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Fernandez-Sojo J, Valdivia E, Esquirol A, Portos JM, Rovira M, Suarez M, Diaz-de-Heredia C, Uría ML, Ortí G, Ferra C, Mussetti A, Paviglianiti A, Marsal J, Badell I, Lozano M, Gomez D, Azqueta C, Martorell L, Rubio N, Garcia-Buendia A, Villa J, Carreras E, Querol S. Development of an in-house bone marrow collection kit: The Catalan bone marrow transplantation group experience. Vox Sang 2023; 118:783-789. [PMID: 37533171 DOI: 10.1111/vox.13499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 05/28/2023] [Accepted: 06/07/2023] [Indexed: 08/04/2023]
Abstract
BACKGROUND AND OBJECTIVES Bone marrow (BM) harvesting is one of the essential sources of stem cells for haematopoietic stem cell transplantation. In 2019, commercial BM collection kits became unavailable in Europe. Consequently, we created an in-house BM collection kit as an alternative. MATERIALS AND METHODS We compared two groups of BM collections. The first collections were taken using an in-house kit from June 2022 through February 2023 and the second with a commercial kit from February 2021 through May 2022. These all took place at seven collection centres (CC). We analysed the harvest quality (cell blood count, CD34+ cells, viability, potency and sterility), the incidents occurring with each kit and the time to neutrophil and platelet engraftment in recipients. RESULTS A total of 23 donors underwent BM harvesting with the in-house kit and 23 with the commercial one. Both cohorts were comparable regarding donor characteristics, CC and time to procedure. No statistical differences were found in harvest quality between the in-house and commercial kits. A new transfusion set was required in three BM harvests (13%) with the in-house kit because of filter clogging. The median time to neutrophil and platelet engraftment was 21 days for both cohorts and 29 days (in-house) and 33 days (commercial), p = 0.284, respectively. CONCLUSION The in-house BM collection kit offers a real approach to solve the diminished supply of commercial kits. A higher risk of filter clogging was observed compared with commercial kits due to the lack of 850 and 500 μm filters.
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Affiliation(s)
- Jesus Fernandez-Sojo
- Advanced & Cell Therapy Services, Banc de Sang i Teixits, Barcelona, Spain
- Transfusion Medicine Group, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Hospital Universitari, Barcelona, Spain
| | - Elena Valdivia
- Advanced & Cell Therapy Services, Banc de Sang i Teixits, Barcelona, Spain
| | - Albert Esquirol
- Adult Haematology Department, Hospital de la Santa Creu i Sant Pau, IIB-Sant Pau and Jose Carreras Leukaemia Research Institute, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Jose-Manuel Portos
- Adult Haematology Department, Hospital de la Santa Creu i Sant Pau, IIB-Sant Pau and Jose Carreras Leukaemia Research Institute, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Montse Rovira
- BMT Unit, Haematology Department, Hospital Clínic, IDIBAPS, University of Barcelona, Josep Carreras Foundation and Leukaemia Research Institute, Barcelona, Spain
| | - Maria Suarez
- BMT Unit, Haematology Department, Hospital Clínic, IDIBAPS, University of Barcelona, Josep Carreras Foundation and Leukaemia Research Institute, Barcelona, Spain
| | - Cristina Diaz-de-Heredia
- Paediatric Oncology and Haematology Department, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institute of Research (VHIR), Barcelona, Spain
| | - Maria-Luz Uría
- Paediatric Oncology and Haematology Department, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institute of Research (VHIR), Barcelona, Spain
| | - Guillermo Ortí
- Adult Haematology Department, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | - Christelle Ferra
- Adult Haematology Department, Institut Català d'Oncologia-Badalona, Barcelona, Spain
| | - Alberto Mussetti
- Adult Haematology Department, Institut Catala d'Oncologia-Hospitalet, Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Spain
| | - Annalisa Paviglianiti
- Adult Haematology Department, Institut Catala d'Oncologia-Hospitalet, Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Spain
| | - Julia Marsal
- Paediatric SCT Unit, Haematology Department, Hospital Sant Joan de Déu, Barcelona, Spain
| | - Isabel Badell
- Paediatric Haematology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Miquel Lozano
- Apheresis & Cellular Therapy Unit, Department of Haemotherapy and Haemostasis ICMHO, Hospital Clínic, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - David Gomez
- Advanced & Cell Therapy Services, Banc de Sang i Teixits, Barcelona, Spain
| | - Carmen Azqueta
- Advanced & Cell Therapy Services, Banc de Sang i Teixits, Barcelona, Spain
| | - Lluis Martorell
- Advanced & Cell Therapy Services, Banc de Sang i Teixits, Barcelona, Spain
| | - Nuria Rubio
- Advanced & Cell Therapy Services, Banc de Sang i Teixits, Barcelona, Spain
| | - Ana Garcia-Buendia
- Statistical Cell Therapy Services, Banc de Sang i Teixits, Barcelona, Spain
| | - Juliana Villa
- Spanish Bone Marrow Donor Registry, Josep Carreras Foundation and Leukaemia Research Institute, Barcelona, Spain
| | - Enric Carreras
- Spanish Bone Marrow Donor Registry, Josep Carreras Foundation and Leukaemia Research Institute, Barcelona, Spain
| | - Sergio Querol
- Advanced & Cell Therapy Services, Banc de Sang i Teixits, Barcelona, Spain
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Cundell T, Atkins JW, Lau AF. Sterility Testing for Hematopoietic Stem Cells. J Clin Microbiol 2023; 61:e0165422. [PMID: 36847535 PMCID: PMC10035301 DOI: 10.1128/jcm.01654-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/01/2023] Open
Abstract
Over the last two decades, rapid technological advances have led to the wide adoption of cell and gene therapy products for the treatment of a variety of disease states. In this study, we reviewed the literature between 2003 and 2021 to provide a summary of overarching trends associated with microbial contamination in hematopoietic stem cells (HSCs) derived from peripheral blood, bone marrow, and cord blood. We provide a brief background on the regulatory context for human cells, tissues, and cellular and tissue-based products (HCT/Ps) as regulated by the US Food and Drug Administration (FDA), sterility testing expectations for autologous (Section 361) and allogeneic (Section 351) HSC products, and discuss clinical risks associated with the infusion of a contaminated HSC product. Finally, we discuss the expectations for current good tissue practices (cGTP) and current good manufacturing practices (cGMP) for the manufacturing and testing of HSC based on Section 361 and Section 351 categorization, respectively. We provide commentary on what is practiced in the field and discuss the critical need for updates to professional standards that keep pace with advancing technologies with an aim to clarify expectations for manufacturing and testing facilities to improve standardization across institutions.
