic Host Susceptibility Factors and Microbial Pathogenic Factors That Predispose to Nontuberculous Mycobacterial Infections","volume":"54","author":"Honda","year":"2018","journal-title":"Curr. Opin. Immunol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1769","DOI":"10.1128\/JCM.00435-13","article-title":"Prosthetic Valve Endocarditis and Bloodstream Infection Due to Mycobacterium Chimaera","volume":"51","author":"Achermann","year":"2013","journal-title":"J. Clin. Microbiol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"67","DOI":"10.1093\/cid\/civ198","article-title":"Prolonged Outbreak of Mycobacterium chimaera Infection After Open-Chest Heart Surgery","volume":"61","author":"Sax","year":"2015","journal-title":"Clin. Infect. Dis."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1","DOI":"10.2807\/1560-7917.ES.2016.21.17.30215","article-title":"Contamination during Production of Heater-Cooler Units by Mycobacterium chimaera Potential Cause for Invasive Cardiovascular Infections: Results of an Outbreak Investigation in Germany, April 2015 to February 2016","volume":"21","author":"Haller","year":"2016","journal-title":"Euro Surveill."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1008","DOI":"10.3201\/eid2206.160045","article-title":"Transmission of Mycobacterium chimaera from Heater-Cooler Units during Cardiac Surgery despite an Ultraclean Air Ventilation System","volume":"22","author":"Sommerstein","year":"2016","journal-title":"Emerg. Infect. Dis."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"335","DOI":"10.1093\/cid\/ciw754","article-title":"Insidious Risk of Severe Mycobacterium chimaera Infection in Cardiac Surgery Patients","volume":"64","author":"Chand","year":"2017","journal-title":"Clin. Infect. Dis"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1117","DOI":"10.15585\/mmwr.mm6540a6","article-title":"Mycobacterium chimaera Contamination of Heater-Cooler Devices Used in Cardiac Surgery\u2014United States","volume":"65","author":"Perkins","year":"2016","journal-title":"MMWR Morb. Mortal. Wkly. Rep."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1333","DOI":"10.1017\/ice.2021.396","article-title":"Mycobacterium chimaera Infections among Cardiothoracic Surgery Patients Associated with Heater-Cooler Devices-Kansas and California, 2019","volume":"43","author":"Xu","year":"2021","journal-title":"Infect. Control Hosp. Epidemiol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"2745","DOI":"10.1093\/eurheartj\/ehv342","article-title":"Healthcare-Associated Prosthetic Heart Valve, Aortic Vascular Graft, and Disseminated Mycobacterium chimaera Infections Subsequent to Open Heart Surgery","volume":"36","author":"Kohler","year":"2015","journal-title":"Eur. Heart J."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"257","DOI":"10.1007\/s11908-010-0108-1","article-title":"Mycobacterial Prosthetic Valve Endocarditis","volume":"12","author":"Bush","year":"2010","journal-title":"Curr. Infect. Dis. Rep."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"214","DOI":"10.1016\/j.jhin.2019.10.009","article-title":"International Society of Cardiovascular Infectious Diseases Guidelines for the Diagnosis, Treatment and Prevention of Disseminated Mycobacterium chimaera Infection Following Cardiac Surgery with Cardiopulmonary Bypass","volume":"104","author":"Hasse","year":"2020","journal-title":"J. Hosp. Infect."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1033","DOI":"10.1016\/S1473-3099(17)30324-9","article-title":"Global Outbreak of Severe Mycobacterium chimaera Disease after Cardiac Surgery: A Molecular Epidemiological Study","volume":"17","author":"Kohl","year":"2017","journal-title":"Lancet Infect. Dis."},{"key":"ref_20","unstructured":"ECDC (2015). EU Protocol for Case Detection, Laboratory Diagnosis and Environmental Testing of Mycobacterium chimaera infections Potentially Associated with Heater-Cooler Units: Case Definition and Environmental Testing Methodology."},{"key":"ref_21","unstructured":"Ministero della Salute (2019). Indicazioni Operative Riguardanti Gli Aspetti Di Laboratorio in Merito Ai Casi Di Infezione Da Mycobacterium chimaera in Italia e Aggiornamento Delle Informazioni Disponibili."