1
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Walker BS, Schmidt RL, Moore RA, White SK, Fisher MA, Metcalf RA. Bacterial culture time to detection in platelet components: An evidence synthesis and estimation of detection failures. Transfusion 2023; 63:182-192. [PMID: 36371753 DOI: 10.1111/trf.17179] [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: 08/17/2022] [Revised: 10/20/2022] [Accepted: 10/21/2022] [Indexed: 11/15/2022]
Abstract
BACKGROUND Non-pathogen reduction platelet bacterial risk control strategies in the US FDA guidance include at least one culture. Almost all of these strategies have a culture hold time of ≥12 h. Studies have reported time to detection (TTD) of bacterial cultures inoculated with bacteria from contaminated platelets, but these data and estimates of risk associated with detection failures have not been synthesized. METHODS We performed a literature search to identify studies reporting TTD for samples obtained from spiked platelet components. Using extracted data, regression analysis was used to estimate TTD for culture bottles at different inoculum sizes. Detection failures were defined as events in which contaminated components are transfused to a patient. We then used published data on time of transfusion (ToT) to estimate the risk of detection failures in practice. RESULTS The search identified 1427 studies, of which 16 were included for analysis. TTD data were available for 16 different organisms, including 14 in aerobic cultures and 11 in anaerobic cultures. For inocula of 1 colony forming unit (CFU), the average TTD for aerobic organisms was 19.2 h while it was 24.9 h in anaerobic organisms, but there was substantial overall variation. A hold time of 12 versus 24 h had minimal effect for most organisms. CONCLUSION TTD variation occurs between bacterial species and within a particular species. Under typical inventory management, the relative contribution of culture detection failures is much smaller than the residual risk from sampling failures. Increasing the hold period beyond 12 h has limited value.
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Affiliation(s)
| | - Robert L Schmidt
- ARUP Laboratories, Salt Lake City, Utah, USA.,Department of Pathology, University of Utah, Salt Lake City, Utah, USA
| | - Ryleigh A Moore
- Department of Mathematics, University of Utah, Salt Lake City, Utah, USA
| | - Sandra K White
- Department of Pathology, University of Utah, Salt Lake City, Utah, USA
| | - Mark A Fisher
- ARUP Laboratories, Salt Lake City, Utah, USA.,Department of Pathology, University of Utah, Salt Lake City, Utah, USA
| | - Ryan A Metcalf
- ARUP Laboratories, Salt Lake City, Utah, USA.,Department of Pathology, University of Utah, Salt Lake City, Utah, USA
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2
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Wagner SJ, Snyder EL. Identification and management of bacterially contaminated platelets-Back to the future. Transfusion 2022; 62:1948-1960. [PMID: 36059246 DOI: 10.1111/trf.17088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 08/15/2022] [Indexed: 11/30/2022]
Affiliation(s)
| | - Edward L Snyder
- Transfusion Medicine Service, Department of Laboratory Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
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3
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Cloutier M, De Korte D. Residual risks of bacterial contamination for
pathogen‐reduced
platelet components. Vox Sang 2022; 117:879-886. [DOI: 10.1111/vox.13272] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 12/22/2021] [Accepted: 02/10/2022] [Indexed: 12/14/2022]
Affiliation(s)
- Marc Cloutier
- Medical Affairs and Innovation Héma‐Québec Québec Canada
- Biochemistry, Microbiology and Bio‐informatics Université Laval Québec Canada
| | - Dirk De Korte
- Blood Cell Research Sanquin Research Amsterdam The Netherlands
- Product and Process Development Sanquin Blood Bank Amsterdam The Netherlands
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4
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Technical challenges for complete implementation of automated growth-based methods for microbiological examination of advanced therapy medicinal products. What's wrong with Candida albicans? Cytotherapy 2022; 24:320-333. [DOI: 10.1016/j.jcyt.2021.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 11/10/2021] [Accepted: 11/15/2021] [Indexed: 11/22/2022]
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5
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Koepsell S. Complications of Transfusion. Transfus Med 2021. [DOI: 10.1002/9781119599586.ch16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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6
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Buren N. Laboratory Testing of Donated Blood. Transfus Med 2021. [DOI: 10.1002/9781119599586.ch7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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7
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Sterility Testing of Platelets Concentrate within Quality Control: Experiences and Opportunities to Extend the Application. SERBIAN JOURNAL OF EXPERIMENTAL AND CLINICAL RESEARCH 2020. [DOI: 10.2478/sjecr-2020-0014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Abstract
Despite numerous measures, bacterial sepsis associated with the transfusion remains a major threat. The incidence of septic events induced by platelets transfusion is approximately 10 times higher than with transfused red blood cells due to their storage temperature. This caused new Standard that implements the methods for the detection and reduction of bacteria in the platelet concentrates (PC). The aim is to consider the possibility of wider application of this tests in order to extend the shelf-life of PC. Sterility testing of PC is done once or twice per month using BacT/Alert BPA and BacT/Alert BPN bottles. If positive, all products from the initial unit were tested to confirm or deny the status. During six years period, 67236 PC units were made and 872 of them were tested. Only two were found initially positive. After testing the other products from the same initial unit, results were negative so, final results proclaimed false positive. Pretransfusion bacterial detection is an important potential method for reducing the risk of bacteriemia and transfusion-associated septic reactions. In addition to routine measures, Mirasol PRT pathogen inactivation system, could be included. This allows certain amount of PC to be inactivated during the first 32 hours. Untreated PC units would be stored in standard conditions and for given time (three days) potentially present bacteria would reach a detectable level. This way the quantity of samples for sterility testing could be reduced, taking only 2 mL of each of four units of PC. Samples would be planted at the same vial-aerobic bottle, which would also, double the capacity in BacT/Alert 3D automated system.
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8
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Corean J, White SK, Schmidt RL, Walker BS, Fisher MA, Metcalf RA. The incremental benefit of anaerobic culture for controlling bacterial risk in platelets: a systematic review and meta-analysis. Vox Sang 2020; 116:397-404. [PMID: 32996621 DOI: 10.1111/vox.13013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 09/08/2020] [Accepted: 09/08/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND AND OBJECTIVES Septic transfusion reactions are a principal cause of transfusion-related mortality. The frequency of detectable bacterial contamination is greater in platelets compared to other blood components because platelets are stored at room temperature. Most strategies outlined in the September 2019 FDA guidance require both aerobic culture (AC) and anaerobic culture (AnC) testing. We performed a systematic review and meta-analysis in an effort to provide the best available estimate of the effectiveness of AnC. MATERIALS AND METHODS Our analysis was performed according to published guidelines. Broad and context-specific meta-analyses of bacterial detection rates in platelets by AnC were performed to assess the practical effectiveness of AnC as a risk control measure. RESULTS Seven studies with a total of 1 767 014 tested platelet components were included for analysis. With exclusion of positives due to Cutibacterium/Propionibacterium species and redundancy due to AC results, AnC detected 0·06 contamination events per thousand (EPT) components tested, twofold lower than the AC (0·12 EPT). CONCLUSION Excluding Cutibacterium/Propionibacterium species, AnC detects occasional bacterial contamination events that are not detected by AC (~1 in 17 000 platelet components).