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Affiliation(s)
- Tony Cundell
- Microbiological Consulting, LLC, Rye, New York, USA
| | - J. Wade Atkins
- Department of Transfusion Medicine, Clinical Center, National Institutes of Health, Bethesda, Maryland, USA
| | - Anna F. Lau
- Sterility Testing Service, Department of Laboratory Medicine, Clinical Center, National Institutes of Health, Bethesda, Maryland, USA
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3
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Jacobs JW, Guarente J, Hendrickson JE, Tormey CA, Bar N. Autologous hematopoietic stem cell product contaminated with Salmonella due to occult salmonellosis in an asymptomatic donor. J Clin Apher 2021; 37:316-319. [PMID: 34953078 DOI: 10.1002/jca.21962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 11/23/2021] [Accepted: 12/20/2021] [Indexed: 11/06/2022]
Abstract
Recent advancements in infectious disease testing methods and pathogen reduction technologies have greatly reduced the incidence of microbial contamination of allogeneic blood products. Despite this significant reduction, contamination of autologous cellular therapy products remains a challenging issue, as many of these mitigation strategies are not feasible for such products. Most microorganisms isolated from cellular therapy products are Gram-positive normal skin flora, and studies have demonstrated that adverse effects are infrequent when these contaminated products are infused. However, no prior report has documented an autologous hematopoietic stem cell (HSC) or other cellular therapy product contaminated with Salmonella bacteria-a pathogenic Gram-negative organism. We present the first known case of Salmonella contaminating an HSC product secondary to occult salmonellosis in the donor, and discuss the implications of this contaminating organism and the therapeutic dilemma posed by this scenario.
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Affiliation(s)
- Jeremy W Jacobs
- Department of Laboratory Medicine, Yale New Haven Hospital, New Haven, Connecticut, USA
| | - Juliana Guarente
- Department of Laboratory Medicine, Yale New Haven Hospital, New Haven, Connecticut, USA
| | - Jeanne E Hendrickson
- Department of Laboratory Medicine, Yale New Haven Hospital, New Haven, Connecticut, USA
| | - Christopher A Tormey
- Department of Laboratory Medicine, Yale New Haven Hospital, New Haven, Connecticut, USA
| | - Noffar Bar
- Section of Hematology, Department of Internal Medicine and Yale Cancer Center, Yale New Haven Hospital, New Haven, Connecticut, USA
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4
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Boey KPY, Zhu P, Tan H, Abdullah MAB, Tang KF, Li MM, Loke I, Hariharan M. Effects of cryopreservation on gram-positive bacteria contaminants in umbilical cord blood. Transfus Med 2021; 32:82-87. [PMID: 34862686 DOI: 10.1111/tme.12834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 11/02/2021] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To evaluate the effects of cryopreservation in post-thaw umbilical cord blood units for the survivability of Gram-positive bacteria strains. BACKGROUND Microbial screening is required for all cord blood units (CBUs). Four gram-positive contaminants were documented to survive cryopreservation poorly and isolation of other contaminants were reported. METHODS Forty-eight contaminated CBUs detected with either Staphylococcus epidermidis, Corynebacterium species, Peptostreptococcus or Streptococcus species before cryopreservation were used in this study. CBUs were processed, DMSO-infused and microbial screened before cryopreservation. Post-thaw microbial screening was achieved using 1 and 10 ml inoculants in BACTEC culture bottles. Positive bottles were subjected for microbial identification and results were compared with those from pre-freeze. RESULTS A higher rate of microbial contamination was found using the 10 ml inoculant. Screening of 11 CBUs did not detect any contaminants while 30 CBUs screened detected more than one unknown contaminants and majority of contaminants were identified to be gram-negative species. CONCLUSION A higher inoculation volume used at post-thaw for microbial screening improves contamination detection but leads to the loss of precious cord blood. Some contaminants did not survive cryopreservation or were not identified due to their low microbial levels. Contrasting contaminants found at post-thaw suggest the improvements made in detection and identification of contaminants over the years.
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Affiliation(s)
| | | | | | | | | | | | - Ian Loke
- Cordlife Group Limited, Singapore, Singapore
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5
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Mukherjee S, Mukherjee S, Mahto R, Basu D, Javed R, Goel G, Bhattacharya S, Basu S, Chandy M. Importance and results of sterility testing of various products in a microbiology laboratory of eastern India. Indian J Med Microbiol 2021; 40:138-140. [PMID: 34740414 DOI: 10.1016/j.ijmmb.2021.10.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 05/27/2021] [Accepted: 10/24/2021] [Indexed: 11/17/2022]
Abstract
Components of blood products from Blood bank, stem cells products from Haemotapoietic Stem Cell Transplant unit, CSSD (Central Sterile Supply Department) items, and pharrrmaceutical products, were sterility tested by liquid culture. 2.91% of the total 3122 samples sent for sterility testing from various departments were positive (i.e. showing contamination). CSSD products showed no contamination (0/37); products from blood bank and bone marrow transplant unit showed a contamination rate of 2.03% (47/2307) and 4.64% (31/667) respectively. The average cost of sterility test was Rs. 302 (INR). Sterility test requires stringent aseptic precautions which is resource intensive.
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Affiliation(s)
| | | | - Rajkumar Mahto
- Department of Microbiology, Tata Medical Center, Kolkata, India
| | - Debabrata Basu
- Central Sterile Supply Department, Tata Medical Center, Kolkata, India
| | - Rizwan Javed
- Department of Clinical Hematology and Celular Therapy, Tata Medical Center, Kolkata, India
| | - Gaurav Goel
- Department of Microbiology, Tata Medical Center, Kolkata, India
| | | | - Sabita Basu
- Department of Transfusion Medicine, Tata Medical Center, Kolkata, India
| | - Mammen Chandy
- Department of Clinical Hematology and Celular Therapy, Tata Medical Center, Kolkata, India
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6
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Garg V, Kodan P, Pushpam D, Bakhshi S, Kumar L, Sharma A, Gupta G, Gupta N. Impact of microbial contamination of haematopoietic stem cells on post-transplant outcomes: A retrospective study from tertiary care centre in India. Transfus Med 2021; 31:377-382. [PMID: 34396610 DOI: 10.1111/tme.12805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 07/17/2021] [Accepted: 07/30/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Haematopoietic stem cells (HSC) may act as a source of infection for the recipient due to manipulation at multiple levels from collection to infusion. Due to the high risk of contamination cultures are usually taken during multiple steps. The clinical significance of microbial contamination of HSC on the post-transplant course and the role of prophylactic antibiotics is relatively unknown. AIMS AND METHODS The aim of our study is to investigate the incidence of microbial contamination of haematopoietic stem cell and to assess its impact on the post-transplant febrile neutropenia, engraftment kinetics, hospitalisation and day 100 mortality. Details of all patients admitted in the bone marrow transplantation unit of a tertiary care centre in India between January 2014 and December 2018 were collected from case records. RESULTS Of the 1306 stem cell harvests from 503 patients sent for culture, 17 harvests (1.3%) were found to have a culture positive report. Sixteen patients had undergone autologous transplant. Multiple myeloma was most common indication of HSC transplant followed by Non-Hodgkin Lymphoma (NHL). Twelve of 17 HSC cultures were positive at the time of infusion and five were positive at the time of harvest. The five HSC that were culture positive at the time of harvest were culture negative at the time of infusion. Gram-positive organisms were isolated in six cultures and gram-negative in rest. All patients developed febrile neutropenia post-transplantation between day 1 and day 7. The median time of onset of fever was day +5 (1-7), the median duration of fever was 4 days (2-7), the median duration of antibiotic use was 11 days (9-16). Median day for neutrophil engraftment was 11 days (9-16), the median day for platelet engraftment was 14 days (10-25) and median duration of hospitalisation was 15 days (12-78). All patients were alive at day 100 of transplant. CONCLUSION This study shows that there appears to be minimal impact of culture positive HSC on transplant related outcomes in terms of engraftment kinetics, duration of hospitalisation and day 100 mortality. Discarding of contaminated HSC may not be required, though on development of febrile neutropenia appropriate antibiotics should be administered based on sensitivity pattern of HSC culture. Larger prospective studies are needed to determine the clinical relevance of such contaminations. Emphasis should be laid on better infection control practices to minimise contamination rates.
