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Heroes AS, Okitale P, Ndalingosu N, Vandekerckhove P, Lunguya O, Jacobs J. Presence of Gram-negative bacteria and Staphylococcus aureus on the skin of blood donors in the Democratic Republic of the Congo. Transfusion 2023; 63:360-372. [PMID: 36478388 DOI: 10.1111/trf.17196] [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: 09/05/2022] [Revised: 11/07/2022] [Accepted: 11/07/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND Skin bacteria may contaminate blood products but few data are available on sub-Saharan Africa (sSA). We assessed the presence of Gram-negative bacteria and Staphylococcus aureus on blood donor skin and evaluated skin antisepsis in the Democratic Republic of the Congo (DRC). STUDY DESIGN AND METHODS Among blood donors at the National Blood Transfusion Center (NBTC) and at a rural hospital, the antecubital fossa skin of the non-disinfected arm (not used for blood collection) was swabbed (25cm2 surface) and cultured for total and Gram-negative bacterial counts. Bacteria were identified with MALDI-TOF and tested for antibiotic susceptibility by disk diffusion. For evaluation of the NBTC antisepsis procedure (i.e., ethanol 70%), the culture results of the disinfected arm (used for blood collection) were compared with those of the non-disinfected arm. RESULTS Median total bacterial counts on 161 studied non-disinfected arms were 1065 Colony-Forming Units (CFU) per 25 cm2 , with 43.8% (70/160) of blood donors growing Gram-negative bacteria and 3.8% (6/159) Staphylococcus aureus (2/6 methicillin-resistant). Non-fermentative Gram-negative rods predominated (74/93 isolates, majority Pseudomonas spp., Acinetobacter spp.). Enterobacterales comprised 19/93 isolates (mostly Pantoea spp. and Enterobacter spp.), 5/19 were multidrug-resistant. In only two cases (1.9%, 2/108) the NBTC antisepsis procedure met the acceptance criterion of ≤2 CFU/25 cm2 . CONCLUSION Skin bacterial counts and species among blood donors in DRC were similar to previously studied Caucasian populations, including cold-tolerating species and bacteria previously described in transfusion reactions. Prevention of contamination (e.g., antisepsis) needs further evaluation and customization to sSA.
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Affiliation(s)
- Anne-Sophie Heroes
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium.,Department of Microbiology, Immunology and Transplantation, KU Leuven, Leuven, Belgium
| | - Patient Okitale
- Department of Microbiology, Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of the Congo.,Department of Clinical Biology, Cliniques Universitaires, Kinshasa, Democratic Republic of the Congo
| | - Natacha Ndalingosu
- Hemovigilance Department, Centre National de Transfusion Sanguine, Kinshasa, Democratic Republic of the Congo
| | - Philippe Vandekerckhove
- Belgian Red Cross-Flanders, Mechelen, Belgium.,Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium.,Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa
| | - Octavie Lunguya
- Department of Microbiology, Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of the Congo.,Department of Clinical Biology, Cliniques Universitaires, Kinshasa, Democratic Republic of the Congo
| | - Jan Jacobs
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium.,Department of Microbiology, Immunology and Transplantation, KU Leuven, Leuven, Belgium
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Arghittu A, Dettori M, Deriu GM, Soddu S, Manca PC, Carboni AA, Collu I, Palmieri A, Deiana G, Azara A, Castiglia P, Masia MD. Controlling Infectious Risk in Transfusion: Assessing the Effectiveness of Skin Disinfection in Blood Donors. Healthcare (Basel) 2022; 10:healthcare10050845. [PMID: 35627982 PMCID: PMC9141022 DOI: 10.3390/healthcare10050845] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 04/22/2022] [Accepted: 05/02/2022] [Indexed: 02/01/2023] Open
Abstract
Bacterial infectious risk is a major problem in transfusion medicine. The type of micro-organisms isolated during bacterial contamination of blood products indicates that the donor’s skin is its main source. In this context, the primary measures to reduce this risk are: (a) optimal disinfection of the donor’s arm and (b) satellite bag diversion of the initial volume of blood collected. This work aimed to verify the effectiveness of skin disinfection of the blood donor’s venipuncture site. Two methodological approaches were used: (a) qualitative and quantitative microbiological testing of the skin at the collection site, before and post-disinfection; (b) qualitative microbiological testing of the first deviated blood. Pre-disinfection testing showed skin microbial load values between 3 and >200 CFU/plate. More than two-thirds of the isolates were Gram-positive bacteria (77.8%) of which 57.7% were staphylococci. Among Gram-negative bacteria, Pseudomonadaceae, Enterobacteriaceae, and Acinetobacter spp. were isolated from the blood donors (BDs). Post-disinfection, a 100% reduction in microbial load was observed in 84.4% of BDs. Microbiological testing of the first blood diverted sample revealed the presence of microbial flora in 1.9% samples; of the isolates, 83.3% were non-aureus staphylococci. This study highlights the importance of the correct application of skin disinfection procedures in order to ensure blood safety.
