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Rezvany MR, Moradi Hasan-Abad A, Sobhani-Nasab A, Esmaili MA. Evaluation of bacterial safety approaches of platelet blood concentrates: bacterial screening and pathogen reduction. Front Med (Lausanne) 2024; 11:1325602. [PMID: 38651065 PMCID: PMC11034438 DOI: 10.3389/fmed.2024.1325602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2023] [Accepted: 03/04/2024] [Indexed: 04/25/2024] Open
Abstract
This mini-review analyzed two approaches to screening bacterial contamination and utilizing pathogen reduction technology (PRT) for Platelet concentrates (PCs). While the culture-based method is still considered the gold standard for detecting bacterial contamination in PCs, efforts in the past two decades to minimize transfusion-transmitted bacterial infections (TTBIs) have been insufficient to eliminate this infectious threat. PRTs have emerged as a crucial tool to enhance safety and mitigate these risks. The evidence suggests that the screening strategy for bacterial contamination is more successful in ensuring PC quality, decreasing the necessity for frequent transfusions, and improving resistance to platelet transfusion. Alternatively, the PRT approach is superior regarding PC safety. However, both methods are equally effective in managing bleeding. In conclusion, PRT can become a more prevalent means of safety for PCs compared to culture-based approaches and will soon comprehensively surpass culture-based bacterial contamination detection methods.
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Affiliation(s)
- Mohammad Reza Rezvany
- Department of Hematology, Faculty of Allied Medicine, Iran University of Medical Sciences, Tehran, Iran
- BioClinicum, Department of Oncology-Pathology, Karolinska Institute, Stockholm, Sweden
- Pediatrics Growth and Development Research Center, Institute of Endocrinology and Metabolism, Iran University of Medical Sciences, Tehran, Iran
| | - Amin Moradi Hasan-Abad
- Autoimmune Diseases Research Center, Shahid Beheshti Hospital, Kashan University of Medical Sciences, Kashan, Iran
| | - Ali Sobhani-Nasab
- Physiology Research Center, Institute for Basic Sciences, Kashan University of Medical Sciences, Kashan, Iran
| | - Mohammad Ali Esmaili
- Department of Laboratory Sciences, Sirjan School of Medical Sciences, Sirjan, Iran
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2
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Periodontitis increases risk of viable bacteria in freshly drawn blood donations. BLOOD TRANSFUSION = TRASFUSIONE DEL SANGUE 2021; 19:376-383. [PMID: 33539285 DOI: 10.2450/2021.0336-20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 12/09/2020] [Indexed: 01/28/2023]
Abstract
BACKGROUND The aim of the study was to determine if periodontitis, which often causes transient bacteraemia, associates with viable bacteria in standard blood donations. MATERIALS AND METHODS This was a cross-sectional study of 60 self-reported medically healthy blood donors aged over 50 years. According to standard procedures, whole blood was separated by fractionation into plasma, buffy-coat, and red blood cell (RBC)-fractions. The buffy-coat was screened for bacterial contamination using BacT/ALERT. Samples from plasma and RBC-fractions were incubated anaerobically and aerobically at 37°C for 7 days on trypticase soy blood agar (TSA). For identification, colony polymerase chain reaction was performed using primers targeting 16S rDNA. RESULTS From 62% of the donors with periodontitis, bacterial growth was observed on at least 1 out of 4 plates inoculated with plasma or RBCs, whereas only 13% of plates inoculated with plasma or RBCs from periodontally healthy controls yielded bacterial growth (relative risk 6.4, 95% CI: 2.1; 19.5; p=0.0011). None of the donors tested positive for bacterial contamination using BacT/ALERT. Cutibacterium acnes was found in 31% of the donations from donors with periodontitis and in 10% of the donations from periodontally healthy donors. In addition, Staphylococcus species, Bacillus mycoides, Aggregatibacter aphrophilus, and Corynebacterium kroppenstedtii were detected. DISCUSSION Periodontitis increased the risk of bacterial contamination of blood products. Contaminating bacteria are often associated with the RBC-fraction. As the BacT/ALERT test is generally performed on platelet products, routine screening fails to detect many occurrences of viable bacteria in the RBC-fraction.
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3
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Vossier L, Valera L, Leon F, Roche S, Piquer D, Rubrecht L, Favier C, Cremer GA, Pouzet A, Dagland T, Rihet S, Galea P, Farre C, Bonnet R, Jaffrézic-Renault N, Chaix C, Fareh J, Fournier-Wirth C. Combining culture and microbead-based immunoassay for the early and generic detection of bacteria in platelet concentrates. Transfusion 2018; 59:277-286. [PMID: 30430585 DOI: 10.1111/trf.15019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Revised: 07/16/2018] [Accepted: 07/22/2018] [Indexed: 01/15/2023]
Abstract
BACKGROUND Despite current preventive strategies, bacterial contamination of platelets is the highest residual infectious risk in transfusion. Bacteria can grow from an initial concentration of 0.03-0.3 colony-forming units (CFUs)/mL up to 108 to 109 CFUs/mL over the product shelf life. The aim of this study was to develop a cost-effective approach for an early, rapid, sensitive, and generic detection of bacteria in platelet concentrates. STUDY DESIGN AND METHODS A large panel of bacteria involved in transfusion reactions, including clinical isolates and reference strains, was established. Sampling was performed 24 hours after platelet spiking. After an optimized culture step for increasing bacterial growth, a microbead-based immunoassay allowed the generic detection of bacteria. Antibody production and immunoassay development took place exclusively with bacteria spiked in fresh platelet concentrates to improve the specificity of the test. RESULTS Antibodies for the generic detection of either gram-negative or gram-positive bacteria were selected for the microbead-based immunoassay. Our approach, combining the improved culture step with the immunoassay, allowed sensitive detection of 1 to 10 CFUs/mL for gram-negative and 1 to 102 CFUs/mL for gram-positive species. CONCLUSION In this study, a new approach combining bacterial culture with immunoassay was developed for the generic and sensitive detection of bacteria in platelet concentrates. This efficient and easily automatable approach allows tested platelets to be used on Day 2 after collection and could represent an alternative strategy for reducing the risk of transfusion-transmitted bacterial infections. This strategy could be adapted for the detection of bacteria in other cellular products.