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Affiliation(s)
- Vikas Garg
- Department of Medical Oncology, BRAIRCH, AIIMS, Delhi, India
| | | | - Deepam Pushpam
- Department of Medical Oncology, BRAIRCH, AIIMS, Delhi, India
| | - Sameer Bakhshi
- Department of Medical Oncology, BRAIRCH, AIIMS, Delhi, India
| | - Lalit Kumar
- Department of Medical Oncology, BRAIRCH, AIIMS, Delhi, India
| | - Atul Sharma
- Department of Medical Oncology, BRAIRCH, AIIMS, Delhi, India
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7
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Damonti L, Buetti N, Droz S, Bacher U, Pabst T, Taleghani BM, Baerlocher GM, Marschall J. Prevalence and significance of bacterial contamination of autologous stem cell products. J Hosp Infect 2021; 114:175-179. [PMID: 33864895 DOI: 10.1016/j.jhin.2021.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 04/06/2021] [Accepted: 04/12/2021] [Indexed: 10/21/2022]
Abstract
There is limited and conflicting information on the prevalence of contamination of haematopoietic stem and progenitor cell products (HPCPs), and their optimal management remains unclear. The authors reviewed the microbial surveillance data of HPCPs collected between January 2002 and December 2019 for autologous transplantation at the study institution to determine the prevalence of microbial contamination and the potential infectious complications among recipients. Among 3935 HPCPs, 25 (0.6%) were contaminated. Ultimately, 22 patients received contaminated grafts, with pre-emptive antimicrobial therapy initiated in six of these patients. No patients developed subsequent infectious complications. These data suggest that microbial contamination of autologous HPCPs and associated adverse outcomes are rare.
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Affiliation(s)
- L Damonti
- Department of Infectious Diseases, Inselspital, University Hospital Bern, Bern, Switzerland; Ente Ospedaliero Cantonale, Division of Infectious Diseases, Regional Hospital Lugano, Lugano, Switzerland.
| | - N Buetti
- Department of Infectious Diseases, Inselspital, University Hospital Bern, Bern, Switzerland; Infection Control Programme, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland; UMR 1137 IAME Team 5 DeSCID: Decision Sciences in Infectious Diseases, Control and Care Inserm/University Paris Diderot, Sorbonne Paris Cité, Paris, France
| | - S Droz
- Institute for Infectious Diseases, University of Bern, Bern, Switzerland
| | - U Bacher
- Department of Haematology and Central Haematology Laboratory, Inselspital, University Hospital Bern, Bern, Switzerland
| | - T Pabst
- Department of Medical Oncology, Inselspital, University Hospital and University of Bern, Bern, Switzerland
| | - B M Taleghani
- Department of Haematology and Central Haematology Laboratory, Inselspital, University Hospital Bern, Bern, Switzerland
| | - G M Baerlocher
- Laboratory for Cellular Therapies, Department of Haematology and Central Haematology Laboratory, Inselspital, Bern University Hospital, Bern, Switzerland; Laboratory for Haematopoiesis and Molecular Genetics, Department of BioMedical Research, University of Bern, Bern, Switzerland
| | - J Marschall
- Department of Infectious Diseases, Inselspital, University Hospital Bern, Bern, Switzerland
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8
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Microbial contamination risk in hematopoietic stem cell products: retrospective analysis of 1996–2016 data. ACTA ACUST UNITED AC 2020. [DOI: 10.2478/ahp-2020-0007] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
AbstractQuality assurance and safety of hematopoietic stem cells (HSC) with special emphasis on bacterial and fungal contamination is the prerequisite for any transplantation procedure. The aim was to determine the incidence rate of such contamination during processing of transplantation material with regard to HSC source: peripheral blood stem cell (PBSC), bone marrow (BM), or cord blood (CB). Analysis involved autologous and allogenic products dedicated for patients and comprised in all 4135 donations, including 112 BM (2.70%), 3787 PBSC (91.60%), and 236 CB (5.70%) processed in cell bank over the period 1996–2016. Aerobic and anaerobic contamination was determined.Analysis of the 20-year data revealed 42 contaminated products: 25 PBSC (0.66% of tested units) and 17 CB (7.20% of tested units). No microbial contamination of BM products was detected. Overall percentage of contaminated products was 1.01%, mostly with Staphylococcus epidermidis (61.36%). Bacterial contamination rate at cell bank is relatively low and processing in a closed system does not seem as crucial as might be expected. This is particularly true for BM components. Equally important are evaluation of donor’s medical status and condition of the puncture site for collection of source material. Implementation of appropriate sample collection procedures should help minimize the risk of false-positive results due to environmental contamination.
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9
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Arlt N, Rothe R, Sielaff S, Juretzek T, Peltroche H, Moog R. Sterility release testing of peripheral blood stem cells for transplantation: impact of culture bottles and incubation temperature. Transfusion 2018; 58:2918-2923. [PMID: 30260478 DOI: 10.1111/trf.14910] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Revised: 05/25/2018] [Accepted: 06/01/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND Sterility testing of peripheral blood stem cells (PBSCs) is mandatory before release. As antibiotic treatment of the PBSC donor may result in false-negative results, PBSC matrix validation must be carried out. STUDY DESIGN AND METHODS Three spiked PBSCs and a buffy coat (BC; control matrix) were analyzed using the blood culture device BacT/ALERT 3D with the low-temperature module. Samples were spiked with Staphylococcus aureus, Bacillus subtilis, Pseudomonas aeruginosa, Candida albicans, Aspergillus brasiliensis, Clostridium sporogenes, and Propionibacterium acnes. Standard iAST/iNST culture bottles and iFA/iFN Plus bottles, which include resorbing polymers, were incubated for 14 days. All aerobic bottles were incubated at 22.5°C and for a direct comparison also at 35°C while all anaerobic bottles were incubated at 35°C. RESULTS The BacT/ALERT 3D system detected all microbes in iAST/iNST culture bottles according to their growth behavior in the BC matrix. Detection of microbes differed significantly in PBSC products using standard iAST/iNST culture bottles and iFA/iFN Plus bottles with resorbing polymers: In Graft 1 no growth was detected in spiked bottles with S. aureus (iAST), B. subtilis (iAST/iNST), C. sporogenes (iNST), and P. acnes (iNST) compared to iFA Plus and iFN Plus bottles wherein growth of spiked microbes was confirmed. Graft 2, with another antibiotic treatment, showed no growth in iAST/iNST bottles spiked with P. aeruginosa, B. subtilis, and C. sporogenes. However, using iFA/iFN Plus bottles all spiked microbes were detectable. The comparison of incubation temperature showed an expected slower growth at 22.5°C. CONCLUSION The use of iFA/iFN Plus culture bottles incubated at different temperatures safely detected microbes in spiked PBSCs.