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Affiliation(s)
- Antonella Arghittu
- Department of Biomedical Sciences, University of Sassari, 07100 Sassari, Italy; (A.A.); (I.C.); (G.D.)
- University Hospital of Sassari, 07100 Sassari, Italy; (G.M.D.); (S.S.); (P.C.M.); (A.A.C.); (A.P.); (A.A.); (P.C.)
| | - Marco Dettori
- University Hospital of Sassari, 07100 Sassari, Italy; (G.M.D.); (S.S.); (P.C.M.); (A.A.C.); (A.P.); (A.A.); (P.C.)
- Department of Medical, Surgical and Experimental Sciences, University of Sassari, 07100 Sassari, Italy;
- Correspondence:
| | - Grazia Maria Deriu
- University Hospital of Sassari, 07100 Sassari, Italy; (G.M.D.); (S.S.); (P.C.M.); (A.A.C.); (A.P.); (A.A.); (P.C.)
| | - Serena Soddu
- University Hospital of Sassari, 07100 Sassari, Italy; (G.M.D.); (S.S.); (P.C.M.); (A.A.C.); (A.P.); (A.A.); (P.C.)
| | - Pietro Carmelo Manca
- University Hospital of Sassari, 07100 Sassari, Italy; (G.M.D.); (S.S.); (P.C.M.); (A.A.C.); (A.P.); (A.A.); (P.C.)
| | - Anna Angela Carboni
- University Hospital of Sassari, 07100 Sassari, Italy; (G.M.D.); (S.S.); (P.C.M.); (A.A.C.); (A.P.); (A.A.); (P.C.)
| | - Irene Collu
- Department of Biomedical Sciences, University of Sassari, 07100 Sassari, Italy; (A.A.); (I.C.); (G.D.)
| | - Alessandra Palmieri
- University Hospital of Sassari, 07100 Sassari, Italy; (G.M.D.); (S.S.); (P.C.M.); (A.A.C.); (A.P.); (A.A.); (P.C.)
- Department of Medical, Surgical and Experimental Sciences, University of Sassari, 07100 Sassari, Italy;
| | - Giovanna Deiana
- Department of Biomedical Sciences, University of Sassari, 07100 Sassari, Italy; (A.A.); (I.C.); (G.D.)
- University Hospital of Sassari, 07100 Sassari, Italy; (G.M.D.); (S.S.); (P.C.M.); (A.A.C.); (A.P.); (A.A.); (P.C.)
| | - Antonio Azara
- University Hospital of Sassari, 07100 Sassari, Italy; (G.M.D.); (S.S.); (P.C.M.); (A.A.C.); (A.P.); (A.A.); (P.C.)
- Department of Medical, Surgical and Experimental Sciences, University of Sassari, 07100 Sassari, Italy;
| | - Paolo Castiglia
- University Hospital of Sassari, 07100 Sassari, Italy; (G.M.D.); (S.S.); (P.C.M.); (A.A.C.); (A.P.); (A.A.); (P.C.)