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Affiliation(s)
- Ludivine Vossier
- Pathogenesis and Control of Chronic Infections, EFS, Inserm, Université de Montpellier, Montpellier, France
| | - Lionel Valera
- Bio-Rad, R&D Marnes la Coquette, Steenvoorde and, Montpellier, France
| | - Fanny Leon
- Pathogenesis and Control of Chronic Infections, EFS, Inserm, Université de Montpellier, Montpellier, France
| | - Stéphanie Roche
- Bio-Rad, R&D Marnes la Coquette, Steenvoorde and, Montpellier, France
| | - Dominique Piquer
- Bio-Rad, R&D Marnes la Coquette, Steenvoorde and, Montpellier, France
| | - Laetitia Rubrecht
- Bio-Rad, R&D Marnes la Coquette, Steenvoorde and, Montpellier, France
| | - Christine Favier
- Bio-Rad, R&D Marnes la Coquette, Steenvoorde and, Montpellier, France
| | | | - Agnès Pouzet
- Bio-Rad, R&D Marnes la Coquette, Steenvoorde and, Montpellier, France
| | - Typhaine Dagland
- Bio-Rad, R&D Marnes la Coquette, Steenvoorde and, Montpellier, France
| | - Stéphane Rihet
- Bio-Rad, R&D Marnes la Coquette, Steenvoorde and, Montpellier, France
| | - Pascale Galea
- Bio-Rad, R&D Marnes la Coquette, Steenvoorde and, Montpellier, France
| | - Carole Farre
- Institut des Sciences Analytiques, (CNRS-Université de Lyon 1-ENS), Lyon, France
| | - Romaric Bonnet
- Institut des Sciences Analytiques, (CNRS-Université de Lyon 1-ENS), Lyon, France
| | | | - Carole Chaix
- Institut des Sciences Analytiques, (CNRS-Université de Lyon 1-ENS), Lyon, France
| | - Jeannette Fareh
- Bio-Rad, R&D Marnes la Coquette, Steenvoorde and, Montpellier, France
| | - Chantal Fournier-Wirth
- Pathogenesis and Control of Chronic Infections, EFS, Inserm, Université de Montpellier, Montpellier, France
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4
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Störmer M, Wood EM, Gathof B. Microbial safety of cellular therapeutics-lessons from over ten years’ experience in microbial safety of platelet concentrates. ACTA ACUST UNITED AC 2018. [DOI: 10.1111/voxs.12452] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Melanie Störmer
- Transfusion Medicine; University Hospital Cologne; Cologne Germany
| | - Erica M. Wood
- Transfusion Research Unit; Department of Epidemiology and Preventive Medicine; Monash University; Melbourne VIC Australia
| | - Birgit Gathof
- Transfusion Medicine; University Hospital Cologne; Cologne Germany
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5
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Vollmer T, Dabisch‐Ruthe M, Weinstock M, Knabbe C, Dreier J. Late sampling for automated culture to extend the platelet shelf life to 5 days in Germany. Transfusion 2018; 58:1654-1664. [DOI: 10.1111/trf.14617] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Revised: 02/22/2018] [Accepted: 02/26/2018] [Indexed: 12/01/2022]
Affiliation(s)
- Tanja Vollmer
- Herz‐ und Diabeteszentrum Nordrhein‐Westfalen, Universitaetsklinik der Ruhr‐Universität BochumBad Oeynhausen Germany
| | - Mareike Dabisch‐Ruthe
- Herz‐ und Diabeteszentrum Nordrhein‐Westfalen, Universitaetsklinik der Ruhr‐Universität BochumBad Oeynhausen Germany
| | - Melanie Weinstock
- Herz‐ und Diabeteszentrum Nordrhein‐Westfalen, Universitaetsklinik der Ruhr‐Universität BochumBad Oeynhausen Germany
| | - Cornelius Knabbe
- Herz‐ und Diabeteszentrum Nordrhein‐Westfalen, Universitaetsklinik der Ruhr‐Universität BochumBad Oeynhausen Germany
| | - Jens Dreier
- Herz‐ und Diabeteszentrum Nordrhein‐Westfalen, Universitaetsklinik der Ruhr‐Universität BochumBad Oeynhausen Germany
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6
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Chetouane Y, Dubourg G, Gallian P, Flaudrops C, Chiaroni J, Chabrière E, Raoult D, Camoin-Jau L. Rapid identification of microorganisms from platelet concentrates by matrix-assisted laser desorption ionization time-of-flight mass spectrometry after short-term incubation on liquid medium. Transfusion 2017; 58:766-773. [PMID: 29193200 DOI: 10.1111/trf.14430] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2017] [Revised: 10/30/2017] [Accepted: 10/31/2017] [Indexed: 01/30/2023]
Abstract
BACKGROUND Platelets (PLTs) are especially affected by the risk of bacterial contamination. Matrix-assisted laser desorption ionization time-of-flight (MALDI-TOF) is an accurate method for the routine identification of bacterial isolates in microbiology laboratories. We directly applied the MALDI-TOF method to bacterial detection in PLTs. In this study, we evaluated the sensitivity, specificity, and speed of a direct MALDI-TOF approach compared to the conventional method BACTEC. STUDY DESIGN AND METHODS Eight bacteria associated with PLT contamination, cited by the ISBT on transfusion-transmitted infectious diseases, were spiked into PLTs for a final concentration of approximately 100 CFU/bag (n = 5 for each strain). The PLTs were then agitated for 24 hours. One milliliter of PLTs was incubated in a shaker incubator for 8 hours at 37°C with 1 mL of trypticase soy broth (TSB). The spectra were analyzed using the MALDI Biotyper software. As a control, 8 mL of PLTs incubated into BACTEC bottles and a positive bottle were subcultured to ensure identification of bacterial growth. RESULTS Regardless of the strain of PLTs tested, MALDI-TOF analysis made detection and early identification possible at 8 hours. Analysis by BACTEC of PLTs infected with Escherichia coli, Bacillus cereus, and Providencia stuartii made early identification possible. For the remaining bacteria, the detection time by BACTEC was significantly longer than 8 hours. CONCLUSION We demonstrated the possibility of detecting bacteria in PLTs using a standardized culture step in TSB with MALDI-TOF, regardless of the strain, with the same specificity and analytical sensitivity and with a time to results of 12 hours. This direct method presented rapid and reliable results.
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Affiliation(s)
- Yasmine Chetouane
- Aix-Marseille Université, Unité de Recherche sur les Maladies Infectieuses et Tropicales Emergentes (URMITE), UM63, CNRS 7278, IRD 198, INSERM U1095, Marseille.,IHU Méditerranée Infection, Pôle des Maladies Infectieuses, Assistance Publique-Hôpitaux de Marseille, Marseille, France
| | - Gregory Dubourg
- Aix-Marseille Université, Unité de Recherche sur les Maladies Infectieuses et Tropicales Emergentes (URMITE), UM63, CNRS 7278, IRD 198, INSERM U1095, Marseille.,IHU Méditerranée Infection, Pôle des Maladies Infectieuses, Assistance Publique-Hôpitaux de Marseille, Marseille, France
| | - Pierre Gallian
- IHU Méditerranée Infection, Pôle des Maladies Infectieuses, Assistance Publique-Hôpitaux de Marseille, Marseille, France.,Etablissement Français du Sang (EFS), La Plaine Saint-Denis, France
| | - Christophe Flaudrops