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Affiliation(s)
- Nicole Arlt
- German Red Cross Blood Donor Service North-East, Institute Cottbus, Cottbus, Germany
| | - Remo Rothe
- German Red Cross Blood Donor Service North-East, Institute Cottbus, Cottbus, Germany
| | - Susann Sielaff
- German Red Cross Blood Donor Service North-East, Institute Cottbus, Cottbus, Germany
| | - Thomas Juretzek
- Department of Microbiology and Hospital Hygiene, Carl-Thiem Clinic, Cottbus, Germany
| | - Heidrun Peltroche
- Department of Microbiology and Hospital Hygiene, Carl-Thiem Clinic, Cottbus, Germany
| | - Rainer Moog
- German Red Cross Blood Donor Service North-East, Institute Cottbus, Cottbus, Germany
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Sakhno NG, Gunar OV, Roshchina MV, Kolosova LV, Grigor’eva VÉ. Isolation of Anaerobic Bacteria During Quality Analysis of Medicinal Products. Pharm Chem J 2018. [DOI: 10.1007/s11094-018-1861-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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11
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Panch SR, Bikkani T, Vargas V, Procter J, Atkins JW, Guptill V, Frank KM, Lau AF, Stroncek DF. Prospective Evaluation of a Practical Guideline for Managing Positive Sterility Test Results in Cell Therapy Products. Biol Blood Marrow Transplant 2018; 25:172-178. [PMID: 30098394 DOI: 10.1016/j.bbmt.2018.08.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Accepted: 08/01/2018] [Indexed: 12/24/2022]
Abstract
Product safety assurance is crucial for the clinical use of manufactured cellular therapies. A rational approach for delivering products that fail release criteria (because of potentially false-positive sterility results) is important to avoid unwarranted wastage of highly personalized and costly therapies in critically ill patients where benefits may outweigh risk. Accurate and timely interpretation of microbial sterility assays represents a major challenge in cell therapies. We developed a systematic protocol for the assessment of positive microbial sterility test results using retrospective data from 2007 to 2016. This protocol was validated and applied prospectively between October 2016 and September 2017 to 13 products from which positive sterility results had been reported. Viable and nonviable environmental monitoring (EM) data were collected concurrently as part of a facility control assessment. Three of 13 (23%) positive sterility results were attributable to bone marrow collections that had been contaminated with skin flora during harvest; all were infused without pertinent infectious sequelae. Of the remaining 10, 1 was deemed a true positive and was discarded before infusion, whereas 9 were classified as false positives attributed to laboratory sampling and/or culturing processes. Three products deemed false positive were infused and 6 were withheld because of patient issues unrelated to microbial sterility results. No postinfusion-associated infectious complications were documented. Almost half of the positive EM findings were skin flora. Paired detection of an organism in both product and associated EM was identified in 1 case. Application of our validated protocol to positive product sterility test results allowed for systematic data compilation for regulatory evaluation and provided comprehensive information to clinical investigators to ensure timely and strategic management for product recipients.
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Affiliation(s)
- Sandhya R Panch
- Department of Transfusion Medicine, Cell Processing Section, Clinical Center, National Institutes of Health, Bethesda, Maryland.
| | - Thejaswi Bikkani
- Department of Transfusion Medicine, Cell Processing Section, Clinical Center, National Institutes of Health, Bethesda, Maryland
| | - Vanessa Vargas
- Department of Transfusion Medicine, Cell Processing Section, Clinical Center, National Institutes of Health, Bethesda, Maryland
| | - Jolynn Procter
- Department of Transfusion Medicine, Cell Processing Section, Clinical Center, National Institutes of Health, Bethesda, Maryland
| | - James W Atkins
- Department of Transfusion Medicine, Cell Processing Section, Clinical Center, National Institutes of Health, Bethesda, Maryland
| | - Virginia Guptill
- Office of Research Support and Compliance, Clinical Center, National Institutes of Health, Bethesda, Maryland
| | - Karen M Frank
- Department of Laboratory Medicine, Clinical Center, National Institutes of Health, Bethesda, Maryland
| | - Anna F Lau
- Department of Laboratory Medicine, Clinical Center, National Institutes of Health, Bethesda, Maryland
| | - David F Stroncek
- Department of Transfusion Medicine, Cell Processing Section, Clinical Center, National Institutes of Health, Bethesda, Maryland
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12
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Pruszczyk K, Skwierawska K, Król M, Moskowicz A, Jabłoński D, Torosian T, Piotrowska I, Urbanowska E, Wiktor-Jędrzejczak W, Snarski E. Bone marrow harvest from unrelated donors-up-to-date methodology. Eur J Haematol 2018; 99:357-365. [PMID: 28719093 DOI: 10.1111/ejh.12929] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/12/2017] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Bone marrow harvesting is one of the essential sources of stem cells for hematopoietic stem cell transplantation. We describe here the current "up-to-date" standard of the bone marrow harvest in unrelated stem cell donors. METHODS We analyzed medical data of 187 unrelated hematopoietic stem cell donors who underwent bone marrow harvest without previous peripheral blood stem collection at the center between 2011 and 2015. The methodology of marrow collection includes multiple cells aimed at safety of the procedure, for example, educational movie, modified skin disinfection protocol, cell enumeration during the procedure, reduction of the contamination surfaces, and ongoing monitoring of the quality of work of the doctors. RESULTS The total nucleated cell count over 2×108 per kg of recipient has been reached in 93.6% of harvests. All of the donors harvested more than 1×108 per kg of the recipient. There were no donors who required transfusions or had serious adverse events during and after the harvest. CONCLUSION We describe here the current up-to-date standard of bone marrow harvest, which leads to excellent results in majority of donors without causing significant complications during the donation.
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Affiliation(s)
- Katarzyna Pruszczyk
- Department of Hematology, Oncology and Internal Medicine, Medical University of Warsaw, Warsaw, Poland
| | - Kamila Skwierawska
- Department of Hematology, Oncology and Internal Medicine, Medical University of Warsaw, Warsaw, Poland
| | - Małgorzata Król
- Department of Hematology, Oncology and Internal Medicine, Medical University of Warsaw, Warsaw, Poland
| | - Albert Moskowicz
- Department of Hematology, Oncology and Internal Medicine, Medical University of Warsaw, Warsaw, Poland
| | | | | | | | - Elżbieta Urbanowska
- Department of Hematology, Oncology and Internal Medicine, Medical University of Warsaw, Warsaw, Poland
| | | | - Emilian Snarski
- Department of Hematology, Oncology and Internal Medicine, Medical University of Warsaw, Warsaw, Poland
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Golay J, Pedrini O, Capelli C, Gotti E, Borleri G, Magri M, Vailati F, Passera M, Farina C, Rambaldi A, Introna M. Utility of routine evaluation of sterility of cellular therapy products with or without extensive manipulation: Best practices and clinical significance. Cytotherapy 2018; 20:262-270. [DOI: 10.1016/j.jcyt.2017.11.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Revised: 10/18/2017] [Accepted: 11/14/2017] [Indexed: 10/18/2022]
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Staphylococcus aureus Bloodstream Infection Due to Contaminated Hematopoietic Stem-Cell Graft. Infect Control Hosp Epidemiol 2018; 39:367-369. [PMID: 29357961 DOI: 10.1017/ice.2017.285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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15
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Dal MS, Tekgündüz E, Çakar MK, Kaya AH, Namdaroğu S, Batgi H, Bekdemir F, Uncu Ulu B, Yiğenoğlu TN, Kılınç A, İskender D, Uğur B, Koçubaba Ş, İskender G, Altuntaş F. Does microbial contamination influence the success of the hematopoietic cell transplantation outcomes? Transfus Apher Sci 2016; 55:125-8. [PMID: 27184293 DOI: 10.1016/j.transci.2016.05.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2016] [Revised: 04/29/2016] [Accepted: 05/02/2016] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Microbial contamination can be a marker for faulty process and is assumed to play an important role in the collection of hematopoietic progenitor cell (HPC) and infusion procedure. We aimed to determine the microbial contamination rates and evaluate the success of hematopoietic cell transplantation (HCT) in patients who received contaminated products. PATIENTS-METHODS We analyzed microbial contamination records of HPC grafts between 2012 and 2015, retrospectively. Contamination rates of autologous donors were evaluated for at three steps: at the end of mobilization, following processing with dimethyl sulfoxide, and just before stem cell infusion. Grafts of allogeneic donors were assessed only before HCT. RESULT A total of 445 mobilization procedures were carried out on 333 (167 autologous and 166 allogeneic) donors. The microbiological contamination of peripheral blood (323/333 donations) and bone marrow (10/333 donations) products were analyzed. Bacterial contamination was detected in 18 of 1552 (1.15 %) culture bottles of 333 donors. During the study period 248 patients underwent HCT and among these patients microbial contamination rate on sample basis was 1.3 % (16/1212). Microbial contamination detected in nine patients (7 autologous; 2 allogeneic). In 8 of 9 patients, a febrile neutropenic attack was observed. The median day for the neutropenic fever was 4 days (0-9). None of the patients died within the post-transplant 30 days who received contaminated products. CONCLUSION The use of contaminated products with antibiotic prophylaxis may be safe in terms of the first day of fever, duration of fever, neutrophil, platelet engraftment and duration of hospitalization.