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Affiliation(s)
- Jessica Corean
- Department of Pathology, University of Utah, Salt Lake City, UT, USA
| | - Sandra K White
- Department of Pathology, University of Utah, Salt Lake City, UT, USA
| | - Robert L Schmidt
- Department of Pathology, University of Utah, Salt Lake City, UT, USA.,ARUP Laboratories, Salt Lake City, UT, USA
| | | | - Mark A Fisher
- Department of Pathology, University of Utah, Salt Lake City, UT, USA.,ARUP Laboratories, Salt Lake City, UT, USA
| | - Ryan A Metcalf
- Department of Pathology, University of Utah, Salt Lake City, UT, USA.,ARUP Laboratories, Salt Lake City, UT, USA
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9
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Günther SK, Geiss C, Kaiser SJ, Mutters NT, Günther F. Microbiological Control of Cellular Products: The Relevance of the Cellular Matrix, Incubation Temperature, and Atmosphere for the Detection Performance of Automated Culture Systems. Transfus Med Hemother 2019; 47:254-263. [PMID: 32595430 DOI: 10.1159/000503397] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Accepted: 09/16/2019] [Indexed: 11/19/2022] Open
Abstract
Background The microbiological control of cellular products sometimes causes significant procedural issues for quality control laboratories. According to the European Pharmacopoeia (EP), the microbiological control of cellular products requires a 7- to 14-day incubation period at two different incubation temperatures using aerobic and anaerobic growth media. However, the suitability of these test conditions for efficient quality control can be influenced by many conditions, such as the expected microbial spectrum of contamination or the texture and composition of the cellular product. Because of interference, direct inoculation and membrane filtration as reference methods of pharmacopoeia are largely unsuitable for the microbiological control of cellular products; therefore, alternative and, above all, automated methods are the focus of interest. Objective The aim of our study was to evaluate the method suitability and possible effects of cell matrix, incubation temperature, and oxygen pressure on the detection performance of automated culture systems. Methods The BacT/ALERT® 3D<sup>TM</sup> Dual T system (bioMérieux, Nürtingen, Germany) was used to evaluate the factors influencing automated microbiological control of cellular products. The tests were performed using microbial strains recommended by the EP for microbiological method suitability testing and additional relevant possible contaminants of human-derived stem-cell products under varying culture and cell matrix conditions. Results All contaminants were detected by the system in the required period of 2-5 days. Low incubation temperatures (22°C) had overall negative effects on the detection kinetics of each type of microbial contamination. The adverse effects of the accompanying cell matrix on the detection properties of the system could be compensated in our study by incubation at 32°C in both the aerobic and the anaerobic culture conditions. Conclusion Automated culture techniques represent a sufficient approach for the microbiological control of cellular products. The negative effects of the cell matrix and microbial contamination on the detection performance can be compensated by the application of variable culture conditions in the automated culture system.
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Affiliation(s)
- Susanne-Katharina Günther
- German Red Cross Blood Donor Service, Mannheim, Germany.,Institute for Laboratory Medicine and Pathobiochemistry, Molecular Diagnostics, Philipps-University of Marburg, Marburg, Germany
| | - Celina Geiss
- Medical Microbiology and Hygiene, Department of Infectious Diseases, Heidelberg University Hospital, Heidelberg, Germany
| | - Stefan J Kaiser
- Medical Microbiology and Hygiene, Department of Infectious Diseases, Heidelberg University Hospital, Heidelberg, Germany
| | - Nico T Mutters
- Medical Microbiology and Hygiene, Department of Infectious Diseases, Heidelberg University Hospital, Heidelberg, Germany.,Department of Infection Control, Freiburg University Hospital, Freiburg, Germany
| | - Frank Günther
- Medical Microbiology and Hygiene, Department of Infectious Diseases, Heidelberg University Hospital, Heidelberg, Germany.,Division of Infection Control, Medical Microbiology and Hygiene, Philipps University of Marburg, Marburg, Germany
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10
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Corrêa TQ, Blanco KC, Soares JM, Inada NM, Kurachi C, Golim MDA, Deffune E, Bagnato VS. Photodynamic inactivation for in vitro decontamination of Staphylococcus aureus in whole blood. Photodiagnosis Photodyn Ther 2019; 28:58-64. [PMID: 31412273 DOI: 10.1016/j.pdpdt.2019.08.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Revised: 08/05/2019] [Accepted: 08/09/2019] [Indexed: 01/22/2023]
Abstract
BACKGROUND Blood can be the target of microbial cells in the human body. Erythrocytes, platelets, and plasma concentrates in blood bags used in hemotherapy for blood transfusion are contamination targets, which can trigger serious diseases in blood. These infections can cause septicemia that can lead to death if not recognized rapidly and treated adequately. The aim of this study was to evaluate the photodynamic inactivation in the in vitro decontamination of Staphylococcus aureus in whole blood, erythrocytes and platelet-rich plasma. METHODS Photodynamic inactivation using light doses of 10, 15 and 30 J/cm2 at 630 nm and an hematoporphyrin-derivative photosensitizer (Photogem®) solutions at 25 and 50 μg/mL were evaluated. Toxicity of treatment was determined by hemolysis and cell viability assays. RESULTS The S. aureus reduction in phosphate buffered saline (PBS), whole blood, erythrocytes and platelet-rich plasma at 15 J/cm2 and 50 μg/mL were 7.2, 1.0, 1.3 and 0.4 log CFU/mL, respectively. Quantitative and qualitative analyses were performed in whole blood samples, and Photogem® showed a low risk of hemolysis (10.7%) in whole blood. However, 100% of erythrocytes suffered hemolysis in the absence of plasma. The cell viability assay showed 13.9% of apoptosis in erythrocytes, but normal platelet viability. CONCLUSION S. aureus inactivation of whole blood samples using 50 μg/mL Photogem® and 15 J/cm2 resulted in better outcomes, providing promising indications for treatment of bacterial contamination of blood, and in this work, alternative possibilities to apply the technique for blood decontamination are discussed.
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Affiliation(s)
- Thaila Quatrini Corrêa
- PPG Biotec, Federal University of São Carlos, 13565-905, São Carlos, São Paulo, Brazil; São Carlos Institute of Physics, University of São Paulo, PO Box 369, 13560-970, São Carlos, São Paulo, Brazil.
| | - Kate Cristina Blanco
- São Carlos Institute of Physics, University of São Paulo, PO Box 369, 13560-970, São Carlos, São Paulo, Brazil
| | - Jennifer Machado Soares
- São Carlos Institute of Physics, University of São Paulo, PO Box 369, 13560-970, São Carlos, São Paulo, Brazil
| | - Natalia Mayumi Inada
- São Carlos Institute of Physics, University of São Paulo, PO Box 369, 13560-970, São Carlos, São Paulo, Brazil
| | - Cristina Kurachi
- São Carlos Institute of Physics, University of São Paulo, PO Box 369, 13560-970, São Carlos, São Paulo, Brazil
| | | | - Elenice Deffune
- Botucatu Medical School, São Paulo State University, 18618-687, Botucatu, São Paulo, Brazil
| | - Vanderlei Salvador Bagnato
- São Carlos Institute of Physics, University of São Paulo, PO Box 369, 13560-970, São Carlos, São Paulo, Brazil
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11
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Siddon AJ, Tormey CA, Snyder EL. Platelet Transfusion Medicine. Platelets 2019. [DOI: 10.1016/b978-0-12-813456-6.00064-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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12
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Chetouane Y, Gallian P, Chetouane K, Dubourg G, Chiaroni J, Raoult D, Camoin-Jau L. Comparing two blood culture systems for the detection of bacterial contamination in platelet concentrates. Transfusion 2018; 58:2604-2610. [PMID: 30293236 DOI: 10.1111/trf.14911] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Revised: 04/27/2018] [Accepted: 05/18/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND The transfusion of platelet concentrates (PCs) contaminated with bacteria may cause serious, and even fatal, septic reactions in patients. The aim of this study was to compare the VersaTREK with the BACTEC FX automated culture systems for screening bacterial contamination, directly after the delay of 24 hours of preparation to obtain the final pooled buffy coat PCs, to prevent transfusion-transmitted bacterial infections. STUDY DESIGN AND METHODS Seven bacterial strains were each inoculated into five replicate pooled buffy coat PCs at approximately 100 colony-forming units/unit, and 5- or 10-mL samples were inoculated into duplicate aerobic culture bottles. The time and detection rates were compared between BACTEC FX, as a reference method, and VersaTREK. RESULTS Time to detection was significantly shorter using VersaTREK for most species detected by both systems for the volumes tested. Of 70 VersaTREK cultures, 69 (98.57% detection rate) were positive after 24 hours of incubation with the 5-mL sample. In contrast, the BACTEC FX system detected all positive samples in PCs for the volume of 10 mL, although seven samples were false negatives for the 5-mL volume. CONCLUSION The VersaTREK system compared favorably to the BACTEC FX system for 5-mL volumes (p < 0.05) and could be considered a potential method for detecting bacterial contamination in PC samples directly after 24 hours of preparation of the final pooled buffy coat PCs.