- Aix-Marseille Université, Unité de Recherche sur les Maladies Infectieuses et Tropicales Emergentes (URMITE), UM63, CNRS 7278, IRD 198, INSERM U1095, Marseille.,IHU Méditerranée Infection, Pôle des Maladies Infectieuses, Assistance Publique-Hôpitaux de Marseille, Marseille, France
| | - Jacques Chiaroni
- Etablissement Français du Sang Alpes Méditerranée and Aix-Marseille Université, CNRS, EFS Biologie des Groupes Sanguins, ADES UMR 7268, Marseille, France
| | - Eric Chabrière
- Aix-Marseille Université, Unité de Recherche sur les Maladies Infectieuses et Tropicales Emergentes (URMITE), UM63, CNRS 7278, IRD 198, INSERM U1095, Marseille.,IHU Méditerranée Infection, Pôle des Maladies Infectieuses, Assistance Publique-Hôpitaux de Marseille, Marseille, France
| | - Didier Raoult
- Aix-Marseille Université, Unité de Recherche sur les Maladies Infectieuses et Tropicales Emergentes (URMITE), UM63, CNRS 7278, IRD 198, INSERM U1095, Marseille.,IHU Méditerranée Infection, Pôle des Maladies Infectieuses, Assistance Publique-Hôpitaux de Marseille, Marseille, France
| | - Laurence Camoin-Jau
- Aix-Marseille Université, Unité de Recherche sur les Maladies Infectieuses et Tropicales Emergentes (URMITE), UM63, CNRS 7278, IRD 198, INSERM U1095, Marseille.,IHU Méditerranée Infection, Pôle des Maladies Infectieuses, Assistance Publique-Hôpitaux de Marseille, Marseille, France.,Assistance Publique Hôpitaux de Marseille, Laboratoire d'Hématologie, CHU Timone, Marseille, France
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7
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Spindler-Raffel E, Benjamin RJ, McDonald CP, Ramirez-Arcos S, Aplin K, Bekeredjian-Ding I, de Korte D, Gabriel C, Gathof B, Hanschmann KM, Hourfar K, Ingram C, Jacobs MR, Keil SD, Kou Y, Lambrecht B, Marcelis J, Mukhtar Z, Nagumo H, Niekerk T, Rojo J, Marschner S, Satake M, Seltsam A, Seifried E, Sharafat S, Störmer M, Süßner S, Wagner SJ, Yomtovian R. Enlargement of the WHO international repository for platelet transfusion-relevant bacteria reference strains. Vox Sang 2017; 112:713-722. [PMID: 28960367 DOI: 10.1111/vox.12548] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Revised: 05/25/2017] [Accepted: 05/26/2017] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND OBJECTIVES Interventions to prevent and detect bacterial contamination of platelet concentrates (PCs) have reduced, but not eliminated the sepsis risk. Standardized bacterial strains are needed to validate detection and pathogen reduction technologies in PCs. Following the establishment of the First International Reference Repository of Platelet Transfusion-Relevant Bacterial Reference Strains (the 'repository'), the World Health Organization (WHO) Expert Committee on Biological Standardisation (ECBS) endorsed further repository expansion. MATERIALS AND METHODS Sixteen bacterial strains, including the four repository strains, were distributed from the Paul-Ehrlich-Institut (PEI) to 14 laboratories in 10 countries for enumeration, identification and growth measurement on days 2, 4 and 7 after low spiking levels [10-25 colony-forming units (CFU)/PC bag]. Spore-forming (Bacillus cereusPEI-B-P-07-S, Bacillus thuringiensisPEI-B-P-57-S), Gram-negative (Enterobacter cloacaePEI-B-P-43, Morganella morganiiPEI-B-P-74, PEI-B-P-91, Proteus mirabilisPEI-B-P-55, Pseudomonas fluorescensPEI-B-P-77, Salmonella choleraesuisPEI-B-P-78, Serratia marcescensPEI-B-P-56) and Gram-positive (Staphylococcus aureusPEI-B-P-63, Streptococcus dysgalactiaePEI-B-P-71, Streptococcus bovisPEI-B-P-61) strains were evaluated. RESULTS Bacterial viability was conserved after transport to the participating laboratories with one exception (M. morganiiPEI-B-P-74). All other strains showed moderate-to-excellent growth. Bacillus cereus, B. thuringiensis, E. coli, K. pneumoniae, P. fluorescens, S. marcescens, S. aureus and S. dysgalactiae grew to >106 CFU/ml by day 2. Enterobacter cloacae, P. mirabilis, S. epidermidis, S. bovis and S. pyogenes achieved >106 CFU/ml at day 4. Growth of S. choleraesuis was lower and highly variable. CONCLUSION The WHO ECBS approved all bacterial strains (except M. morganiiPEI-B-P-74 and S. choleraesuisPEI-B-P-78) for repository enlargement. The strains were stable, suitable for spiking with low CFU numbers, and proliferation was independent of the PC donor.
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Affiliation(s)
| | | | - C P McDonald
- National Health Service Blood and Transplant, London, UK
| | | | - K Aplin
- National Health Service Blood and Transplant, London, UK
| | | | - D de Korte
- Sanquin Blood Supply Foundation, Amsterdam, The Netherlands
| | - C Gabriel
- Blood Centre Linz, Austrian Red Cross, Linz, Austria
| | - B Gathof
- Institute of Transfusion Medicine, University Hospital of Cologne, Cologne, Germany
| | | | - K Hourfar
- German Red Cross, Frankfurt/Main, Germany
| | - C Ingram
- Constantia Kloof, South African National Blood Service, Johannesburg, South Africa
| | - M R Jacobs
- Case Western Reserve University, Cleveland, OH, USA
| | - S D Keil
- Terumo BCT Biotechnologies, Lakewood, CO, USA
| | - Y Kou
- Canadian Blood Service, Ottawa, ON, Canada
| | - B Lambrecht
- German Red Cross Blood Service NSTOB, Springe, Germany
| | - J Marcelis
- Elisabeth Hospital, Tilburg, The Netherlands
| | - Z Mukhtar
- Dow Safe Blood Transfusion Services, DUHS, Khi, Pakistan
| | - H Nagumo
- Japanese Red Cross, Tokyo, Japan
| | - T Niekerk
- Constantia Kloof, South African National Blood Service, Johannesburg, South Africa
| | - J Rojo
- Centro Nacional de la Transfusión Sanguínea, Mexico, Mexico
| | - S Marschner
- Terumo BCT Biotechnologies, Lakewood, CO, USA
| | - M Satake
- Japanese Red Cross, Tokyo, Japan
| | - A Seltsam
- German Red Cross Blood Service NSTOB, Springe, Germany
| | - E Seifried
- German Red Cross, Frankfurt/Main, Germany
| | - S Sharafat
- Dow University of Health Sciences, Khi, Pakistan
| | - M Störmer
- Institute of Transfusion Medicine, University Hospital of Cologne, Cologne, Germany
| | - S Süßner
- Blood Centre Linz, Austrian Red Cross, Linz, Austria
| | - S J Wagner
- Holland Laboratory, Transfusion Innovation Department, American Red Cross, Rockville, MD, USA
| | - R Yomtovian
- Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, OH, USA
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8
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Genome Sequences of the First WHO Repository of Platelet Transfusion-Relevant Bacterial Reference Strains. GENOME ANNOUNCEMENTS 2017; 5:5/29/e00001-17. [PMID: 28729253 PMCID: PMC5522920 DOI: 10.1128/genomea.00001-17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
To develop novel techniques for improving blood safety, dedicated bacterial strains, which are able to persist and to proliferate in blood platelet concentrates, are needed. Here, we present draft genome sequences of the four bacterial strains approved for the first WHO repository of platelet transfusion-relevant bacterial reference strains.