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Affiliation(s)
- Mehmet Sinan Dal
- Ankara Oncology Education and Research Hospital, Hematology and Stem Cell Transplantation Clinic, Ankara, Turkey.
| | - Emre Tekgündüz
- Ankara Oncology Education and Research Hospital, Hematology and Stem Cell Transplantation Clinic, Ankara, Turkey
| | - Merih Kızıl Çakar
- Ankara Oncology Education and Research Hospital, Hematology and Stem Cell Transplantation Clinic, Ankara, Turkey
| | - Ali Hakan Kaya
- Ankara Oncology Education and Research Hospital, Hematology and Stem Cell Transplantation Clinic, Ankara, Turkey
| | - Sinem Namdaroğu
- Ankara Oncology Education and Research Hospital, Hematology and Stem Cell Transplantation Clinic, Ankara, Turkey
| | - Hikmetullah Batgi
- Ankara Oncology Education and Research Hospital, Hematology and Stem Cell Transplantation Clinic, Ankara, Turkey
| | - Filiz Bekdemir
- Ankara Oncology Education and Research Hospital, Hematology and Stem Cell Transplantation Clinic, Ankara, Turkey
| | - Bahar Uncu Ulu
- Ankara Oncology Education and Research Hospital, Hematology and Stem Cell Transplantation Clinic, Ankara, Turkey
| | - Tuğçe Nur Yiğenoğlu
- Ankara Oncology Education and Research Hospital, Hematology and Stem Cell Transplantation Clinic, Ankara, Turkey
| | - Ali Kılınç
- Ankara Oncology Education and Research Hospital, Therapeutic Apheresis Center, Ankara, Turkey
| | - Dicle İskender
- Ankara Oncology Education and Research Hospital, Hematology and Stem Cell Transplantation Clinic, Ankara, Turkey
| | - Bilge Uğur
- Ankara Oncology Education and Research Hospital, Hematology and Stem Cell Transplantation Clinic, Ankara, Turkey
| | - Şerife Koçubaba
- Ankara Oncology Education and Research Hospital, Hematology and Stem Cell Transplantation Clinic, Ankara, Turkey
| | - Gülşen İskender
- Ankara Oncology Education and Research Hospital, Department of Clinical Microbiology and Infectious Diseases, Ankara, Turkey
| | - Fevzi Altuntaş
- Ankara Oncology Education and Research Hospital, Hematology and Stem Cell Transplantation Clinic, Ankara, Turkey
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Sitti M, Ceylan H, Hu W, Giltinan J, Turan M, Yim S, Diller E. Biomedical Applications of Untethered Mobile Milli/Microrobots. PROCEEDINGS OF THE IEEE. INSTITUTE OF ELECTRICAL AND ELECTRONICS ENGINEERS 2015; 103:205-224. [PMID: 27746484 PMCID: PMC5063027 DOI: 10.1109/jproc.2014.2385105] [Citation(s) in RCA: 293] [Impact Index Per Article: 32.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/19/2023]
Abstract
Untethered robots miniaturized to the length scale of millimeter and below attract growing attention for the prospect of transforming many aspects of health care and bioengineering. As the robot size goes down to the order of a single cell, previously inaccessible body sites would become available for high-resolution in situ and in vivo manipulations. This unprecedented direct access would enable an extensive range of minimally invasive medical operations. Here, we provide a comprehensive review of the current advances in biome dical untethered mobile milli/microrobots. We put a special emphasis on the potential impacts of biomedical microrobots in the near future. Finally, we discuss the existing challenges and emerging concepts associated with designing such a miniaturized robot for operation inside a biological environment for biomedical applications.
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Affiliation(s)
- Metin Sitti
- Max-Planck Institute for Intelligent Systems, 70569 Stuttgart, Germany, and also are with Department of Mechanical Engineering, Carnegie Mellon University, Pittsburgh, PA 15238 USA
| | - Hakan Ceylan
- Max-Planck Institute for Intelligent Systems, 70569 Stuttgart, Germany
| | - Wenqi Hu
- Max-Planck Institute for Intelligent Systems, 70569 Stuttgart, Germany
| | - Joshua Giltinan
- Max-Planck Institute for Intelligent Systems, 70569 Stuttgart, Germany, and also are with Department of Mechanical Engineering, Carnegie Mellon University, Pittsburgh, PA 15238 USA
| | - Mehmet Turan
- Max-Planck Institute for Intelligent Systems, 70569 Stuttgart, Germany
| | - Sehyuk Yim
- Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139 USA
| | - Eric Diller
- Department of Mechanical and Industrial Engineering, University of Toronto, Toronto, ON M5S3G8, Canada
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Kozlowska-Skrzypczak M, Bembnista E, Kubiak A, Matuszak P, Schneider A, Komarnicki M. Microbial Contamination of Peripheral Blood and Bone Marrow Hematopoietic Cell Products and Environmental Contamination in a Stem Cell Bank: A Single-Center Report. Transplant Proc 2014; 46:2873-6. [DOI: 10.1016/j.transproceed.2014.09.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Störmer M, Wood EM, Schurig U, Karo O, Spreitzer I, McDonald CP, Montag T. Bacterial safety of cell-based therapeutic preparations, focusing on haematopoietic progenitor cells. Vox Sang 2013; 106:285-96. [PMID: 24697216 DOI: 10.1111/vox.12097] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2013] [Revised: 02/14/2013] [Accepted: 09/03/2013] [Indexed: 11/28/2022]
Abstract
Bacterial safety of cellular preparations, especially haematopoietic progenitor cells (HPCs), as well as advanced therapy medicinal products (ATMPs) derived from stem cells of various origins, present a challenge for physicians, manufacturers and regulators. The article describes the background and practical issues in this area and illustrates why sterility of these products cannot currently be guaranteed. Advantages and limitations of approaches both for classical sterility testing and for microbiological control using automated culture systems are discussed. The review considers novel approaches for growth-based rapid microbiological control with high sensitivity and faster availability of results, as well as new methods for rapid bacterial detection in cellular preparations enabling meaningful information about product contamination within one to two hours. Generally, however, these direct rapid methods are less sensitive and have greater sampling error compared with the growth-based methods. Opportunities for pyrogen testing of cell therapeutics are also discussed. There is an urgent need for development of novel principles and methods applicable to bacterial safety of cellular therapeutics. We also need a major shift in approach from the traditional view of sterility evaluation (identify anything and everything) to a new thinking about how to find what is clinically relevant within the time frame available for the special clinical circumstances in which these products are used. The review concludes with recommendations for optimization of microbiological control of cellular preparations, focusing on HPCs.
