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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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Haass KA, Sapiano MRP, Savinkina A, Kuehnert MJ, Basavaraju SV. Transfusion-Transmitted Infections Reported to the National Healthcare Safety Network Hemovigilance Module. Transfus Med Rev 2019; 33:84-91. [PMID: 30930009 DOI: 10.1016/j.tmrv.2019.01.001] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Revised: 12/04/2018] [Accepted: 01/02/2019] [Indexed: 11/29/2022]
Abstract
Transfusion-transmitted infections (TTIs) can be severe and result in death. Transfusion-transmitted viral pathogen transmission has been substantially reduced, whereas sepsis due to bacterial contamination of platelets and transfusion-transmitted babesiosis may occur more frequently. Quantifying the burden of TTI is important to develop targeted interventions. From January 1, 2010, to December 31, 2016, health care facilities participating in the National Healthcare Safety Network Hemovigilance Module monitored transfusion recipients for evidence of TTI and recorded the total number of units transfused. Facilities use standard criteria to report TTIs. Incidence rates of TTIs, including for bacterial contamination of platelets and transfusion-transmitted babesiosis, are presented. One hundred ninety-five facilities reported 111 TTIs and 7.9 million transfused components to the National Healthcare Safety Network Hemovigilance Module. Of these 111 reports, 54 met inclusion criteria. The most frequently reported pathogens were Babesia spp in RBCs (16/23, 70%) and Staphylococcus aureus in platelets (12/30, 40%). There were 1.95 (26 apheresis, 4 whole blood derived) TTIs per 100 000 transfused platelet units and 0.53 TTI per 100 000 transfused RBC components, compared to 0.68 TTI per 100 000 all transfused components. Bacterial contamination of platelets and transfusion-transmitted babesiosis were the most frequently reported TTIs. Interventions that reduce the burden of bacterial contamination of platelets, particularly collected by apheresis, and Babesia transmission through RBC transfusion would reduce transfusion recipient morbidity and mortality. These analyses demonstrate the value and importance of facility participation in national recipient hemovigilance using standard reporting criteria.
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Affiliation(s)
- Kathryn A Haass
- Office of Blood, Organ, and Other Tissue Safety, Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention.
| | - Mathew R P Sapiano
- Surveillance Branch, Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, US Centers for Disease Control and Prevention
| | - Alexandra Savinkina
- Office of Blood, Organ, and Other Tissue Safety, Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention; Oak Ridge Institute for Science and Education
| | - Matthew J Kuehnert
- Office of Blood, Organ, and Other Tissue Safety, Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention
| | - Sridhar V Basavaraju
- Office of Blood, Organ, and Other Tissue Safety, Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention
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3
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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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Thyer J, Perkowska-Guse Z, Ismay SL, Keller AJ, Chan HT, Dennington PM, Bell B, Kotsiou G, Pink JM. Bacterial testing of platelets - has it prevented transfusion-transmitted bacterial infections in Australia? Vox Sang 2017; 113:13-20. [DOI: 10.1111/vox.12561] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Revised: 05/24/2017] [Accepted: 07/09/2017] [Indexed: 11/28/2022]
Affiliation(s)
- J. Thyer
- Australian Red Cross Blood Service; Melbourne Vic Australia
| | | | - S. L. Ismay
- Australian Red Cross Blood Service; Melbourne Vic Australia
| | - A. J. Keller
- Australian Red Cross Blood Service; Melbourne Vic Australia
| | - H. T. Chan
- Australian Red Cross Blood Service; Melbourne Vic Australia
| | | | - B. Bell
- Australian Red Cross Blood Service; Melbourne Vic Australia
| | - G. Kotsiou
- Australian Red Cross Blood Service; Melbourne Vic Australia
| | - J. M. Pink
- Australian Red Cross Blood Service; Melbourne Vic Australia
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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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Corash L. Bacterial contamination of platelet components: potential solutions to prevent transfusion-related sepsis. Expert Rev Hematol 2014; 4:509-25. [DOI: 10.1586/ehm.11.53] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Brecher ME, Jacobs MR, Katz LM, Jacobson J, Riposo J, Carr-Greer A, Kleinman S. Survey of methods used to detect bacterial contamination of platelet products in the United States in 2011. Transfusion 2013; 53:911-8. [PMID: 23461271 DOI: 10.1111/trf.12148] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2012] [Accepted: 12/19/2012] [Indexed: 12/01/2022]
Abstract
BACKGROUND Testing of platelets (PLTs) for bacterial contamination is required by the AABB Standards but is not fully standardized. On January 31, 2011, a new AABB Standard, 5.1.5.1.1, specified that bacterial detection methods for PLT components shall use assays either approved by the Food and Drug Administration (FDA) or validated to provide sensitivity equivalent to these FDA-approved methods. METHODS An Internet-based survey of AABB member institutions was conducted from May to June 2012, to document current practices used in 2011 for bacterial detection in different PLT products and to assess the impact of the new standard. RESULTS Of 1053 AABB member institutions surveyed, 40 of 99 blood centers (40.4%) and 184 of 954 hospital blood banks or transfusion services (19.3%) responded. Sixty-four respondents manufactured PLTs. Apheresis PLTs (APs) were predominantly screened with the BacT/ALERT system (89.5%); the majority (95.2%) were cultured with at least 8 mL of product. There was substantial variation in the minimum incubation time of cultures before release of PLTs (range, 0 to >24 hr). Recalls of released AP for possible bacterial contamination were largely successful (67.3%); successful interdiction before transfusion was associated with incubation for more than 12 hours before release (p < 0.01). After Standard 5.1.5.1.1 took effect, there was a decrease in production of whole blood-derived PLT concentrates (WBPCs). Point-of-issue ("rapid") immunoassays were used to screen a substantial proportion of WBPC PLTs, but were rarely used as secondary tests for previously cultured APs. CONCLUSION The survey identified variability in culture methods and release times with AP, while use of WBPC decreased after AABB Standard 5.1.5.1.1 became effective.