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9
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Kell D, Potgieter M, Pretorius E. Individuality, phenotypic differentiation, dormancy and 'persistence' in culturable bacterial systems: commonalities shared by environmental, laboratory, and clinical microbiology. F1000Res 2015; 4:179. [PMID: 26629334 PMCID: PMC4642849 DOI: 10.12688/f1000research.6709.2] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/04/2015] [Indexed: 01/28/2023] Open
Abstract
For bacteria, replication mainly involves growth by binary fission. However, in a very great many natural environments there are examples of phenotypically dormant, non-growing cells that do not replicate immediately and that are phenotypically 'nonculturable' on media that normally admit their growth. They thereby evade detection by conventional culture-based methods. Such dormant cells may also be observed in laboratory cultures and in clinical microbiology. They are usually more tolerant to stresses such as antibiotics, and in clinical microbiology they are typically referred to as 'persisters'. Bacterial cultures necessarily share a great deal of relatedness, and inclusive fitness theory implies that there are conceptual evolutionary advantages in trading a variation in growth rate against its mean, equivalent to hedging one's bets. There is much evidence that bacteria exploit this strategy widely. We here bring together data that show the commonality of these phenomena across environmental, laboratory and clinical microbiology. Considerable evidence, using methods similar to those common in environmental microbiology, now suggests that many supposedly non-communicable, chronic and inflammatory diseases are exacerbated (if not indeed largely caused) by the presence of dormant or persistent bacteria (the ability of whose components to cause inflammation is well known). This dormancy (and resuscitation therefrom) often reflects the extent of the availability of free iron. Together, these phenomena can provide a ready explanation for the continuing inflammation common to such chronic diseases and its correlation with iron dysregulation. This implies that measures designed to assess and to inhibit or remove such organisms (or their access to iron) might be of much therapeutic benefit.
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Affiliation(s)
- Douglas Kell
- School of Chemistry and The Manchester Institute of Biotechnology, The University of Manchester, Manchester, Lancashire, M1 7DN, UK
| | - Marnie Potgieter
- Department of Physiology, Faculty of Health Sciences, University of Pretoria, Arcadia, 0007, South Africa
| | - Etheresia Pretorius
- Department of Physiology, Faculty of Health Sciences, University of Pretoria, Arcadia, 0007, South Africa
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10
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Kell D, Potgieter M, Pretorius E. Individuality, phenotypic differentiation, dormancy and 'persistence' in culturable bacterial systems: commonalities shared by environmental, laboratory, and clinical microbiology. F1000Res 2015; 4:179. [PMID: 26629334 DOI: 10.12688/f1000research.6709.1] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/29/2015] [Indexed: 01/28/2023] Open
Abstract
For bacteria, replication mainly involves growth by binary fission. However, in a very great many natural environments there are examples of phenotypically dormant, non-growing cells that do not replicate immediately and that are phenotypically 'nonculturable' on media that normally admit their growth. They thereby evade detection by conventional culture-based methods. Such dormant cells may also be observed in laboratory cultures and in clinical microbiology. They are usually more tolerant to stresses such as antibiotics, and in clinical microbiology they are typically referred to as 'persisters'. Bacterial cultures necessarily share a great deal of relatedness, and inclusive fitness theory implies that there are conceptual evolutionary advantages in trading a variation in growth rate against its mean, equivalent to hedging one's bets. There is much evidence that bacteria exploit this strategy widely. We here bring together data that show the commonality of these phenomena across environmental, laboratory and clinical microbiology. Considerable evidence, using methods similar to those common in environmental microbiology, now suggests that many supposedly non-communicable, chronic and inflammatory diseases are exacerbated (if not indeed largely caused) by the presence of dormant or persistent bacteria (the ability of whose components to cause inflammation is well known). This dormancy (and resuscitation therefrom) often reflects the extent of the availability of free iron. Together, these phenomena can provide a ready explanation for the continuing inflammation common to such chronic diseases and its correlation with iron dysregulation. This implies that measures designed to assess and to inhibit or remove such organisms (or their access to iron) might be of much therapeutic benefit.
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Affiliation(s)
- Douglas Kell
- School of Chemistry and The Manchester Institute of Biotechnology, The University of Manchester, Manchester, Lancashire, M1 7DN, UK
| | - Marnie Potgieter
- Department of Physiology, Faculty of Health Sciences, University of Pretoria, Arcadia, 0007, South Africa
| | - Etheresia Pretorius
- Department of Physiology, Faculty of Health Sciences, University of Pretoria, Arcadia, 0007, South Africa
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11
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Schmidt M, Hourfar MK, Sireis W, Pfeiffer U, Göttig S, Kempf VA, McDonald CP, Seifried E. Evaluation of the effectiveness of a pathogen inactivation technology against clinically relevant transfusion-transmitted bacterial strains. Transfusion 2015; 55:2104-12. [DOI: 10.1111/trf.13171] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2015] [Revised: 04/09/2015] [Accepted: 04/10/2015] [Indexed: 12/15/2022]
Affiliation(s)
- Michael Schmidt
- DRK Blutspendedienst Baden-Württemberg-Hessen gGmbH, Institute of Transfusion Medicine and Immunohematology; Goethe University Frankfurt am Main, and
| | - Michael K. Hourfar
- DRK Blutspendedienst Baden-Württemberg-Hessen gGmbH, Institute of Transfusion Medicine and Immunohematology; Goethe University Frankfurt am Main, and
| | - Walid Sireis
- DRK Blutspendedienst Baden-Württemberg-Hessen gGmbH, Institute of Transfusion Medicine and Immunohematology; Goethe University Frankfurt am Main, and
| | - Ulrich Pfeiffer
- DRK Blutspendedienst Baden-Württemberg-Hessen gGmbH, Institute of Transfusion Medicine and Immunohematology; Goethe University Frankfurt am Main, and
| | - Stephan Göttig
- Institute for Medical Microbiology and Infection Control; Hospital of Goethe-University; Frankfurt am Main Germany
| | - Volkhard A.J. Kempf
- Institute for Medical Microbiology and Infection Control; Hospital of Goethe-University; Frankfurt am Main Germany
| | - Carl P. McDonald
- National Bacteriology Laboratory; NHS Blood and Transplant; Colindale London UK
| | - Erhard Seifried
- DRK Blutspendedienst Baden-Württemberg-Hessen gGmbH, Institute of Transfusion Medicine and Immunohematology; Goethe University Frankfurt am Main, and
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12
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Damgaard C, Magnussen K, Enevold C, Nilsson M, Tolker-Nielsen T, Holmstrup P, Nielsen CH. Viable bacteria associated with red blood cells and plasma in freshly drawn blood donations. PLoS One 2015; 10:e0120826. [PMID: 25751254 PMCID: PMC4353618 DOI: 10.1371/journal.pone.0120826] [Citation(s) in RCA: 77] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2014] [Accepted: 01/26/2015] [Indexed: 01/28/2023] Open
Abstract
Objectives Infection remains a leading cause of post-transfusion mortality and morbidity. Bacterial contamination is, however, detected in less than 0.1% of blood units tested. The aim of the study was to identify viable bacteria in standard blood-pack units, with particular focus on bacteria from the oral cavity, and to determine the distribution of bacteria revealed in plasma and in the red blood cell (RBC)-fraction. Design Cross-sectional study. Blood were separated into plasma and RBC-suspensions, which were incubated anaerobically or aerobically for 7 days on trypticase soy blood agar (TSA) or blue lactose plates. For identification colony PCR was performed using primers targeting 16S rDNA. Setting Blood donors attending Capital Region Blood Bank, Copenhagen University Hospital, Rigshospitalet, Hvidovre, Denmark, October 29th to December 10th 2013. Participants 60 donors (≥50 years old), self-reported medically healthy. Results Bacterial growth was observed on plates inoculated with plasma or RBCs from 62% of the blood donations. Growth was evident in 21 (35%) of 60 RBC-fractions and in 32 (53%) of 60 plasma-fractions versus 8 of 60 negative controls (p = 0.005 and p = 2.6x10-6, respectively). Propionibacterium acnes was found in 23% of the donations, and Staphylococcus epidermidis in 38%. The majority of bacteria identified in the present study were either facultative anaerobic (59.5%) or anaerobic (27.8%) species, which are not likely to be detected during current routine screening. Conclusions Viable bacteria are present in blood from donors self-reported as medically healthy, indicating that conventional test systems employed by blood banks insufficiently detect bacteria in plasma. Further investigation is needed to determine whether routine testing for anaerobic bacteria and testing of RBC-fractions for adherent bacteria should be recommended.