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Affiliation(s)
- M Störmer
- Department of Transfusion Medicine, University of Cologne, Cologne, Germany; Paul-Ehrlich-Institut, Federal Institute for Vaccines and Biomedicines, Langen, Germany
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Zhu L, Lv H, Wang Y, Yang J, Ni B, Meng Z. Microbial screening of unrelated cord blood units in a Chinese cord blood bank. Transfus Med 2013; 23:438-41. [PMID: 24118280 DOI: 10.1111/tme.12079] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2013] [Revised: 07/23/2013] [Accepted: 08/18/2013] [Indexed: 12/01/2022]
Abstract
BACKGROUND Given limited sample volume available for sterility testing, optimal testing methods and algorithms of cord blood (CB) have not been established according to standards. STUDY DESIGN AND METHODS The volume of CB unit was reduced to 20 mL in a closed system. Hetastarch and cryopreservation solution was added to the processed CB unit in Class 100 environment. In the routine sterility testing, 20 mL of red blood cells (RBC) sample was cultured in aerobic and anaerobic culture bottles. In verification post-thaw culture of the final product, some of the discarded final product units were also sampled and cultured after thaw. All the culture bottles were incubated in the BacT/ALERT 3D system. RESULTS In the routine sterility testing, 139 of 7032 CB units (1·98%) were contaminated with microorganism. In 84 of these 139 units (60·4%) only the anaerobic bottle was positive. Lactobacillus spp. were the most prevalent contaminant. Sixty-two discarded CB stem cell units were recultured after thaw. Of these, 10 of 48 units with a positive culturing of RBC sample were negative in the post-thaw reculture. One of 14 units with negative culturing of RBC sample was contaminated with Bifidobacterium breve in special verification test. CONCLUSION Our study demonstrates the predominant organisms implicated in CB microbial contamination were part of the human intestinal and vaginal flora. The larger sample volume and anaerobic culture would significantly increase the detection rate of microbial contaminated CB. We also found that potential transfusion-transmitted bacterial infection risk still existed in final product although microbial screening was performed.
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Affiliation(s)
- L Zhu
- Blood Center of Zhejiang Province, Hangzhou, Zhejiang, China; Key Laboratory of Blood Safety Research, Ministry of Health, Hangzhou, Zhejiang, China
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Clark P, Trickett A, Chimenti M, Stark D. Optimization of microbial screening for cord blood. Transfusion 2013; 54:550-9. [PMID: 23889674 DOI: 10.1111/trf.12352] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2013] [Revised: 06/05/2013] [Accepted: 06/11/2013] [Indexed: 11/30/2022]
Abstract
BACKGROUND Collection and processing of cord blood (CB) is associated with significant risk of contamination; hence standards mandate microbial screening of the final product. The sensitivity of current methods to evaluate the microbial content of CB is unknown, given the small volume tested and reduced sensitivity of pediatric bottles. Hence, this study was undertaken to evaluate an optimal microbial screening method. STUDY DESIGN AND METHODS CB was collected using a closed system then spiked with organisms at 1 or 10 colony-forming units (CFUs)/mL. Samples were screened using culture bottles (BacT/ALERT, bioMérieux; and BACTEC, Becton Dickinson). Several methods were evaluated with different combinations of inoculated bottles (adult vs. pediatric), sample types (plasma discard, red blood cell [RBC] discard, or final product), and sample volumes. RESULTS Of 94 cord blood units (CBUs) spiked with organisms before screening, 81% tested positive for contamination overall. Screening of CB in pediatric bottles resulted in equivalent detection rates on the BacT/ALERT and BACTEC systems (33% at 1 CFU/mL and 73% at 10 CFUs/mL, respectively). However, the pediatric bottle screen only detected 15% of obligate anaerobes. A combined fraction method showed superior detection (71%) compared to the plasma fraction (27%) and resulted in optimal anaerobic detection. CONCLUSIONS This study demonstrates that the optimal microbial screening method for CB includes testing a combination of discard fractions (plasma and RBCs) in addition to final product using an automated culture system. Inoculating a small sample of final product in a pediatric bottle is suboptimal for microbial detection and may lead to distribution of contaminated CB for transplantation.
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Affiliation(s)
- Pamela Clark
- Sydney Cord Blood Bank, Sydney Children's Hospital, Randwick, NSW, Australia; University of New South Wales, Sydney, NSW, Australia
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21
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Clark P, Trickett A, Saffo S, Stark D. Effects of cryopreservation on microbial-contaminated cord blood. Transfusion 2013; 54:532-40. [PMID: 23808601 DOI: 10.1111/trf.12323] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2013] [Revised: 05/12/2013] [Accepted: 05/20/2013] [Indexed: 12/01/2022]
Abstract
BACKGROUND Cord blood units (CBUs) are associated with significant risk of exposure to microbial contamination during collection and processing; however, the survival of bacteria within a CBU is poorly understood. This study aimed to determine whether contaminating organisms in CBU survive the cryopreservation, frozen storage, and subsequent thawing conditions before infusion. STUDY DESIGN AND METHODS A total of 134 CBUs rejected from banking due to known contamination were thawed and rescreened using blood culture bottles (BacT/ALERT, bioMérieux). An additional 61 fresh CBUs were deliberately spiked with a range of microbial organisms and evaluated both before freeze and after thaw. RESULTS Microbial contaminants were detected after thaw in 63% of stored contaminated CBUs and 85% of spiked CBUs. Postthaw organism detection in spiked cord blood (CB) was higher in adult culture bottles (80%) than pediatric culture bottles (61%). Twenty percent of spiked organisms, particularly Bacillus subtilis, Escherichia coli, Clostridium sporogenes, and Propionibacterium acnes, were not detected in prefreeze samples but were detectable after thaw. CONCLUSIONS This study demonstrates that the majority of contaminating organisms isolated in a prefreeze sample of CB have the ability to survive cryopreservation, frozen storage, and thawing. Further, CBUs reported as microbial free may contain microbial contamination, which could result in transplantation of contaminated CB and be potentially deleterious to a patient.