- Department of Medical, Surgical and Experimental Sciences, University of Sassari, 07100 Sassari, Italy;
| | - Maria Dolores Masia
- Department of Medical, Surgical and Experimental Sciences, University of Sassari, 07100 Sassari, Italy;
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Fuchsjäger N, Winterleitner H, Krause R, Feierl G, Koch H. Susceptibility of microorganisms causing acute hand infections. PLoS One 2019; 14:e0220555. [PMID: 31437151 PMCID: PMC6705788 DOI: 10.1371/journal.pone.0220555] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2018] [Accepted: 07/18/2019] [Indexed: 12/17/2022] Open
Abstract
Hand infections are a common presentation at the emergency departments. Without knowing the source of infection clinicians are dependent on systematic reports on the bacterial spectrum and susceptibility tests of the specific infection in their patient community. This study was based on a retrospective chart review of patients presenting to our outpatient clinic with acute hand infections. We documented patient demographics, the etiology, location, culture tests of the infection and analyzed if certain bacteria could be cultured significantly more often in certain etiologies or in specific sites of the hand infection. Susceptibility tests were added. Bacterial swabs of 204 patients were analyzed. Overall S. aureus was found in 53% of all cases, in only one case revealed methicillin-resistant S. aureus (MRSA). There was no significant difference in the bacterial spectrum according to the etiology of the hand infections, except for animal bites where Pasteurella multocida was the dominating bacteria in 63% of all cases. Amoxicillin-clavulanic acid, fluoroquinolones, and piperacillin were effective against the main bacteria. Our study confirms the previously published antibiotic resistance reports and reinforces the current antibiotic treatment guidelines also in this western European population.
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Affiliation(s)
- Nina Fuchsjäger
- Division of Plastic, Aesthetic and Reconstructive surgery, Department of Surgery, Medical University of Graz, Graz, Austria
- * E-mail:
| | - Herwig Winterleitner
- Division of Plastic, Aesthetic and Reconstructive surgery, Department of Surgery, Medical University of Graz, Graz, Austria
| | - Robert Krause
- Section of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Gebhard Feierl
- Institute of Hygiene, Microbiology and Environmental Medicine, Medical University of Graz, Graz, Austria
| | - Horst Koch
- Division of Plastic, Aesthetic and Reconstructive surgery, Department of Surgery, Medical University of Graz, Graz, Austria
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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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Temperature-dependent haemolytic propensity of CPDA-1 stored red blood cells vs whole blood - Red cell fragility as donor signature on blood units. BLOOD TRANSFUSION = TRASFUSIONE DEL SANGUE 2017; 15:447-455. [PMID: 28488959 DOI: 10.2450/2017.0332-16] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Accepted: 01/16/2017] [Indexed: 11/21/2022]
Abstract
BACKGROUND To preserve cellular integrity and avoid bacterial growth, storage and transfer of blood and blood products follow strict guidelines in terms of temperature control. We evaluated the impact of ineligible warming of whole blood donations on the quality of blood components. MATERIALS AND METHODS One-hundred and twenty units of whole blood (WB) from eligible blood donors were collected in CPDA-1 and stored at 4±2 °C. During shipment to the blood processing centre, a gradual warming up to 17 °C was recorded within a period of less than eight hours. The warmed units were processed to packed red blood cells (PRBCs) or stored as WB units at 4±2 °C. In-bag haemolysis, osmotic fragility (mean corpuscular fragility, MCF) and bacterial growth were assessed in blood and blood components throughout the storage period. RESULTS Normal basal and early storage levels of haemolysis were recorded in both PRBC and WB units. Thereafter, PRBCs exhibited higher average in-bag haemolysis and MCF index compared to the WB units throughout the storage. Moreover, 14.3 and 52.4% of the PRBC units exceeded the upper permissible limit of 0.8% haemolysis at the middle (1.220±0.269%) or late (1.754±0.866%) storage period, respectively. MCF index was similar in all PRBCs at the middle of storage but significantly lower in the non-haemolysed compared to the haemolysed units of PRBCs on the last days. The fragility of stored RBCs was proportional to the donor-related values of day 2 samples (r=0.861, p<10-32). In the qualified PRBCs, MCF was correlated with haemolysis at every time point of the storage period (r=0.332, p<0.050). Bacterial growth was detected by blood culture in two units of PRBCs. DISCUSSION Transient, gradient warming of whole blood from 4 to 17 °C led to increased incidence of in-bag haemolysis in PRBC but not in WB units. Haemolysis is a multi-parametric phenotype of stored blood, and MCF is a donor-related and highly dynamic measure that can, in part, predict the storage lesion.
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Klausen SS, Hervig T, Seghatchian J, Reikvam H. Bacterial contamination of blood components: Norwegian strategies in identifying donors with higher risk of inducing septic transfusion reactions in recipients. Transfus Apher Sci 2014; 51:97-102. [DOI: 10.1016/j.transci.2014.08.007] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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