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Affiliation(s)
- Christian Damgaard
- Section for Periodontology, Microbiology and Community Dentistry, Department of Odontology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Institute for Inflammation Research, Department of Infectious Diseases and Rheumatology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
- * E-mail:
| | - Karin Magnussen
- Department of Clinical Immunology and Blood Centre, Rigshospitalet, Copenhagen University Hospital, Hvidovre, Denmark
| | - Christian Enevold
- Section for Periodontology, Microbiology and Community Dentistry, Department of Odontology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Institute for Inflammation Research, Department of Infectious Diseases and Rheumatology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Martin Nilsson
- Costerton Biofilm Center, Department of International Health, Immunology and Microbiology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Tim Tolker-Nielsen
- Costerton Biofilm Center, Department of International Health, Immunology and Microbiology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Palle Holmstrup
- Section for Periodontology, Microbiology and Community Dentistry, Department of Odontology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Claus Henrik Nielsen
- Section for Periodontology, Microbiology and Community Dentistry, Department of Odontology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Institute for Inflammation Research, Department of Infectious Diseases and Rheumatology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
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Müller B, Walther-Wenke G, Kalus M, Alt T, Bux J, Zeiler T, Schottstedt V. Routine bacterial screening of platelet concentrates by flow cytometry and its impact on product safety and supply. Vox Sang 2014; 108:209-18. [PMID: 25469957 DOI: 10.1111/vox.12214] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2014] [Revised: 08/29/2014] [Accepted: 09/29/2014] [Indexed: 12/01/2022]
Abstract
BACKGROUND AND OBJECTIVES Bacterial contamination represents the major infectious hazard associated with transfusion of platelet concentrates (PCs). As bacterial screening of PCs is not mandatory in Germany, the BactiFlow flow cytometry test has been introduced as a rapid detection method to increase product safety. MATERIALS AND METHODS During a period of 25 months, a total of 34 631 PCs (26 411 pooled and 8220 apheresis-derived PCs) were tested at the end of day 3 of their shelf life using the BactiFlow system. PCs initially reactive in BactiFlow testing and expired PCs not reactive in BactiFlow on day 3 were also investigated by the BacT/ALERT system and by microbiological cultivation in order to identify the contaminating bacterial species and to confirm reactive BactiFlow results. RESULTS Two hundred and twenty-eight PCs (0.7%) had an initially reactive result, 24 of them remained reactive in a second test run. Out of these reproducible reactive BactiFlow results, 12 could not be verified by parallel BacT/ALERT culturing, resulting in a confirmed false-positive rate of 0.03%. The bacterial species were identified as S. aureus, S. epidermidis, S. dysgalactiae ssp. equisimilis and B. cereus. In 10 out of 9017 expired PCs (0.11%), a confirmed-positive result was obtained in the BacT/ALERT system which had a negative result in the BactiFlow system. CONCLUSION Testing of PCs by BactiFlow was successfully implemented in our blood donation service and proved sufficient as a rapid and reliable screening method. False reactive results are in an acceptable range since the transfusion of 12 bacterially contaminated PCs was prevented.
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Affiliation(s)
- B Müller
- GRC-West Blood Donation Service, Central Laboratory Hagen, Hagen, Germany
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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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15
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Shih DTB, Burnouf T. Preparation, quality criteria, and properties of human blood platelet lysate supplements for ex vivo stem cell expansion. N Biotechnol 2014; 32:199-211. [PMID: 24929129 PMCID: PMC7102808 DOI: 10.1016/j.nbt.2014.06.001] [Citation(s) in RCA: 110] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2013] [Revised: 05/30/2014] [Accepted: 06/02/2014] [Indexed: 02/06/2023]
Abstract
Most clinical applications of human multipotent mesenchymal stromal cells (MSCs) for cell therapy, tissue engineering, regenerative medicine, and treatment of immune and inflammatory diseases require a phase of isolation and ex vivo expansion allowing a clinically meaningful cell number to be reached. Conditions used for cell isolation and expansion should meet strict quality and safety requirements. This is particularly true for the growth medium used for MSC isolation and expansion. Basal growth media used for MSC expansion are supplemented with multiple nutrients and growth factors. Fetal bovine serum (FBS) has long been the gold standard medium supplement for laboratory-scale MSC culture. However, FBS has a poorly characterized composition and poses risk factors, as it may be a source of xenogenic antigens and zoonotic infections. FBS has therefore become undesirable as a growth medium supplement for isolating and expanding MSCs for human therapy protocols. In recent years, human blood materials, and most particularly lysates and releasates of platelet concentrates have emerged as efficient medium supplements for isolating and expanding MSCs from various origins. This review analyzes the advantages and limits of using human platelet materials as medium supplements for MSC isolation and expansion. We present the modes of production of allogeneic and autologous platelet concentrates, measures taken to ensure optimal pathogen safety profiles, and methods of preparing PLs for MSC expansion. We also discuss the supply of such blood preparations. Produced under optimal conditions of standardization and safety, human platelet materials can become the future 'gold standard' supplement for ex vivo production of MSCs for translational medicine and cell therapy applications.
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Affiliation(s)
- Daniel Tzu-Bi Shih
- Graduate Institute of Medical Sciences, College of Medicine, Taipei Medical University, Taipei, Taiwan; Pediatrics Department, Taipei Medical University Hospital, Taipei, Taiwan
| | - Thierry Burnouf
- Graduate Institute of Biomedical Materials and Tissue Engineering, College of Oral Medicine, Taipei Medical University, Taipei, Taiwan.
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Bacterial screening of platelet concentrates on day 2 and 3 with flow cytometry: the optimal sampling time point? BLOOD TRANSFUSION = TRASFUSIONE DEL SANGUE 2014; 12:388-95. [PMID: 24887230 DOI: 10.2450/2014.0175-13] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 06/17/2013] [Accepted: 10/24/2013] [Indexed: 12/14/2022]
Abstract
BACKGROUND There is growing concern on the residual risk of bacterial contamination of platelet concentrates in Germany, despite the reduction of the shelf-life of these concentrates and the introduction of bacterial screening. In this study, the applicability of the BactiFlow flow cytometric assay for bacterial screening of platelet concentrates on day 2 or 3 of their shelf-life was assessed in two German blood services. The results were used to evaluate currently implemented or newly discussed screening strategies. MATERIALS AND METHODS Two thousand and ten apheresis platelet concentrates were tested on day 2 or day 3 after donation using BactiFlow flow cytometry. Reactive samples were confirmed by the BacT/Alert culture system. RESULTS Twenty-four of the 2,100 platelet concentrates tested were reactive in the first test by BactiFlow. Of these 24 platelet concentrates, 12 were false-positive and the other 12 were initially reactive. None of the microbiological cultures of the initially reactive samples was positive. Parallel examination of 1,026 platelet concentrates by culture revealed three positive platelet concentrates with bacteria detected only in the anaerobic culture bottle and identified as Staphylococcus species. Two platelet concentrates were confirmed positive for Staphylcoccus epidermidis by culture. Retrospective analysis of the growth kinetics of the bacteria indicated that the bacterial titres were most likely below the diagnostic sensitivity of the BactiFlow assay (<300 CFU/mL) and probably had no transfusion relevance. CONCLUSIONS The BactiFlow assay is very convenient for bacterial screening of platelet concentrates independently of the testing day and the screening strategy. Although the optimal screening strategy could not be defined, this study provides further data to help achieve this goal.