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Affiliation(s)
- Yasmine Chetouane
- Aix-Marseille Université, Microbes, Evolution, Phylogeny and Infection (MEPHI) MEPHI, Institut de Recherche pour le Développement (IRD) IRD 198, Marseille, France.,Institut Hospitalo-Universitaire Méditerranée-Infection, Pôle des Maladies Infectieuses, Assistance Publique-Hôpitaux de Marseille
| | - Pierre Gallian
- Institut Hospitalo-Universitaire Méditerranée-Infection, Pôle des Maladies Infectieuses, Assistance Publique-Hôpitaux de Marseille.,Etablissement Français du Sang (EFS) Alpes Méditerranée, Marseille, France
| | - Kahina Chetouane
- Université Paris-Sud, Châtenay-Malabry, Assistance Publique des Hôpitaux de Paris, Paris, France
| | - Gregory Dubourg
- Aix-Marseille Université, Microbes, Evolution, Phylogeny and Infection (MEPHI) MEPHI, Institut de Recherche pour le Développement (IRD) IRD 198, Marseille, France.,Institut Hospitalo-Universitaire Méditerranée-Infection, Pôle des Maladies Infectieuses, Assistance Publique-Hôpitaux de Marseille
| | - Jacques Chiaroni
- Etablissement Français du Sang (EFS) Alpes Méditerranée, Marseille, France.,Aix-Marseille Université, Centre national de la recherche scientifique (CNRS) CNRS, EFS, Anthropologie Bio-culturelle, Droit, Ethique et Santé ADES Unité mixte de recherche (UMR) UMR 7268, Marseille, France
| | - Didier Raoult
- Aix-Marseille Université, Microbes, Evolution, Phylogeny and Infection (MEPHI) MEPHI, Institut de Recherche pour le Développement (IRD) IRD 198, Marseille, France.,Institut Hospitalo-Universitaire Méditerranée-Infection, Pôle des Maladies Infectieuses, Assistance Publique-Hôpitaux de Marseille
| | - Laurence Camoin-Jau
- Aix-Marseille Université, Microbes, Evolution, Phylogeny and Infection (MEPHI) MEPHI, Institut de Recherche pour le Développement (IRD) IRD 198, Marseille, France.,Institut Hospitalo-Universitaire Méditerranée-Infection, Pôle des Maladies Infectieuses, Assistance Publique-Hôpitaux de Marseille.,Laboratoire d'Hématologie, Centre hospitalo-universitaire CHU Timone, Assistance Publique Hôpitaux de Marseille, Marseille, France
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13
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Brailsford SR, Tossell J, Morrison R, McDonald CP, Pitt TL. Failure of bacterial screening to detect Staphylococcus aureus: the English experience of donor follow-up. Vox Sang 2018; 113:540-546. [PMID: 29799121 DOI: 10.1111/vox.12670] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Revised: 04/27/2018] [Accepted: 05/05/2018] [Indexed: 12/17/2022]
Abstract
BACKGROUND AND OBJECTIVES Between February 2011 and December 2016, over 1·6 million platelet units, 36% pooled platelets, underwent bacterial screening prior to issue. Contamination rates for apheresis and pooled platelets were 0·02% and 0·07%, respectively. Staphylococcus aureus accounted for 21 contaminations, including four pooled platelets, one confirmed transfusion-transmitted infection (TTI) and three 'near-miss' incidents detected on visual inspection which were negative on screening. We describe follow-up investigations of 16 donors for skin carriage of S. aureus and molecular characterisation of donor and pack isolates. MATERIALS AND METHODS Units were screened by the BacT/ALERT 3D detection system. Contributing donors were interviewed and consent requested for skin and nasal swabbing. S. aureus isolates were referred for spa gene type and DNA macrorestriction profile to determine identity between carriage strains and packs. RESULTS Donors of 10 apheresis and two pooled packs screen positive for S. aureus were confirmed as the source of contamination; seven had a history of skin conditions, predominantly eczema; 11 were nasal carriers. The 'near-miss' incidents were associated with apheresis donors, two donors harboured strains indistinguishable from the pack strain. The TTI was due to a screen-negative pooled unit, and a nasal isolate of one donor was indistinguishable from that in the unit. CONCLUSION Staphylococcus aureus contamination is rare but potentially harmful in platelet units. Donor isolates showed almost universal correspondence in molecular type with pack isolates, thus confirming the source of contamination. The importance of visual inspection of packs prior to transfusion is underlined by the 'near-miss' incidents.
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Affiliation(s)
- S R Brailsford
- Microbiology Services, NHS Blood and Transplant, London, UK
| | - J Tossell
- Microbiology Services, NHS Blood and Transplant, London, UK
| | - R Morrison
- Microbiology Services, NHS Blood and Transplant, London, UK
| | - C P McDonald
- Microbiology Services, NHS Blood and Transplant, London, UK
| | - T L Pitt
- Microbiology Services, NHS Blood and Transplant, London, UK
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14
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Tomasulo PA. Reducing the risk of septic transfusion reactions from platelets. Transfusion 2018; 57:1099-1103. [PMID: 28425607 DOI: 10.1111/trf.14111] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Accepted: 02/28/2017] [Indexed: 11/30/2022]
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15
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Benjamin RJ, Braschler T, Weingand T, Corash LM. Hemovigilance monitoring of platelet septic reactions with effective bacterial protection systems. Transfusion 2017; 57:2946-2957. [PMID: 28840603 DOI: 10.1111/trf.14284] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Revised: 07/01/2017] [Accepted: 07/02/2017] [Indexed: 02/05/2023]
Abstract
BACKGROUND Delayed, large-volume bacterial culture and amotosalen/ultraviolet-A light pathogen reduction are effective at reducing the risk of bacterial proliferation in platelet concentrates (PCs). Hemovigilance programs continue to receive reports of suspected septic transfusion reactions, most with low imputability. Here, we compile national hemovigilance data to determine the relative efficacy of these interventions. STUDY DESIGN AND METHODS Annual reports from the United Kingdom, France, Switzerland, and Belgium were reviewed between 2005 and 2016 to assess the risk of bacterial contamination and septic reactions. RESULTS Approximately 1.65 million delayed, large-volume bacterial culture-screened PCs in the United Kingdom and 2.3 million amotosalen/ultraviolet-A-treated PCs worldwide were issued with no reported septic fatalities. One definite, one possible, and 12 undetermined/indeterminate septic reactions and eight contaminated "near misses" were reported with delayed, large-volume bacterial cultures between 2011 and 2016, for a lower false-negative culture rate than that in the previous 5 years (5.4 vs. 16.3 per million: odds ratio, 3.0; 95% confidence interval, 1.4-6.5). Together, the Belgian, Swiss, and French hemovigilance programs documented zero probable or definite/certain septic reactions with 609,290 amotosalen/ultraviolet-A-treated PCs (<1.6 per million). The rates were significantly lower than those reported with concurrently transfused, nonpathogen-reduced PCs in Belgium (<4.4 vs. 35.6 per million: odds ratio, 8.1; 95% confidence interval,1.1-353.3) and with historic septic reaction rates in Switzerland (<6.0 vs. 82.9 per million: odds ratio, 13.9; 95% confidence interval, 2.1-589.2), and the rates tended to be lower than those from concurrently transfused, nonpathogen-reduced PCs in France (<4.7 vs. 19.0 per million: odds ratio, 4.1; 95% confidence interval, 0.7-164.3). CONCLUSION Pathogen reduction and bacterial culture both reduced the incidence of septic reactions, although under-reporting and strict imputability criteria resulted in an underestimation of risk.