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Affiliation(s)
- Pamela Clark
- Sydney Cord Blood Bank, Sydney Children's Hospital, Randwick, NSW, Australia; University of New South Wales, Sydney, NSW, Australia; BMT Laboratory, SEALS, Prince of Wales Hospital, Randwick, NSW, Australia; Division of Microbiology, SydPath, St. Vincent's Hospital, Darlinghurst, NSW, Australia
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Namdaroğlu S, Tekgündüz E, Bozdağ SC, Durgun G, Sarıca A, Demiriz IŞ, Koçubaba S, Iskender G, Kayıkçı O, Altuntaş F. Microbial contamination of hematopoietic progenitor cell products. Transfus Apher Sci 2013; 48:403-6. [PMID: 23664302 DOI: 10.1016/j.transci.2013.04.026] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Microbial screening for contamination is a part of hematopoietic progenitor cell (HPC) collection and infusion procedure. We aimed to find out our microbial contamination rates during collection, processing and infusion steps of HPC products. We also evaluated the clinical course of patients who received contaminated HPC products. PATIENTS-METHODS We retrospectively analyzed microbial contamination records of HPC grafts between 2010 and 2012. HPC products of autologous donors were evaluated for contamination at three steps: at the end of mobilization, following processing with DMSO and just before stem cell infusion. Grafts of allogeneic donors were assessed only before HPC transplantation (HCT). Microbiological analysis of HPC samples were performed with an automated system (BacT/Alert®). RESULT During the study period a total of 492 mobilization procedures were performed on 329 (214 autologous and 115 allogeneic) donors. Bacterial contamination has been detected in 103 of 1630 samples (6%). Ninety-seven out of 1162 blood samples (8%) from 265 patients who were treated with HCT were contaminated. Forty-six patients (41 autologous and 5 allogeneic) were transplanted with contaminated HPC products. During HCT 42 patients experienced febrile neutropenic attack and 34 of them had positive blood culture results. In none of these 34 patients the isolated pathogens were the same organisms with those found in the final contaminated stem cell product before stem cell infusion. None of the patients who received contaminated products died because of sepsis within the posttransplant 30days. There was no significant difference between patients who received contaminated and non-contaminated products in terms of the first day of fever, duration of fever, engraftment kinetics and duration of hospitalization. CONCLUSION Our results suggest that microbial contamination of HPC products is an issue to be prevented, although it may not have a major impact on the general success of HCT.
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Affiliation(s)
- Sinem Namdaroğlu
- Ankara Oncology Education and Research Hospital, Hematology and Stem Cell Transplantation Clinic, Ankara, Turkey.
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Jacobs MR, Good CE, Fox RM, Roman KP, Lazarus HM. Microbial contamination of hematopoietic progenitor and other regenerative cells used in transplantation and regenerative medicine. Transfusion 2013; 53:2690-6. [PMID: 23461309 DOI: 10.1111/trf.12150] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2012] [Revised: 12/27/2012] [Accepted: 01/03/2013] [Indexed: 11/29/2022]
Abstract
BACKGROUND Microbial contamination of hematopoietic progenitor cells (HPCs) and other regenerative cells used in transplantation and regenerative medicine can occur during collection and after in vitro manipulation, including purging, cryopreservation, thawing, and infusion. STUDY DESIGN AND METHODS Microbiologic culture findings on consecutive HPCs and other cell preparations at a single institution derived from peripheral blood, marrow, cord blood, and mesenchymal stromal cells during all phases of manipulation were retrospectively examined from 2005 through 2011. Results were classified as confirmed positive, false positive, and indeterminate. RESULTS During the 6-year surveillance period, 365 patients underwent 912 procedures involving HPC or other cell-based transfusion. True positive microbial contamination was found in five of 663 (0.8%) peripheral blood and two of 34 (5.9%) marrow preparations (p = 0.04), while no contamination was found in 118 preparations from other sources. True-positive microbial contaminants included coagulase-negative staphylococci in autologous HPC products derived from peripheral blood from two patients with asymptomatic central venous catheter infections at time of apheresis and Propionibacterium acnes in one apheresis and two marrow products. Organism loads were low in all cases (≤500 colony-forming units/mL), and no adverse sequelae occurred in four patients that received contaminated products. CONCLUSION The incidence of microbial contamination of progenitor cell products in our institution over a 6-year period was low (0.8% overall), with contaminants originating from infected central venous catheters or from skin flora. All contaminants were bacterial species of low virulence, present in low titers and, if transfused, did not result in adverse reactions.
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Affiliation(s)
- Michael R Jacobs
- Departments of Pathology and Medicine and Case Comprehensive Cancer Center, Case Western Reserve University and University Hospitals Case Medical Center, Cleveland, Ohio
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Clark P, Trickett A, Stark D, Vowels M. Factors affecting microbial contamination rate of cord blood collected for transplantation. Transfusion 2012; 52:1770-7. [PMID: 22211719 DOI: 10.1111/j.1537-2995.2011.03507.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Collection and processing of cord blood (CB) is associated with significant risk of microbial contamination and hence relevant standards mandate microbial screening of the final product. This study aimed to determine the contamination rate and associated risk factors during 14 years of banking at the Sydney Cord Blood Bank. STUDY DESIGN AND METHODS CB was collected and processed using a closed system and tested for contamination using blood culture bottles (BacT/ALERT, bioMérieux) incubated for a minimum of 5 days. Four microbial screening methods were used with different combinations of inoculated bottles (adult or pediatric) and associated sample volumes (10 or 1 mL). RESULTS Of 13,344 CB units screened, 537 (4.0%) tested positive for contamination, with Bacteroides spp. (20.9%), Staphylococcus spp. (18.6%), and Propionibacterium spp. (13.7%) being the most common isolates. The contamination rate reduced from 10% in 1997 to 1.1% in 2009. Multivariate analysis demonstrated the following variables were independently associated with higher contamination rates: vaginal delivery, collection by obstetric staff, and use of an anaerobic bottle in addition to an aerobic bottle (which facilitated a larger sample inoculation volume than pediatric bottles). CONCLUSIONS This study demonstrates that contamination rates of CB collected for transplantation can be substantially reduced by collection after cesarean delivery and utilizing trained CB collection staff. These data also indicate that the common practice of testing using a pediatric (aerobic) bottle with its attendant small volume of the final CB product may be suboptimal for sensitive detection of contaminating anaerobic microbes.
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Affiliation(s)
- Pamela Clark
- Sydney Cord Blood Bank, Sydney Children's Hospital, Randwick, NSW, Australia.