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Störmer M, Vollmer T. Diagnostic methods for platelet bacteria screening: current status and developments. ACTA ACUST UNITED AC 2013; 41:19-27. [PMID: 24659944 DOI: 10.1159/000357651] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2013] [Accepted: 11/20/2013] [Indexed: 11/19/2022]
Abstract
Bacterial contamination of blood components and the prevention of transfusion-associated bacterial infection still remains a major challenge in transfusion medicine. Over the past few decades, a significant reduction in the transmission of viral infections has been achieved due to the introduction of mandatory virus screening. Platelet concentrates (PCs) represent one of the highest risks for bacterial infection. This is due to the required storage conditions for PCs in gas-permeable containers at room temperature with constant agitation, which support bacterial proliferation from low contamination levels to high titers. In contrast to virus screening, since 1997 in Germany bacterial testing of PCs is only performed as a routine quality control or, since 2008, to prolong the shelf life to 5 days. In general, bacterial screening of PCs by cultivation methods is implemented by the various blood services. Although these culturing systems will remain the gold standard, the significance of rapid methods for screening for bacterial contamination has increased over the last few years. These new methods provide powerful tools for increasing the bacterial safety of blood components. This article summarizes the course of policies and provisions introduced to increase bacterial safety of blood components in Germany. Furthermore, we give an overview of the different diagnostic methods for bacterial screening of PCs and their current applicability in routine screening processes.
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Affiliation(s)
- Melanie Störmer
- Institut für Transfusionsmedizin, Blutspendezentrale, Universitätsklinikum Köln, Bad Oeynhausen, Germany
| | - Tanja Vollmer
- Institut für Laboratoriums- und Transfusionsmedizin, Herz- und Diabeteszentrum Nordrhein-Westfalen, Universitätsklinik der Ruhr-Universität Bochum, Bad Oeynhausen, Germany
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Vollmer T, Knabbe C, Dreier J. Novel flow cytometric screening method for bacterial contamination of red blood cells: a proof-of-principle evaluation. Transfusion 2013; 54:900-9. [DOI: 10.1111/trf.12513] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2013] [Revised: 10/19/2013] [Accepted: 10/20/2013] [Indexed: 11/28/2022]
Affiliation(s)
- Tanja Vollmer
- Institut für Laboratoriums- und Transfusionsmedizin; Herz- und Diabeteszentrum Nordrhein-Westfalen; Universitätsklinik der Ruhr-Universität Bochum; Bad Oeynhausen Germany
| | - Cornelius Knabbe
- Institut für Laboratoriums- und Transfusionsmedizin; Herz- und Diabeteszentrum Nordrhein-Westfalen; Universitätsklinik der Ruhr-Universität Bochum; Bad Oeynhausen Germany
| | - Jens Dreier
- Institut für Laboratoriums- und Transfusionsmedizin; Herz- und Diabeteszentrum Nordrhein-Westfalen; Universitätsklinik der Ruhr-Universität Bochum; Bad Oeynhausen Germany
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In vitro and in vivo characterization of ultraviolet light C-irradiated human platelets in a 2 event mouse model of transfusion. PLoS One 2013; 8:e79869. [PMID: 24224014 PMCID: PMC3815158 DOI: 10.1371/journal.pone.0079869] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2013] [Accepted: 09/27/2013] [Indexed: 12/11/2022] Open
Abstract
UV-based pathogen reduction technologies have been developed in recent years to inactivate pathogens and contaminating leukocytes in platelet transfusion products in order to prevent transfusion-transmitted infections and alloimmunization. UVC-based technology differs from UVA or UVB-based technologies in that it uses a specific wavelength at 254 nm without the addition of any photosensitizers. Previously, it was reported that UVC irradiation induces platelet aggregation and activation. To understand if UVC-induced changes of platelet quality correlate with potential adverse events when these platelets are transfused into animals, we used a 2-event SCID mouse model in which the predisposing event was LPS treatment and the second event was infusion of UVC-irradiated platelets. We analyzed lung platelet accumulation, protein content in bronchoalveolar lavage fluid as an indication of lung injury, and macrophage inflammatory protein-2 (MIP-2) release in mice received UVC-irradiated or untreated control platelets. Our results showed UVC-irradiated platelets accumulated in lungs of the mice in a dose-dependent manner. High-doses of UVC-irradiated platelets were sequestered in the lungs to a similar level as we previously reported for UVB-irradiated platelets. Unlike UVB-platelets, UVC-platelets did not lead to lung injury or induce MIP-2 release. This could potentially be explained by our observation that although UVC treatment activated platelet surface αIIbβ3, it failed to activate platelet cells. It also suggests lung platelet accumulation and subsequent lung damage are due to different and separate mechanisms which require further investigation.
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Vollmer T, Dreier J, Schottstedt V, Bux J, Tapernon K, Sibrowski W, Kleesiek K, Knabbe C. Detection of bacterial contamination in platelet concentrates by a sensitive flow cytometric assay (BactiFlow): a multicentre validation study. Transfus Med 2012; 22:262-71. [DOI: 10.1111/j.1365-3148.2012.01166.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2012] [Revised: 04/27/2012] [Accepted: 04/30/2012] [Indexed: 11/27/2022]
Affiliation(s)
- T. Vollmer
- 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
| | - V. Schottstedt
- DRK-Blutspendedienst West; Zentrallabor Hagen; Hagen; Germany
| | - J. Bux
- DRK-Blutspendedienst West; Zentrallabor Hagen; Hagen; Germany
| | - K. Tapernon
- Institut für Transfusionsmedizin und Transplantationsimmunologie; Universitätsklinikum Münster; Münster; Germany
| | - W. Sibrowski
- Institut für Transfusionsmedizin und Transplantationsimmunologie; Universitätsklinikum Münster; Münster; Germany
| | - K. Kleesiek
- Institut für Laboratoriums- und Transfusionsmedizin, Herz- und Diabeteszentrum Nordrhein-Westfalen; Universitätsklinik der Ruhr-Universität Bochum; Bad Oeynhausen; Germany
| | - C. Knabbe
- Institut für Laboratoriums- und Transfusionsmedizin, Herz- und Diabeteszentrum Nordrhein-Westfalen; Universitätsklinik der Ruhr-Universität Bochum; Bad Oeynhausen; Germany
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Mueller MM, Hourfar MK, Huber E, Sireis W, Weichert W, Seifried E, Tonn T, Schmidt M. Oxygen measurements in platelet fluids - a new non-invasive method to detect bacterial contaminations in platelets. Transfus Med 2012; 22:211-6. [PMID: 22462725 DOI: 10.1111/j.1365-3148.2012.01146.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND The residual risk for bacterial contamination in blood components especially in platelets is one to two orders of magnitude higher than for transfusion relevant viral infections. The majority of all bacterial transmitted fatalities occurred at the end of platelet shelf life. Therefore, the maximum shelf life of platelet concentrates (PC) was reduced to 4 days after blood donation in Germany in 2008. METHODS A new continuous non-invasive bacterial detection method was developed by O(2) measurements in the platelet fluids and tested with 10 transfusion relevant bacteria species. RESULTS The bacterial concentration at the time point of a positive signal of PreSense O(2) ranged between 10(2) and 10(5) CFU mL(-1) . Harmful transfusion-transmitted bacterial infection would have probably been prevented by this novel technology. Only strict anaerobic bacteria strains like Clostridium perfringens were not detected within the study period of 72 h. CONCLUSIONS The described non-invasive bacterial detection method represents a new approach to prevent transmission of bacterial infection in platelets. The method is characterised by the advantage that all investigations can be performed until right up to the time of transfusion, and therefore, reduce the risk for sample errors to a minimum.