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Affiliation(s)
| | | | - Tina Weingand
- Blutspendedienst Zentralschweiz SRK, Luzern, Switzerland
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16
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Complications of Transfusion. Transfus Med 2016. [DOI: 10.1002/9781119236504.ch14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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17
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Laboratory Testing of Donated Blood. Transfus Med 2016. [DOI: 10.1002/9781119236504.ch8] [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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18
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Hadjesfandiari N, Schubert P, Fallah Toosi S, Chen Z, Culibrk B, Ramirez-Arcos S, Devine DV, Brooks DE. Effect of texture of platelet bags on bacterial and platelet adhesion. Transfusion 2016; 56:2808-2818. [DOI: 10.1111/trf.13756] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Revised: 06/29/2016] [Accepted: 07/03/2016] [Indexed: 11/30/2022]
Affiliation(s)
- Narges Hadjesfandiari
- Department of Chemistry; Canadian Blood Services; Vancouver British Columbia
- Centre for Blood Research, University of British Columbia, Canadian Blood Services; Vancouver British Columbia
| | - Peter Schubert
- Centre for Blood Research, University of British Columbia, Canadian Blood Services; Vancouver British Columbia
- Centre for Innovation, Canadian Blood Services; Vancouver British Columbia
- Department of Pathology and Laboratory Medicine; University of British Columbia; Vancouver British Columbia
| | - Salma Fallah Toosi
- Department of Chemical and Biological Engineering; University of British Columbia; Vancouver Canada
| | - Zhongming Chen
- Centre for Blood Research, University of British Columbia, Canadian Blood Services; Vancouver British Columbia
- Centre for Innovation, Canadian Blood Services; Vancouver British Columbia
| | - Brankica Culibrk
- Centre for Blood Research, University of British Columbia, Canadian Blood Services; Vancouver British Columbia
- Centre for Innovation, Canadian Blood Services; Vancouver British Columbia
| | | | - Dana V. Devine
- Centre for Blood Research, University of British Columbia, Canadian Blood Services; Vancouver British Columbia
- Centre for Innovation, Canadian Blood Services; Vancouver British Columbia
- Department of Pathology and Laboratory Medicine; University of British Columbia; Vancouver British Columbia
| | - Donald E. Brooks
- Department of Chemistry; Canadian Blood Services; Vancouver British Columbia
- Centre for Blood Research, University of British Columbia, Canadian Blood Services; Vancouver British Columbia
- Department of Pathology and Laboratory Medicine; University of British Columbia; Vancouver British Columbia
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19
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Zomorodian K, Rahimi MJ, Taheri M, Ghanbari Asad A, Khani S, Ahrari I, Pakshir K, Khashei R. The cutaneous bacterial microflora of the bodybuilders using anabolic-androgenic steroids. Jundishapur J Microbiol 2014; 8:e12269. [PMID: 25789120 PMCID: PMC4350042 DOI: 10.5812/jjm.12269] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2013] [Revised: 07/10/2014] [Accepted: 08/05/2014] [Indexed: 11/16/2022] Open
Abstract
Background: Anabolic-androgenic steroids (AAS) abuse by the athletes has dramatically increased during the recent decades. These substances might increase the skin lipids and enhance the cutaneous microbial proliferation. Objectives: The current study aimed to investigate the potential side effects of AAS on the bacterial microflora colonization of the bodybuilders` skin. Patients and Methods: The skin samples of 94 male bodybuilders (71 AAS users, 23 non-AAS users) and 46 subjects of the control group, with similar gender and age, were cultured and incubated in both aerobic condition to isolate Staphylococcus aureus and anaerobic condition for Propionibacterium acnes. The isolated bacteria were identified by standard microbiological techniques. Results: The skin lesions were more frequent in the body builders than the controls. Moreover, statistically significant differences were also observed in skin lesions among the AAS users and the non-AAS user athletes. The prevalence of S. aureus and P. acnes in the athletes was higher than that of the control group. In addition, there was a significant difference in distribution of P. acnes between the bodybuilders who used AAS and those who did not. Conclusions: A higher number of bacterial flora was found in the bodybuilders particularly those using AAS in comparison to the controls, which might be due to the influence of these AAS on the skin microflora and transmission of the bacteria through the direct contact of the naked skin with the exercise instruments.
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Affiliation(s)
- Kamiar Zomorodian
- Basic Sciences in Infectious Diseases Research Center, Shiraz University Of Medical Sciences, Shiraz, IR Iran
- Department of Medical Mycology and Parasitology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, IR Iran
- Corresponding author: Kamiar Zomorodian, Department of Medical Mycology and Parasitology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, IR Iran. Tel/Fax: +98-7112305291, E-mail:
| | - Mohammad Javad Rahimi
- Basic Sciences in Infectious Diseases Research Center, Shiraz University Of Medical Sciences, Shiraz, IR Iran
- Department of Medical Mycology and Parasitology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, IR Iran
| | - Mohammad Taheri
- Department of Bacteriology and Virology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, IR Iran
| | - Ali Ghanbari Asad
- Department of Medical Mycology and Parasitology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, IR Iran
| | - Soghra Khani
- Department of Medical Mycology and Parasitology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, IR Iran
| | - Iman Ahrari
- Department of Bacteriology and Virology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, IR Iran
| | - Keyvan Pakshir
- Basic Sciences in Infectious Diseases Research Center, Shiraz University Of Medical Sciences, Shiraz, IR Iran
- Department of Medical Mycology and Parasitology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, IR Iran
| | - Reza Khashei
- Department of Bacteriology and Virology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, IR Iran
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Characterization of the growth dynamics and biofilm formation of Staphylococcus epidermidis strains isolated from contaminated platelet units. J Med Microbiol 2014; 63:884-891. [DOI: 10.1099/jmm.0.071449-0] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Bacterial contamination of platelet concentrates (PCs) poses the highest transfusion-associated infectious risk, with Staphylococcus epidermidis being a predominant contaminant. Herein, the growth dynamics of 20 S. epidermidis strains in PCs and regular media were characterized. Strains were categorized as fast (short lag phase) or slow (long lag phase) growers in PCs. All strains were evaluated for the presence of the biofilm-associated icaAD genes by PCR, their capability to produce extracellular polysaccharide (slime) on Congo red agar plates and their ability to form surface-attached aggregates (biofilms) in glucose-supplemented trypticase soy broth (TSBg) using a crystal violet staining assay. A subset of four strains (two slow growers and two fast growers) was further examined for the ability for biofilm formation in PCs. Two of these strains carried the icAD genes, formed slime and produced biofilms in TSBg and PCs, while the other two strains, which did not carry icaAD, did not produce slime or form biofilms in TSBg. Although the two ica-negative slime-negative strains did not form biofilms in media, they displayed a biofilm-positive phenotype in PCs. Although all four strains formed biofilms in PCs, the two slow growers formed significantly more biofilms than the fast growers. Furthermore, growth experiments of the two ica-positive strains in plasma-conditioned platelet bags containing TSBg revealed that a slow grower isolate was more likely to escape culture-based screening than a fast grower strain. Therefore, this study provides novel evidence that links S. epidermidis biofilm formation with slow growth in PCs and suggests that slow-growing biofilm-positive S. epidermidis would be more likely to be missed with automate culture.