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Autologous transplant: microbial contamination of hematopoietic stem cell products. Braz J Infect Dis 2012; 16:345-50. [DOI: 10.1016/j.bjid.2012.06.012] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2011] [Accepted: 03/18/2012] [Indexed: 11/22/2022] Open
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Verdugo F, Castillo A, Simonian K, Russo P, D'Addona A, Raffaelli L, Moragues MD, Quindós G, Pontón J. Periodontopathogen and Epstein-Barr Virus Contamination Affects Transplanted Bone Volume in Sinus Augmentation. J Periodontol 2012; 83:162-73. [DOI: 10.1902/jop.2011.110086] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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Donmez A, Aydemir S, Arik B, Tunger A, Cilli F, Orman M, Tombuloglu M. Risk factors for microbial contamination of peripheral blood stem cell products. Transfusion 2011; 52:777-81. [DOI: 10.1111/j.1537-2995.2011.03359.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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28
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Chiang HY, Steelman VM, Pottinger JM, Schlueter AJ, Diekema DJ, Greenlee JDW, Howard MA, Herwaldt LA. Clinical significance of positive cranial bone flap cultures and associated risk of surgical site infection after craniotomies or craniectomies. J Neurosurg 2011; 114:1746-54. [PMID: 21375380 DOI: 10.3171/2011.1.jns10782] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT The risk of surgical site infection (SSI) after craniotomies or craniectomies in patients in whom contaminated bone flaps have been reimplanted has not been determined. The objectives of this study were to identify the prevalence of bone flaps with positive cultures--especially those contaminated with Propionibacterium acnes--to assess the risk of SSI after reimplanting (either during the initial operation or subsequently) bone flaps with positive cultures, and to identify risk factors for SSI following the initial craniotomies or craniectomies. METHODS The authors conducted a retrospective review of cases in which patients underwent craniotomy/craniectomy procedures between January and October 2007 in the neurosurgery department at the University of Iowa Hospitals and Clinics. They also reviewed processes and procedures and did pulsed field gel electrophoresis of P. acnes isolates to look for a common source of contamination. They then conducted a prospective cohort study that included all patients who underwent craniotomy/craniectomy procedures between November 2007 and November 2008 and met the study criteria. For the cohort study, the authors obtained cultures from each patient's bone flap during the craniotomy/craniectomy procedures. Data about potential risk factors were collected by circulating nurses during the procedures or by a research assistant who reviewed medical records after the procedures. An infection preventionist independently identified SSIs through routine surveillance using the Centers for Disease Control and Prevention's definitions. Univariate and bivariate analyses were performed to determine the association between SSI and potential risk factors. RESULTS The retrospective review did not identify specific breaks in aseptic technique or a common source of P. acnes. Three hundred seventy-three patients underwent 393 craniotomy/craniectomy procedures during the cohort study period, of which 377 procedures met the study criteria. Fifty percent of the bone flaps were contaminated by microorganisms, primarily skin flora such as P. acnes, coagulase-negative staphylococci, and Staphylococcus aureus. Reimplanting bone flaps that had positive culture results did not increase the risk of infection after the initial craniotomy/craniectomy procedures and the subsequent cranioplasty procedures (p = 0.80). Allowing the skin antiseptic to dry before the procedures (p = 0.04, OR 0.26) was associated with lower risk of SSIs. Female sex (p = 0.02, OR = 3.49) was associated with an increased risk of SSIs; Gliadel wafer implants (p = 0.001, OR = 8.38) were associated with an increased risk of SSIs after procedures to treat tumors. CONCLUSIONS Operative factors such as the way the skin is prepared before the incision rather than the skin flora contaminants on the bone flaps may play an important role in the pathogenesis of SSIs after craniotomy/craniectomy. Gliadel wafers significantly increased the risk of SSI after procedures to treat tumors.
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Affiliation(s)
- Hsiu-yin Chiang
- Department of Epidemiology, University of Iowa College of Public Health, Iowa City, Iowa, USA
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Tung S, Parmar S, Robinson S, De Lima M, Shpall E. Ex vivo expansion of umbilical cord blood for transplantation. Best Pract Res Clin Haematol 2010; 23:245-57. [DOI: 10.1016/j.beha.2010.06.004] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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30
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Quality monitoring of microbial contamination of cryopreserved parathyroid tissue. Cell Tissue Bank 2010; 12:111-6. [PMID: 20058088 DOI: 10.1007/s10561-009-9169-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2009] [Accepted: 12/19/2009] [Indexed: 10/20/2022]
Abstract
Cryopreservation of parathyroid tissue (PT) provides patients undergoing parathyroidectomy with an option for delayed autologous heterotopic parathyroid transplantation. A standard protocol for quality monitoring of PT has not been established. This article describes a method for detecting the presence of bacterial contamination in PT tissue intended for autologous transplantation. PT was received in the tissue bank, processed under aseptic conditions, and placed into cryopreservation medium. Sterility testing was performed at 2 time points prior to cryopreservation. From January 2005 to October 2008, 47 PT samples were cryopreserved. The following bacteria were isolated from 11 PT specimens: Staphylococcus epidermidis, Staphylococcus capitis subspecies ureolyticus, Staphylococcus lugdunensis, Bacillus pumilus, and corynebacteria (diphtheroids). 23% of PTs were contaminated at the time of collection, predominantly with indigenous bacteria. Quality monitoring using this protocol is a useful tool to identify tissues contaminated with bacteria.
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Verdugo F, Castillo A, Moragues MD, Pontón J. Bone microbial contamination influences autogenous grafting in sinus augmentation. J Periodontol 2009; 80:1355-64. [PMID: 19656037 DOI: 10.1902/jop.2009.090113] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND The oral occurrence of putative microbial pathogens in humans has been documented in health and disease. The presence of periodontopathogens in patients with a history of periodontal disease may have a negative impact on bone regeneration. This investigation was conducted to confirm the presence of periodontal pathogens in bone particles harvested intraorally for maxillary sinus augmentation and to assess the clinical and radiographic outcomes 6 to 12 months after bone augmentation. METHODS Culture and polymerase chain reaction (PCR)-based identification were performed by paper-point sampling of intraorally harvested bone particles in a group of 12 maintenance patients undergoing maxillary sinus augmentation. Radiographs were taken to assess and compare bone healing and volume gain at baseline and at 6 to 12 months after augmentation. RESULTS The presence of periodontal pathogens (Porphyromonas gingivalis, Aggregatibacter actinomycetemcomitans [previously Actinobacillus actinomycetemcomitans], Prevotella intermedia, Tannerella forsythia [previously T. forsythensis], Fusobacterium nucleatum, Parvimonas micra [previously Peptostreptococcus micros or Micromonas micros], Campylobacter rectus, enteric Gram-negative rods, and Dialister pneumosintes) was identified in 10 of 12 patients (83%) by culture, PCR, or both and was associated with greater bone volume loss at 6 months postaugmentation. The PCR-positive triad, P. gingivalis, A. actinomycetemcomitans, and P. intermedia, was associated with pronounced volume loss of the grafted sinus at 6 months. CONCLUSIONS To the best of our knowledge, this is the first study to confirm osseous microbial contamination with major periodontopathogens in individuals undergoing maxillary sinus augmentation with a history of periodontitis. The effect on the grafting outcome translated into bone volume loss in the grafted sinus 6 months postaugmentation. Specific microbial contamination may have an impact on osteogenesis in osseous regeneration.
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Mir MA, Battiwalla M. Immune deficits in allogeneic hematopoietic stem cell transplant (HSCT) recipients. Mycopathologia 2009; 168:271-82. [PMID: 19156534 DOI: 10.1007/s11046-009-9181-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2008] [Accepted: 12/31/2008] [Indexed: 01/08/2023]
Abstract
Immune deficits account for the high frequency of life threatening bacterial, viral, and fungal opportunistic infections seen in allogeneic HSCT recipients. Despite advances in infectious disease management, the integrity of host defenses remains the mainstay of defense. The intensity of the preparative regimen, degree of HLA matching, source of stem cells (marrow, blood, or cord), extent of T-cell depletion, and immunosuppressive therapy are some of the factors that impact the kinetics, characteristics, and quality of immune reconstitution. Graft-versus-host disease and its prophylaxis or treatment produce a host environment that is particularly vulnerable to infections. Mucosal disruption and prolonged severe neutropenia usually confine their impact to the early course of transplant. After initial engraftment, HSCT recipients remain at great risk for opportunistic infections and this is related to prolonged and severe T-lymphocyte dysfunction of a complex multifactorial nature. B cell dysfunction is less problematic clinically, but includes deficiencies of immunoglobulin subclasses and impaired ability to mount a vaccine response. Advances in understanding of these immune deficits have resulted in successful strategies including revaccination, growth factors, thymic protection, and adoptive cellular therapy with antigen-specific cells.
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Affiliation(s)
- Muhammad A Mir
- Division of Hematology, University at Buffalo, Buffalo, NY, USA
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Reich-Slotky R, Wu F, Della-Latta P, Savage DG, Schwartz J. Application of pulsed-field gel electrophoresis to identify the source of bacterial contamination of peripheral blood progenitor cell products. Transfusion 2008; 48:2409-13. [DOI: 10.1111/j.1537-2995.2008.01851.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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