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Affiliation(s)
- M M Mueller
- Institute for Transfusion Medicine and Immunohematology, German Red Cross, Johann Wolfgang Goethe University, Frankfurt, Germany
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Vollmer T, Schottstedt V, Bux J, Knabbe C, Dreier J. How new is new: the late sampling strategy with rapid bacterial screening of platelet concentrates? Vox Sang 2012; 102:365. [DOI: 10.1111/j.1423-0410.2011.01579.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Vollmer T, Hinse D, Schottstedt V, Bux J, Tapernon K, Sibrowski W, Knabbe C, Dreier J. Inter-laboratory comparison of different rapid methods for the detection of bacterial contamination in platelet concentrates. Vox Sang 2011; 103:1-9. [DOI: 10.1111/j.1423-0410.2011.01572.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Chou ML, Wu YW, Su CY, Lee LW, Burnouf T. Impact of solvent/detergent treatment of plasma on transfusion-relevant bacteria. Vox Sang 2011; 102:277-84. [PMID: 22092109 DOI: 10.1111/j.1423-0410.2011.01560.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND A solvent/detergent (S/D) treatment in a medical device has been developed for pathogen reduction of plasma for transfusion. Impact of S/D on bacterial growth and on the capacity of complement to kill bacteria has been investigated in this study. STUDY DESIGN AND METHODS A pool of apheresis plasma from four donors was spiked with eight transfusion-relevant bacteria. Plasma was treated with 1% tri(n-butyl) phosphate and 1% Triton X-45 at 31°C for 90 min and then extracted by oil at 31°C for 70 min. Decomplemented plasma and Phosphate Buffer Saline were used as controls. Bacterial count was determined in samples taken immediately after spiking, or after S/D and oil treatment. Similar experiments were conducted using three individual recovered plasma donations. Bacteria growth inhibition tests were performed using discs soaked with plasma samples whether containing the S/D agents or not. RESULTS The mean reduction factors of Escherichia coli, Pseudomonas aeruginosa, and Klebsiella pneumoniae due to complement during S/D treatment were >8·75, 4·71, and 4·18 log in pooled plasma and >7·42, 2·24 and >6·08 log in individual plasmas, respectively. Bacillus cereus and Bacillus subtilis were inactivated by S/D (>7·04 and 1·60 log in pooled, and >6·06 and 2·39 in individual plasmas, respectively). Staphylococcus aureus, Staphylococcus epidermidis and Enterobacter cloacae did not multiply during S/D treatment of plasma. Growth inhibition tests revealed an inhibition of three gram-negative bacteria by complement and all gram-positive by S/D. CONCLUSION The S/D treatment of plasma does not alter the bactericidal activity of complement, and inactivates some gram-positive bacteria.
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Affiliation(s)
- M-L Chou
- Department of Microbiology and Immunology, Taipei Medical University, Taipei, Taiwan
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Müller TH, Montag T, Seltsam AW. Laboratory Evaluation of the Effectiveness of Pathogen Reduction Procedures for Bacteria. ACTA ACUST UNITED AC 2011; 38:242-250. [PMID: 22016694 DOI: 10.1159/000330338] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2011] [Accepted: 05/05/2011] [Indexed: 11/19/2022]
Abstract
SUMMARY: Bacterial contamination remains a leading factor for transfusion-associated serious morbidity and mortality. Pathogen reduction procedures offer a pro-active approach to prevent bacterial contamination of cellular blood components and especially of platelet concentrates. In the past, the laboratory evaluation of the effectiveness of the pathogen reduction procedures to minimise the bacterial load of blood components has been primarily based on log reduction assays similar to the assessment of antiviral activities. Bacteria strains with the ability to multiply in the blood components are seeded in highest possible cell numbers, the pathogen reduction procedure is applied, and the post-treatment number of bacteria is measured. The effectiveness of the procedure is characterised by calculating the log reduction of the post- to pre-treatment bacteria titres. More recently, protocols have been developed for experiments starting with a low bacteria load and monitoring the sterility of the blood component during the entire storage period of the blood component. Results for 3 different pathogen reduction technologies in these experimental models are compared and critical determinants for the results are addressed. The heterogeneity of results observed for different strains suggests that the introduction of international transfusion-relevant bacterial reference strains may facilitate the validity of findings in pathogen reduction experiments.
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Affiliation(s)
- Thomas H Müller
- DRK-Blutspendedienst NSTOB, Institut Springe, Langen, Germany
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Schmidt M, Sireis W, Seifried E. Implementation of Bacterial Detection Methods into Blood Donor Screening - Overview of Different Technologies. ACTA ACUST UNITED AC 2011; 38:259-265. [PMID: 22016697 DOI: 10.1159/000330305] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2011] [Accepted: 06/08/2011] [Indexed: 11/19/2022]
Abstract
SUMMARY: BACKGROUND: Through the implementation of modern technology, such as nucleic acid testing, over the last two decades, blood safety has improved considerably in that the risk of viral infection is less than 1 in a million blood transfusions. By contrast, the residual risk of transfusion-associated bacterial infection is stable at approximately 1 in 2,000 to 1 in 3,000 in platelets. To improve blood safety with regard to bacterial infections, many countries have implemented bacterial screening methods as part of their blood donor screening programmes. METHODS: BACTERIAL DETECTION METHODS ARE CLUSTERED INTO THREE GROUPS: i) culture methods in combination with the 'negative-to-date' concept, ii) rapid detection systems with a late sample collection, and iii) bedside screening tests. RESULTS: The culture methods are convincing because of their very high analytical sensitivity. Nevertheless, false-negative culture results and subsequent fatalities were reported in several countries. Rapid bacterial systems are characterised as having short testing time but reduced sensitivity. Sample errors are prevented by late sample collection. Finally, bedside tests reduce the risk for sample errors to a minimum, but testing outside of blood donation services may have risks for general testing failures. CONCLUSION: Bacterial screening of blood products, especially platelets, can be performed using a broad range of technologies. Each system exhibits advantages and disadvantages and offers only a temporary solution until a general pathogen inactivation technology is available for all blood components.