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The International Experience of Bacterial Screen Testing of Platelet Components With an Automated Microbial Detection System: A Need for Consensus Testing and Reporting Guidelines. Transfus Med Rev 2014; 28:61-71. [DOI: 10.1016/j.tmrv.2014.01.001] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2013] [Revised: 01/25/2014] [Accepted: 01/27/2014] [Indexed: 11/30/2022]
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Heaton WA, Good CE, Galloway-Haskins R, Yomtovian RA, Jacobs MR. Evaluation of a rapid colorimetric assay for detection of bacterial contamination in apheresis and pooled random-donor platelet units. Transfusion 2014; 54:1634-41. [DOI: 10.1111/trf.12603] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2013] [Revised: 10/04/2013] [Accepted: 10/07/2013] [Indexed: 12/26/2022]
Affiliation(s)
- W. Andrew Heaton
- Blood Component Research Laboratory; Feinstein Institute for Medical Research; Manhasset New York
| | - Caryn E. Good
- Department of Pathology; Case Western Reserve University; Cleveland Ohio
- Department of Pathology; University Hospitals Case Medical Center; Cleveland Ohio
| | - Rakijah Galloway-Haskins
- Blood Component Research Laboratory; Feinstein Institute for Medical Research; Manhasset New York
| | - Roslyn A. Yomtovian
- Department of Pathology; Case Western Reserve University; Cleveland Ohio
- Department of Pathology and Laboratory Medicine; Louis Stokes VA Medical Center; Cleveland Ohio
| | - Michael R. Jacobs
- Department of Pathology; Case Western Reserve University; Cleveland Ohio
- Department of Pathology; University Hospitals Case Medical Center; Cleveland Ohio
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Hahn S, Sireis W, Hourfar K, Karpova D, Dauber K, Kempf VAJ, Seifried E, Schmidt M, Bönig H. Effects of storage temperature on hematopoietic stability and microbial safety of BM aspirates. Bone Marrow Transplant 2013; 49:338-48. [PMID: 24185589 DOI: 10.1038/bmt.2013.176] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2013] [Revised: 09/06/2013] [Accepted: 09/24/2013] [Indexed: 12/31/2022]
Abstract
Bone marrow (BM) remains a common source for hematopoietic SCT. Due to the transcutaneous approach, contamination with skin bacteria is common. The delay between harvest and transfusion can be considerable, potentially allowing for bacterial proliferation. The optimal transportation temperature, specifically with respect to bacterial growth and consequences thereof for hematopoietic quality, remain undefined. For 72 h, 66 individual BM samples, non-spiked/spiked with different bacteria, stored at 20-24 °C room temperature (RT) or 3-5 °C (cold), were serially analyzed for hematopoietic quality and microbial burden. Under most conditions, hematopoietic quality of BM was equal or better at RT: Typical BM contaminants (P. acnes and S. epidermidis) and E. coli were killed or bacterial proliferation was arrested at RT; hematopoietic quality was not impacted by the contamination. However, several pathogenic bacteria not typically found in BM (S. aureus and K. pneumoniae) proliferated dramatically at RT and impaired hematopoietic quality. Bacterial proliferation was arrested in the cold. The overwhelming majority of BM samples, that is, those that are sterile or contaminated only with skin commensals, will benefit from transportation at RT. Those bacteria that proliferate and perturb hematopoietic quality are not typically found in BM. Our data support recommendations for RT transportation and storage of BM.
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Affiliation(s)
- S Hahn
- German Red Cross Blood Service Baden-Wuerttemberg-Hessen and Institute for Transfusion Medicine and Immunohematology, Goethe University Medical Center, Frankfurt, Germany
| | - W Sireis
- German Red Cross Blood Service Baden-Wuerttemberg-Hessen and Institute for Transfusion Medicine and Immunohematology, Goethe University Medical Center, Frankfurt, Germany
| | - K Hourfar
- German Red Cross Blood Service Baden-Wuerttemberg-Hessen and Institute for Transfusion Medicine and Immunohematology, Goethe University Medical Center, Frankfurt, Germany
| | - D Karpova
- German Red Cross Blood Service Baden-Wuerttemberg-Hessen and Institute for Transfusion Medicine and Immunohematology, Goethe University Medical Center, Frankfurt, Germany
| | - K Dauber
- German Red Cross Blood Service Baden-Wuerttemberg-Hessen and Institute for Transfusion Medicine and Immunohematology, Goethe University Medical Center, Frankfurt, Germany
| | - V A J Kempf
- Institute for Medical Microbiology and Infection Control, Goethe University Medical Center, Frankfurt, Germany
| | - E Seifried
- German Red Cross Blood Service Baden-Wuerttemberg-Hessen and Institute for Transfusion Medicine and Immunohematology, Goethe University Medical Center, Frankfurt, Germany
| | - M Schmidt
- German Red Cross Blood Service Baden-Wuerttemberg-Hessen and Institute for Transfusion Medicine and Immunohematology, Goethe University Medical Center, Frankfurt, Germany
| | - H Bönig
- 1] German Red Cross Blood Service Baden-Wuerttemberg-Hessen and Institute for Transfusion Medicine and Immunohematology, Goethe University Medical Center, Frankfurt, Germany [2] Department of Medicine/Hematology, University of Washington, Seattle, WA, USA
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Platelet Transfusion Medicine. Platelets 2013. [DOI: 10.1016/b978-0-12-387837-3.00062-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
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Vuk T, Barišić M, Hećimović A, Rukavina L, Batarilo I, Šarlija D, Jukić I. Bacterial contamination of blood products at the Croatian Institute of Transfusion Medicine: results of eleven-year monitoring. Transfus Med 2012; 22:432-9. [PMID: 23020303 DOI: 10.1111/j.1365-3148.2012.01190.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2012] [Revised: 05/14/2012] [Accepted: 09/05/2012] [Indexed: 11/28/2022]
Abstract
OBJECTIVES The aim of this study is to present the results and experiences of the Croatian Institute of Transfusion Medicine (CITM) in blood product testing for the presence of bacterial contamination. This is the first study analysing the results of bacterial testing of blood products in Croatia. METHODS Results of monitoring blood products for the presence of bacterial contamination during an 11-year period (2000-2010) were retrospectively analysed. As universal screening of platelet concentrates for bacterial contamination is not mandatory in Croatia, the results presented refer to the products tested within the frame of statistical process control. RESULTS A total of 23,130 blood products were tested during the study period. There were 122 (0·53%) initially positive and 41 (0·18%) confirmed positive blood products, whereas suspicion of bacterial contamination could be neither confirmed nor ruled out in 8 (0·03%) blood products. While the frequency of bacterial contamination of plasma products was very low (0·03%), there was no statistically significant difference between bacterial contamination of platelet concentrates (0·26%) and RBC concentrates (0·20%). There were 73 (0·32%) false-positive blood products, with nearly equal proportion of causes related to laboratory contamination (n = 34; 0·15%) and those related to the testing system (n = 39; 0·17%). CONCLUSION The results obtained in the study did not differ significantly from literature data. A number of measures to reduce the risk of bacterial contamination of blood products have been implemented at CITM. The introduction of universal screening of platelet concentrates for the presence of bacterial contamination should be taken into consideration.
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Affiliation(s)
- T Vuk
- Croatian Institute of Transfusion Medicine, Zagreb, Croatia.