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Affiliation(s)
- Mark E Brecher
- Laboratory Corporation of America, Burlington, North Carolina; Case Western Reserve University, Cleveland, Ohio, USA.
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Pearce S, Rowe GP, Field SP. Screening of platelets for bacterial contamination at the Welsh Blood Service. Transfus Med 2011; 21:25-32. [PMID: 20854460 DOI: 10.1111/j.1365-3148.2010.01037.x] [Citation(s) in RCA: 75] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
BACKGROUND AND OBJECTIVE This report details the results of the implementation of a bacterial screening system at the Welsh Blood Service and provides an estimate of the levels of bacterial contamination at the time of sampling. MATERIALS AND METHODS Apheresis (Caridian BCT) and buffy coat-derived pooled platelet components were sampled on day 1 for bacterial contamination and the sample was monitored throughout the lifespan of the platelet component. Unused platelet components were re-tested to determine the effectiveness of the screening. Results from the BacT/ALERT are uploaded to the in-house Blood Establishment Computer System (BECS) every 12 min. Positive alerts are automatically sent to staff, facilitating a timely intervention. RESULTS Between February 2003 and March 2010 the screening system tested 54 828 platelets and detected 257 (1 in 213) initial positives of which 35 (1 in 1567, 0·06%) were confirmed [95% confidence interval (CI), 0·04-0·08%]. Additionally, screening of 6438 unused platelet components detected another 6 (1 in 1073, 0·09%) confirmed positives not detected during initial testing (95% CI, 0·02-0·16%). Analysis of the data suggests that on day 1 the number of bacteria in such platelet component packs was between 5 and 62 cfus total. Day 1 culture has a sensitivity of 40%. CONCLUSIONS The bacterial screening system has removed a significant number, but not all bacterially contaminated platelet components from the supply. The sample volume is an important factor in sensitivity due to the low number of bacteria in a platelet component pack on day 1. An effective notification and recall system is a critical part of the bacterial screening system.
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Affiliation(s)
- S Pearce
- Welsh Blood Service, Laboratory Services, Pontyclun, UK.
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Satake M, Mitani T, Oikawa S, Nagumo H, Sugiura S, Tateyama H, Awakihara S, Mitsutomi Y, Muraoka M, Tadokoro K. Frequency of bacterial contamination of platelet concentrates before and after introduction of diversion method in Japan. Transfusion 2009; 49:2152-7. [DOI: 10.1111/j.1537-2995.2009.02243.x] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Eder AF, Kennedy JM, Dy BA, Notari EP, Skeate R, Bachowski G, Mair DC, Webb JS, Wagner SJ, Dodd RY, Benjamin RJ. Limiting and detecting bacterial contamination of apheresis platelets: inlet-line diversion and increased culture volume improve component safety. Transfusion 2009; 49:1554-63. [DOI: 10.1111/j.1537-2995.2009.02192.x] [Citation(s) in RCA: 102] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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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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Lessa F, Leparc GF, Benson K, Sanderson R, Van Beneden CA, Shewmaker PL, Jensen B, Arduino MJ, Kuehnert MJ. Fatal group C streptococcal infection due to transfusion of a bacterially contaminated pooled platelet unit despite routine bacterial culture screening. Transfusion 2008; 48:2177-83. [DOI: 10.1111/j.1537-2995.2008.01802.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Dreier J, Störmer M, Pichl L, Schottstedt V, Grolle A, Bux J, Kleesiek K. Sterility screening of platelet concentrates: questioning the optimal test strategy. Vox Sang 2008; 95:181-8. [DOI: 10.1111/j.1423-0410.2008.01087.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Su LL, Kamel H, Custer B, Vanderpool S, Harpool D, Busch M, Tomasulo P. Bacterial detection in apheresis platelets: blood systems experience with a two-bottle and one-bottle culture system. Transfusion 2008; 48:1842-52. [DOI: 10.1111/j.1537-2995.2008.01763.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Benjamin RJ. Bacterial culture of apheresis platelet products and the residual risk of sepsis. ACTA ACUST UNITED AC 2008. [DOI: 10.1111/j.1751-2824.2008.00148.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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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: 50] [Impact Index Per Article: 3.1] [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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Wagner SJ, Benjamin RJ. Reply. Transfusion 2008. [DOI: 10.1111/j.1537-2995.2007.01640.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Yomtovian R, Tomasulo P, Jacobs MR. Platelet bacterial contamination: assessing progress and identifying quandaries in a rapidly evolving field. Transfusion 2007; 47:1340-6. [PMID: 17655575 DOI: 10.1111/j.1537-2995.2007.01402.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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