},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Ditommaso, S., Giacomuzzi, M., Memoli, G., Garlasco, J., and Zotti, C.M. (2020). Persistence of Legionella in Routinely Disinfected Heater-Cooler Units and Heater Units Assessed by Propidium Monoazide QPCR. Pathogens, 9.","DOI":"10.3390\/pathogens9110978"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"626","DOI":"10.1177\/0267659120963878","article-title":"Real-Time PCR, the Best Approaches for Rapid Testing for Mycobacterium chimaera Detection in Heater Cooler Units and Extracorporeal Membrane Oxygenation","volume":"36","author":"Ditommaso","year":"2021","journal-title":"Perfusion"},{"key":"ref_24","doi-asserted-by":"crossref","unstructured":"Ditommaso, S., Giacomuzzi, M., Memoli, G., Garlasco, J., Curtoni, A., Iannaccone, M., and Zotti, C.M. (2022). A New Culture Method for the Detection of Non-Tuberculous Mycobacteria in Water Samples from Heater-Cooler Units and Extracorporeal Membrane Oxygenation Machines. Int. J. Environ. Res. Public Health, 19.","DOI":"10.3390\/ijerph191710645"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"100150","DOI":"10.1016\/j.jctube.2020.100150","article-title":"A Scalable, Efficient, and Safe Method to Prepare High Quality DNA from Mycobacteria and Other Challenging Cells","volume":"19","author":"Epperson","year":"2020","journal-title":"J. Clin. Tuberc. Other Mycobact. Dis."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"111358","DOI":"10.1016\/j.dib.2025.111358","article-title":"Image Dataset of Environmental Non-Tuberculous Mycobacteria Isolated from Heater Cooler Units Water by the New NTM Elite Agar","volume":"59","author":"Giacomuzzi","year":"2025","journal-title":"Data Brief"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"365","DOI":"10.1016\/j.jhin.2019.10.010","article-title":"Reduction of Turnaround Time for Non-Tuberculous Mycobacteria Detection in Heater-Cooler Units by Propidium Monoazide-Real-Time Polymerase Chain Reaction","volume":"104","author":"Ditommaso","year":"2019","journal-title":"J. Hosp. Infect."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"giab008","DOI":"10.1093\/gigascience\/giab008","article-title":"Twelve Years of SAMtools and BCFtools","volume":"10","author":"Danecek","year":"2021","journal-title":"Gigascience"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"33","DOI":"10.12688\/f1000research.29032.2","article-title":"Sustainable Data Analysis with Snakemake","volume":"10","author":"Jablonski","year":"2021","journal-title":"F1000Research"},{"key":"ref_30","doi-asserted-by":"crossref","unstructured":"Cannas, A., Campanale, A., Minella, D., Messina, F., Butera, O., Nisii, C., Mazzarelli, A., Fontana, C., Lispi, L., and Maraglino, F. (2023). Epidemiological and Molecular Investigation of the Heater\u2013Cooler Unit (HCU)-Related Outbreak of Invasive Mycobacterium chimaera Infection Occurred in Italy. Microorganisms, 11.","DOI":"10.3390\/microorganisms11092251"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"559","DOI":"10.3201\/eid2503.181282","article-title":"Genomic Analysis of Cardiac Surgery\u2013Associated Mycobacterium chimaera Infections, United States","volume":"25","author":"Hasan","year":"2019","journal-title":"Emerg. Infect. Dis."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"507","DOI":"10.3201\/eid2303.161941","article-title":"Mycobacterium chimaera in Heater-Cooler Units in Denmark Related to Isolates from the United States and United Kingdom","volume":"23","author":"Svensson","year":"2017","journal-title":"Emerg. Infect. Dis."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"388","DOI":"10.1097\/QCO.0000000000000385","article-title":"Mycobacterium chimaera Infections Associated with Heater-Cooler Units in Cardiac Surgery","volume":"30","author":"Schreiber","year":"2017","journal-title":"Curr. Opin. Infect. Dis."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"600","DOI":"10.1056\/NEJMc1612023","article-title":"Mycobacterium chimaera Spread from Heating and Cooling Units in Heart Surgery","volume":"376","author":"Williamson","year":"2017","journal-title":"N. Engl. J. Med."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"9","DOI":"10.1016\/j.jhin.2024.10.006","article-title":"Emergence of Mycobacterium gordonae in Heater-Cooler Units: A Five-Year Prospective Surveillance of Devices Frequently Subjected to Chloramine-T Booster Disinfection","volume":"155","author":"Ditommaso","year":"2024","journal-title":"J. Hosp. Infect."}],"container-title":["Pathogens"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2076-0817\/14\/10\/964\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T18:48:44Z","timestamp":1760035724000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2076-0817\/14\/10\/964"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,9,24]]},"references-count":35,"journal-issue":{"issue":"10","published-online":{"date-parts":[[2025,10]]}},"alternative-id":["pathogens14100964"],"URL":"https:\/\/doi.org\/10.3390\/pathogens14100964","relation":{},"ISSN":["2076-0817"],"issn-type":[{"value":"2076-0817","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,9,24]]}}}