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Plantamura E, Huyghe G, Panterne B, Delesalle N, Thépot A, Reverdy ME, Damour O, Auxenfans C. Validation of the BacT/ALERT®3D automated culture system for the detection of microbial contamination of epithelial cell culture medium. Cell Tissue Bank 2011; 13:453-9. [DOI: 10.1007/s10561-011-9281-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2011] [Accepted: 11/17/2011] [Indexed: 10/14/2022]
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Complications of Transfusion. Transfus Med 2011. [DOI: 10.1002/9781444398748.ch14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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29
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Laboratory Testing of Donated Blood. Transfus Med 2011. [DOI: 10.1002/9781444398748.ch8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Tomasulo P, Su L. Is it time for new initiatives in the blood center and/or the hospital to reduce bacterial risk of platelets? Transfusion 2011; 51:2527-33. [DOI: 10.1111/j.1537-2995.2011.03423.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Greco-Stewart VS, Brown EE, Parr C, Kalab M, Jacobs MR, Yomtovian RA, Ramírez-Arcos SM. Serratia marcescens strains implicated in adverse transfusion reactions form biofilms in platelet concentrates and demonstrate reduced detection by automated culture. Vox Sang 2011; 102:212-20. [PMID: 21967170 DOI: 10.1111/j.1423-0410.2011.01550.x] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND AND OBJECTIVES Serratia marcescens is a gram-negative bacterium that has been implicated in adverse transfusion reactions associated with contaminated platelet concentrates. The aim of this study was to investigate whether the ability of S. marcescens to form surface-attached aggregates (biofilms) could account for contaminated platelet units being missed during screening by the BacT/ALERT automated culture system. MATERIALS AND METHODS Seven S. marcescens strains, including biofilm-positive and biofilm-negative control strains and five isolates recovered from contaminated platelet concentrates, were grown in enriched Luria-Bertani medium and in platelets. Biofilm formation was examined by staining assay, dislodging experiments and scanning electron microscopy. Clinical strains were also analysed for their ability to evade detection by the BacT/ALERT system. RESULTS All strains exhibited similar growth in medium and platelets. While only the biofilm-positive control strain formed biofilms in medium, this strain and three clinical isolates associated with transfusion reactions formed biofilms in platelet concentrates. The other two clinical strains, which had been captured during platelet screening by BacT/ALERT, failed to form biofilms in platelets. Biofilm-forming clinical isolates were approximately three times (P<0·05) more likely to be missed by BacT/ALERT screening than biofilm-negative strains. CONCLUSION S. marcescens strains associated with transfusion reactions form biofilms under platelet storage conditions, and initial biofilm formation correlates with missed detection of contaminated platelet concentrates by the BacT/ALERT system.
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Albertoni G, Andrade SS, Araújo PRB, Carvalho FO, Girão MJBC, Barreto JA. Evaluation of two detection methods of microorganisms in platelet concentrates. Transfus Med 2011; 21:408-16. [DOI: 10.1111/j.1365-3148.2011.01105.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Rieder R, Zhao Z, Nittayajarn A, Zavizion B. Direct detection of the bacterial stress response in intact samples of platelets by differential impedance. Transfusion 2010; 51:1037-46. [PMID: 20977486 DOI: 10.1111/j.1537-2995.2010.02917.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND We have previously described a new rapid approach that relies on monitoring intentionally stressed bacteria in contaminated platelet concentrates (PCs). This earlier work included human cell lysis with Triton X-100 and filtration as steps in the sample preparation. This study was undertaken to develop an improved and time-saving protocol that enables direct bacterial detection in PCs without lysis and filtration. STUDY DESIGN AND METHODS Apheresis- or whole blood-derived PCs were spiked with 17 model bacteria and tested at final concentrations from 10(3) to 10(6) colony-forming units (CFUs)/mL. The contaminated PCs were treated with a chemical compound that induces a stress response in bacteria and monitored using differential impedance sensing to detect and record subtle changes in the dielectric permittivities of the contaminated platelet (PLT) samples. RESULTS No measurable responses from sterile PLT samples were observed during exposure to the compounds used as stressors. In contrast, distinct response profiles were obtained without exception for all 17 bacterial species for all bacterial concentrations tested. Bacterial presence was established within 5 to 10 minutes for high inocula (10(6) and 10(5) CFUs/mL) while low inocula (10(4) and 10(3) CFUs/mL) were usually detectable within 20 minutes. The entire testing process routinely took less than 30 minutes from the point of sampling to the time that the final results are available. CONCLUSIONS The results described here demonstrate that monitoring the development of stress in bacteria is a fast and simple way to detect 10(3) CFUs/mL or more bacteria in complex cellular blood products such as PCs.
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Affiliation(s)
- Ronald Rieder
- BioSense Technologies, Inc., Woburn, Massachusetts 01801, USA.
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Slichter SJ, Bolgiano D, Corson J, Jones MK, Christoffel T. Extended storage of platelet-rich plasma-prepared platelet concentrates in plasma or Plasmalyte. Transfusion 2010; 50:2199-209. [PMID: 20456703 PMCID: PMC2970715 DOI: 10.1111/j.1537-2995.2010.02669.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Using bacterial detection or pathogen reduction, extended platelet (PLT) storage may be licensed if PLT viability is maintained. The Food and Drug Administration (FDA)'s poststorage PLT acceptance guidelines are that autologous stored PLT recoveries and survivals should be 66 and 58% or greater, respectively, of each donor's fresh PLT data. STUDY DESIGN AND METHODS Nonleukoreduced PLT concentrates were prepared from whole blood donations. Autologous PLT concentrates from 62 subjects were stored in 100% plasma (n=44) or 20% plasma/80% Plasmalyte (n=18), an acetate-based, non-glucose-containing crystalloid solution previously used for PLT storage. Fresh PLTs were obtained on the day the donor's stored PLTs were to be transfused. The fresh and stored PLTs were alternately radiolabeled with either (51) chromium or (111) indium, and in vitro measurements were performed on the stored PLTs. RESULTS The FDA's PLT recovery criteria were met for 7 days of plasma storage, but PLT survivals maintained viability for only 6 days. Plasmalyte-stored PLTs did not meet either acceptance criteria after 6 days of storage. After 7 days of storage, PLT recoveries averaged 43±4 and 30±4% and survivals 4.1±0.4 and 2.0±0.2 days for plasma- and Plasmalyte-stored PLTs, respectively (p=0.03 for recoveries and p<0.001 for survivals). Poststorage PLT recoveries correlated with the commonly used in vitro PLT quality measurements of hypotonic shock response and annexin V binding, while survivals correlated with extent of shape change, morphology score, and pH. CONCLUSION There is a progressive decrease in recoveries and survivals of plasma-stored PLTs over time. PLT viability is better maintained in plasma than Plasmalyte.
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Affiliation(s)
- Sherrill J Slichter
- Puget Sound Blood Center and the University of Washington School of Medicine, Seattle, Washington 98104-1256, USA.