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Affiliation(s)
- Michael Schmidt
- German Red Cross, Institute for Transfusion Medicine and Immunohaematology, Johann Wolfgang Goethe University, Frankfurt/M., Germany
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Störmer M, Arroyo A, Brachert J, Carrero H, Devine D, Epstein JS, Gabriel C, Gelber C, Goodrich R, Hanschmann KM, Heath DG, Jacobs MR, Keil S, de Korte D, Lambrecht B, Lee CK, Marcelis J, Marschner S, McDonald C, McGuane S, McKee M, Müller TH, Muthivhi T, Pettersson A, Radziwon P, Ramirez-Arcos S, Reesink HW, Rojo J, Rood I, Schmidt M, Schneider CK, Seifried E, Sicker U, Wendel S, Wood EM, Yomtovian RA, Montag T. Establishment of the first international repository for transfusion-relevant bacteria reference strains: ISBT working party transfusion-transmitted infectious diseases (WP-TTID), subgroup on bacteria. Vox Sang 2011; 102:22-31. [PMID: 21732948 DOI: 10.1111/j.1423-0410.2011.01510.x] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Bacterial contamination of platelet concentrates (PCs) still remains a significant problem in transfusion with potential important clinical consequences, including death. The International Society of Blood Transfusion Working Party on Transfusion-Transmitted Infectious Diseases, Subgroup on Bacteria, organised an international study on Transfusion-Relevant Bacteria References to be used as a tool for development, validation and comparison of both bacterial screening and pathogen reduction methods. MATERIAL AND METHODS Four Bacteria References (Staphylococcus epidermidis PEI-B-06, Streptococcus pyogenes PEI-B-20, Klebsiella pneumoniae PEI-B-08 and Escherichia coli PEI-B-19) were selected regarding their ability to proliferate to high counts in PCs and distributed anonymised to 14 laboratories in 10 countries for identification, enumeration and bacterial proliferation in PCs after low spiking (0·3 and 0·03 CFU/ml), to simulate contamination occurring during blood donation. RESULTS Bacteria References were correctly identified in 98% of all 52 identifications. S. pyogenes and E. coli grew in PCs in 11 out of 12 laboratories, and K. pneumoniae and S. epidermidis replicated in all participating laboratories. The results of bacterial counts were very consistent between laboratories: the 95% confidence intervals were for S. epidermidis: 1·19-1·32 × 10(7) CFU/ml, S. pyogenes: 0·58-0·69 × 10(7) CFU/ml, K. pneumoniae: 18·71-20·26 × 10(7) CFU/ml and E. coli: 1·78-2·10 × 10(7) CFU/ml. CONCLUSION The study was undertaken as a proof of principle with the aim to demonstrate (i) the quality, stability and suitability of the bacterial strains for low-titre spiking of blood components, (ii) the property of donor-independent proliferation in PCs, and (iii) their suitability for worldwide shipping of deep frozen, blinded pathogenic bacteria. These aims were successfully fulfilled. The WHO Expert Committee Biological Standardisation has approved the adoption of these four bacteria strains as the first Repository for Transfusion-Relevant Bacteria Reference Strains and, additionally, endorsed as a project the addition of six further bacteria strain preparations suitable for control of platelet contamination as the next step of enlargement of the repository.
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Affiliation(s)
- M Störmer
- Paul Ehrlich Institute, Langen, Germany.
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Vollmer T, Engemann J, Kleesiek K, Dreier J. Bacterial screening by flow cytometry offers potential for extension of platelet storage: results of 14 months of active surveillance. Transfus Med 2011; 21:175-82. [DOI: 10.1111/j.1365-3148.2011.01070.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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The Pan Genera Detection immunoassay: a novel point-of-issue method for detection of bacterial contamination in platelet concentrates. J Clin Microbiol 2010; 48:3475-81. [PMID: 20702673 DOI: 10.1128/jcm.00542-10] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Bacterial contamination of platelet concentrates (PCs) still represents an ongoing risk in transfusion-transmitted sepsis. Recently the Pan Genera Detection (PGD) system was developed and FDA licensed for screening of bacterial contamination of PCs directly prior to transfusion. The test principle is based on the immunological detection of lipopolysaccharide (for Gram-negative bacteria) or lipoteichoic acid (for Gram-positive bacteria). In the present study we analyzed the applicability of this method with regard to detection limit, practicability, implementation, and performance. PCs were spiked with Staphylococcus aureus, Bacillus subtilis, and five different Klebsiella pneumoniae strains, as well as eight different Escherichia coli strains. The presence of bacteria was assessed by the PGD immunoassay, and bacteria were enumerated by plating cultures. Application of the PGD immunoassay showed that it is a rapid test with a short hands-on time for sample processing and no demand for special technical equipment and instrument operation. The lower detection limits of the assay for Gram-positive bacteria showed a good agreement with the manufacturer's specifications (8.2 × 10(3) to 5.5 × 10(4) CFU/ml). For some strains of K. pneumoniae and E. coli, the PGD test showed analytical sensitivities (>10(6) CFU/ml) that were divergent from the designated values (K. pneumoniae, 2.0 × 10(4) CFU/ml; E. coli, 2.8 × 10(4) CFU/ml). Result interpretation is sometimes difficult due to very faint bands. In conclusion, our study demonstrates that the PGD immunoassay is an easy-to-perform bedside test for the detection of bacterial contamination in PCs. However, to date there are some shortcomings in the interpretation of results and in the detection limits for some strains of Gram-negative bacteria.
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Gathof BS, Tauszig ME, Picker SM. Pathogen inactivation/reduction of platelet concentrates: turning theory into practice. ISBT SCIENCE SERIES 2010; 5:114-119. [PMID: 32328165 PMCID: PMC7169244 DOI: 10.1111/j.1751-2824.2010.01417.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Background Pathogen reduction technology (PRT) has been proven to reduce the residual risk of transmission of infectious agents. Reduction of various contaminating bacteriae, viruses and parasites by few to several log steps and efficiency to prevent GVHD has been shown. Aim To evaluate and compare advantages and disadvantages of PRT available for practical application in platelets. Materials and Methods PRT for the treatment of platelets is currently offered by two formats: Amotosalen (INTERCEPT, Cerus, Concord, CA, USA) and vitamin B2 (Mirasol, Caridian, Denver, USA). Results from different studies and our own experiences with the two techniques are compared and discussed. Results and Discussion For both technologies, different groups of investigators have shown acceptable in-vitro results with respect to functional and storage data for platelets stored for up to 5 days after production and before transfusion. Initial clinical studies showed no inferiority of the treated platelets in comparison to untreated controls in thrombocytopenic patients. However for both techniques a tendency towards lower CCI has been reported, which may be more pronounced in the platelets treated with the Intercept process. For introduction of PRT many countries require not only CE mark but licensing with the respective authorities since treatment for pathogen reduction is regarded as creating a 'new' blood product. With respect to a platelet loss during pathogen reduction it seems recommendable to increase the lower limit of platelet content of the product to 2.5 × 1011. Particularly for the Intercept system, where a considerable amount of platelets is lost in the purification of the product from Amotosalen, a change in the production process to increase the platelet yield may be necessary. Data from our group show a tendency for improved functional and storage parameters for platelets treated with the Mirasol process. Compared to conventional manufacturing of platelets by apheresis or pooling of buffy coats, pathogen reduction requires additional labour, space, and quality control. Shelf life of platelets is limited in most countries because of the risk of bacterial contamination (in Germany presently to 4 days). A prolongation to 5 or more days after pathogen reduction seems feasible but remains a topic for future studies. Conclusion Results of in vitro and clinical studies of pathogen reduced platelets are promising. Larger clinical trials will help to determine whether PRT proves to be beneficial (reduction of transmission of infections, less alloimmunisation) and overall cost effective (bearing in mind that additional costs may be compensated for by omission of gamma irradiation and potential longer shelf life).
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Affiliation(s)
- B S Gathof
- Department of Transfusion Medicine, University of Cologne, Cologne, Germany
| | - M E Tauszig
- Department of Transfusion Medicine, University of Cologne, Cologne, Germany
| | - S M Picker
- Department of Transfusion Medicine, University of Cologne, Cologne, Germany
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