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Barker LM, Nanassy OZ, Reed MW, Geelhood SJ, Pfalzgraf RD, Cangelosi GA, De Korte D. Multiple pH measurement during storage may detect bacterially contaminated platelet concentrates. Transfusion 2010; 50:2731-7. [DOI: 10.1111/j.1537-2995.2010.02727.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Read E, Shah R, Riley B, Park J, Brorson K, Rathore A. Process analytical technology (PAT) for biopharmaceutical products: Part II. Concepts and applications. Biotechnol Bioeng 2010; 105:285-95. [DOI: 10.1002/bit.22529] [Citation(s) in RCA: 113] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Blumberg N, Heal JM, Phillips GL. Platelet transfusions: trigger, dose, benefits, and risks. F1000 MEDICINE REPORTS 2010; 2:5. [PMID: 20502614 PMCID: PMC2874899 DOI: 10.3410/m2-5] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Over the last half century, platelet transfusion has been an effective therapy for the prevention and treatment of bleeding, particularly in patients with hematologic malignancies. Recent randomized trials have demonstrated that current practices may be suboptimal in a number of ways. The rationale for parsimony in the use of this powerful therapy includes previously described severe and fatal adverse outcomes (including refractoriness, hemolysis from ABO-mismatched transfusions, acute lung injury, and bacterial sepsis), newly described serious potential risks (including thrombosis and earlier leukemic recurrence), difficulty in maintaining adequate supplies of platelets, the need to place volunteer donors on cell separators to provide the product, and cost. Recent findings demonstrate that the platelet count threshold for prophylactic transfusion can be as low as 10,000/µL, and a therapeutic rather than a prophylactic strategy of transfusion for bleeding manifestations only may be equally safe for most patients. Another recently completed study suggests that very low doses of platelet transfusions (the equivalent of half a unit of apheresis platelets or two to three units of whole blood-derived platelets) are as effective at preventing bleeding as much higher doses. One question for which there are no randomized trial data is at what threshold prophylactic platelet transfusion should be given before invasive procedures or major surgery. The typically recommended threshold of 50,000/µL is based only on expert opinion, and substantial observational data indicate that this threshold leads to many transfusions that are likely unnecessary and therefore represent risk with little or no additional benefit.
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Affiliation(s)
- Neil Blumberg
- Transfusion Medicine Unit, Department of Pathology & Laboratory Medicine, University of Rochester Medical Center601 Elmwood Avenue, Box 608, Rochester, NY 14642USA
| | - Joanna M Heal
- Transfusion Medicine Unit, Department of Pathology & Laboratory Medicine, University of Rochester Medical Center601 Elmwood Avenue, Box 608, Rochester, NY 14642USA
| | - Gordon L Phillips
- Hematology-Oncology Unit, Department of Medicine, JP Wilmot Cancer Center, University of Rochester Medical Center601 Elmwood Avenue, Box 704, Rochester, NY 14642USA
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Savini V, Balbinot A, Giancola R, Quaglietta A, Accorsi P, D'Antonio D, Iacone A. Comparison between the BACTEC 9240 and the Pall eBDS system for detection of bacterial platelet concentrate contamination. Transfusion 2009; 49:1217-23. [DOI: 10.1111/j.1537-2995.2009.02149.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Patel A, Calfee RP, Plante M, Fischer SA, Green A. Propionibacterium acnes colonization of the human shoulder. J Shoulder Elbow Surg 2009; 18:897-902. [PMID: 19362854 DOI: 10.1016/j.jse.2009.01.023] [Citation(s) in RCA: 206] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2008] [Revised: 12/28/2008] [Accepted: 01/24/2009] [Indexed: 02/01/2023]
Abstract
BACKGROUND Propionibacterium acnes (P. acnes) is frequently cultured in patients with wound infections after shoulder surgery. The purpose of this study was to characterize the colonization of various anatomic locations with P. acnes in order to explain this clinical observation. METHODS Culture samples were collected from the skin overlying the shoulder, hip, and knee of 20 subjects (10 male, 10 female). Semi-quantitative cultures of P. acnes and Staphylococcus species were performed to define bacterial prevalence and burden at each site. The participants completed a questionnaire that assessed skin health, hygiene, and co-morbid medical conditions. Physical examination was performed to define local skin characteristics. RESULTS Anterior and posterior acromial sites had a greater prevalence of P. acnes than the hip (anterior p=0.018; posterior p= 0.038) and knee (anterior p=0.0014; posterior p= 0.035) sites. The axilla had a greater prevalence of P. acnes than the knee (p=0.008). Males had a greater prevalence of P. acnes than females at the anterior (p=0.007) and posterior acromion sites (p=0.025). The burden of P. acnes at the anterior acromion (p=0.024), posterior acromion (p=0.035), and axilla (p=0.03) was greater than the mean burden at the hip. The burden of P. acnes at the anterior acromion (p=0.004), posterior acromion (p=0.007), and axilla (p=0.008) was greater than the mean burden at the knee. Males had a greater burden of P. acnes than females at the acromial sites (anterior p=0.0049; posterior p=0.0131). CONCLUSIONS Propionibacterium acnes colonizes the shoulder at increased rates compared to the knee and hip, and men have a higher bacterial burden than females. These findings are consistent with clinical observations of postoperative shoulder infections. LEVEL OF EVIDENCE Basic science study.
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Affiliation(s)
- Amar Patel
- Department of Orthopaedic Surgery, The Warren Alpert School of Medicine, Brown University, Providence, RI 02905, USA
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Performance evaluation of the VersaTREK blood culture system for quality control testing of platelet units. J Clin Microbiol 2009; 47:817-8. [PMID: 19144815 DOI: 10.1128/jcm.02173-08] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The performance of the VersaTREK blood culture system for the detection of a bacterial contamination of platelet concentrates was assessed using samples spiked with serial dilutions of nine bacterial species associated with platelet contamination. The system detected growth for all organisms in <20 h, and the detection sensitivity was <20 CFU/ml.
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Rieder R, Zavizion B. Monitoring the physiologic stress response: a novel biophysical approach for the rapid detection of bacteria in platelet concentrate. Transfusion 2008; 48:2596-605. [DOI: 10.1111/j.1537-2995.2008.01880.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Lee C, Ho P, Lee K, Tsui G, Chua E, Tsoi W, Lin C. Value of anaerobic culture in bacterial surveillance program for platelet concentrates. Transfusion 2008; 48:2606-11. [DOI: 10.1111/j.1537-2995.2008.01887.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Müller TH, Mohr H, Montag T. Methods for the detection of bacterial contamination in blood products. Clin Chem Lab Med 2008; 46:933-46. [PMID: 18624616 DOI: 10.1515/cclm.2008.154] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Culture-based and molecular assays have been developed for the screening of platelet concentrates and other blood components for bacterial contaminations. In this review, the principles of the assays are outlined. The focus of this review is the assessment of the analytical qualities of the methods. Spiking studies by adding defined levels of a wide range of bacteria to the complex biological matrix provide the first basis to evaluate and compare the qualities of methods for bacterial detection. The sensitivity acceptable for reliable screening for bacteria critically depends on the timing of either early sampling (within a period of up to 24 h after preparation of the blood component) or late sampling (a few hours before issuing the blood component). Large screening studies are essential to confirm both adequate sensitivity and specificity of the testing. In the ideal setting, these studies are prospectively planned and include systematic surveillance of adverse events in response to the administration of the screened products. The findings from sterility testing (predominantly with automated systems for detection of bacteria based on CO(2) generation) of more than 550,000 platelet concentrates in 13 studies are summarised. The limitations of the early sampling and the "negative-to-date" strategy to issue platelet concentrates are addressed. A few reported cases of probable transmission of bacteria by platelet transfusion despite negative screening tests emphasise the need to further develop optimised methods for testing of bacteria blood components.
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Affiliation(s)
- Thomas H Müller
- Institute Springe, German Red Cross-Blood Transfusion Service NSTOB, Springe, Germany.
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Störmer M, Kleesiek K, Dreier J. Propionibacterium acnes lacks the capability to proliferate in platelet concentrates. Vox Sang 2008; 94:193-201. [PMID: 18086288 DOI: 10.1111/j.1423-0410.2007.01019.x] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND OBJECTIVES Propionibacterium acnes is considered to be one of the most frequent contaminants of platelet concentrates (PCs) when anaerobic culture-based detection methods are used. But Propionibacteria are often detected too late when blood products have already been transfused. Therefore, its transfusion relevance is still demanding clarification because studies of the outcome of patients transfused with P. acnes-contaminated PCs are still uncommon. In this study, we monitored clinical effects in patients after transfusion of PCs, which were detected too late in sterility testing. Furthermore, we assessed the bacterial proliferation of Propionibacterium species seeded into PCs to clarify their significance for platelet bacteria screening. MATERIALS AND METHODS In the look-back process, we followed the route of the putative contaminated PC units from storage to transfusion. In the in vitro study, PCs were inoculated with 1-100 colony-forming unit (CFU)/ml of clinical isolates of Propionibacteria (n = 10). Sampling was performed during 10-day aerobic storage at 22 degrees C. The presence of bacteria was assessed by plating culture and automated BacT/Alert culture system. RESULTS Propionibacterium acnes shows slow or no growth under PC storage conditions. Clinical signs of adverse events after transfusion of potentially contaminated PC units were not reported. CONCLUSION Propionibacteria do not proliferate under PC storage conditions and therefore may be missed or detected too late when blood products have already been transfused.
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Affiliation(s)
- M Störmer
- Institut für Laboratoriums- und Transfusionsmedizin, Herz- und Diabeteszentrum Nordrhein-Westfalen, Universitätsklinik der Ruhr-Universität Bochum, Bad Oeynhausen, Germany
| | - K Kleesiek
- Institut für Laboratoriums- und Transfusionsmedizin, Herz- und Diabeteszentrum Nordrhein-Westfalen, Universitätsklinik der Ruhr-Universität Bochum, Bad Oeynhausen, Germany
| | - J Dreier
- Institut für Laboratoriums- und Transfusionsmedizin, Herz- und Diabeteszentrum Nordrhein-Westfalen, Universitätsklinik der Ruhr-Universität Bochum, Bad Oeynhausen, Germany
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Greco C, Mastronardi C, Pagotto F, Mack D, Ramirez-Arcos S. Assessment of biofilm-forming ability of coagulase-negative staphylococci isolated from contaminated platelet preparations in Canada. Transfusion 2008; 48:969-77. [PMID: 18346023 DOI: 10.1111/j.1537-2995.2007.01631.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Coagulase-negative staphylococci (CoNS) are the most prevalent bacterial contaminants of platelet (PLT) preparations and have been implicated in adverse transfusion reactions worldwide. The most frequently identified contaminant is Staphylococcus epidermidis, which is noted for its ability to maintain chronic hospital-acquired infections by forming biofilms as a chief virulence mechanism. STUDY DESIGN AND METHODS Strains of S. epidermidis isolated from contaminated PLT preparations in Canada were distinguished via gene-specific polymerase chain reaction (PCR) with divIVA as a marker. Biofilm-forming ability was assessed by the presence of the gene icaD, slime production on Congo red agar, and biofilm formation on polystyrene surfaces. Production of polysaccharide intercellular adhesin (PIA) was resolved by immunofluorescence. RESULTS Eight of the 13 (62%) CoNS isolates under study were identified as S. epidermidis. Of these, four strains (50%) were classified as strong biofilm producers. Three of the four biofilm-positive strains (75%) produced slime, harbored the icaD gene, and had positive expression of PIA. CONCLUSIONS Despite the presumable commensal origin of the CoNS isolates, a large proportion of S. epidermidis strains demonstrated a potential for enhanced virulence. Identification of contaminant staphylococci as biofilm producers is thus relevant and informative with regard to treatment approach in the circumstance of inadvertent infection of a PLT recipient.
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Affiliation(s)
- Carey Greco
- Canadian Blood Services, Ottawa, Ontario, Canada
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Greco C, Mastronardi C, Pagotto F, Mack D, Ramirez-Arcos S. Assessment of biofilm-forming ability of coagulase-negative staphylococci isolated from contaminated platelet preparations in Canada. Transfusion 2008. [DOI: 10.1111/j.1537-2995.2007.01631.x-i2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Reesink HW, Mohammadi T, Pietersz RN, Savelkoul PH. Rapid screening by real-time 16S rDNA PCR for bacterial contamination of blood products. Clin Chem Lab Med 2008; 46:954-62. [DOI: 10.1515/cclm.2008.155] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Trampuz A, Salzmann S, Antheaume J, Daniels AU. Microcalorimetry: a novel method for detection of microbial contamination in platelet products. Transfusion 2007; 47:1643-50. [PMID: 17725729 DOI: 10.1111/j.1537-2995.2007.01336.x] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Measuring heat from replicating microorganisms in culture may be a rapid, accurate, and simple screening method for platelets (PLTs). Microcalorimetry for detection of microorganisms in in vitro contaminated PLT products was evaluated. STUDY DESIGN AND METHODS Staphylococcus epidermidis, Staphylococcus aureus, Streptococcus sanguinis, Escherichia coli, Propionibacterium acnes, and Candida albicans were inoculated in single-donor apheresis PLTs to achieve target concentrations of 10(5), 10(3), 10, or 1 colony-forming units (CFU) per mL of PLTs. Contaminated PLTs in growth medium were incubated at 37 degrees C for 5 days in a calorimeter. Positivity was defined as heat flow of at least 10 microW above the lowest value of the power-time curve. RESULTS With microcalorimetry, inocula of 10 CFUs per mL PLTs could be detected with the following detection times: S. epidermidis (31.65 hr), S. aureus (24.24 hr), S. sanguinis (7.82 hr), E. coli (7.53 hr), P. acnes (73.57 hr), and C. albicans (43.77 hr). The detection time was less than 4 hr at 10(5) CFUs per mL PLTs for S. aureus, S. sanguinis, and E. coli. Noncontaminated PLTs remained negative. The total heat ranged from 2.8 (S. sanguinis) to 8.3 J (E. coli). The shape of the power-time curve was species-specific and independent from the initial concentration of microorganisms. CONCLUSION The detection limit of microcalorimetry was 1 to 10 CFUs per mL PLTs. Microcalorimetry is a promising novel method for detection of contaminated PLTs. Applying this method to all PLT products could reduce the frequency of transfusion-related sepsis and prolong the shelf life of PLTs.
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Affiliation(s)
- Andrej Trampuz
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, Basel, Switzerland.
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Abstract
Ever since platelet transfusions were shown to reduce mortality from haemorrhage in patients with acute leukaemia in the 1950s, the use of this therapy has steadily grown to become an essential part of the treatment of cancer, haematological malignancies, marrow failure, and haematopoietic stem cell transplantation. Today, more than 1.5 million platelet products are transfused in the USA each year, 2.9 million products in Europe. However, platelet transfusion can transmit infections and trigger serious immune reactions and they can be rendered ineffective by alloimmunisation. There are several types of platelet components and all can be modified to reduce the chances of many of the complications of platelet transfusion. Transfusion practices, including indications for transfusion, dose of platelets transfused, and methods of treating alloimmunised recipients vary between countries, and even within countries. We review commonly used platelet components, product modifications, transfusion practices, and adverse consequences of platelet transfusions.
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Affiliation(s)
- David F Stroncek
- Department of Transfusion Medicine, Clinical Center, National Institutes of Health, Bethesda, Maryland 20892-1184, USA.
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Abstract
This article provides guidelines for the appropriate use of platelet transfusions to reduce unnecessary transfusions, thereby avoiding transfusion-related risks to the patients and the costs of platelet therapy. Platelet products available for transfusion are whole blood derived platelet concentrates and apheresis platelets. Leukoreduced platelets can be used to reduce platelet alloimmunization, cytomegalovirus transmission, and febrile transfusion reactions, while gamma irradiation prevents transfusion-associated graftversus-host disease. Other topics discussed are the expected response to transfused platelets and reasons for poor responses related to alloimmunization, underlying disease state, clinical conditions, and drugs. Appropriate transfusion guidelines based on pretransfusion platelet count, platelet dose, and whether the transfusion is prophylactic or therapeutic are outlined. Identification, prevention, and management of adverse consequences of platelet transfusions and platelet refractoriness are discussed.
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