1
|
Raghav N, Parveen S, Kaur S, Wilson David SA, Kong H, Kenney JL, Gupta RK. A rapid and simple sterility test method based on solid culture medium containing blood. Biologicals 2024; 85:101722. [PMID: 37956628 DOI: 10.1016/j.biologicals.2023.101722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 08/02/2023] [Accepted: 10/25/2023] [Indexed: 11/15/2023] Open
Abstract
Current sterility test performed for most biological products takes 14 days. We evaluated solid medium, containing 5% blood for use in the membrane filtration (MF) and direct inoculation (DI) sterility test. Representative microorganisms prepared in a sample matrix at approximately 0.1, 1, 10 and 100 colony forming units were tested for growth by compendial MF sterility test using fluid thioglycolate medium and tryptic soy broth and also on the Schaedler blood agar (SBA). Sterility test performed on SBA was significantly more sensitive and faster in detecting various microorganisms than the compendial method, particularly for sample matrix containing 0.01% thimerosal (p < 0.05). SBA detected all microorganisms within 7 days. To implement solid medium in the DI sterility test, multiple BA plates were inoculated with the sample. All representative microorganisms were detected within 5 days. The sterility test using solid medium required 3 different incubation conditions, 30-35 °C aerobically and anaerobically to detect bacteria, and at 20-25 °C aerobically to detect mold and yeast. To eliminate aerobic incubation of solid medium at 20-25 °C, we evaluated representative species of mold and yeast for their growth at 30-35 °C and 20-25 °C in the sterility test performed on solid medium. Penicillium chrysogenum could not be detected at 30-35 °C consistently within 7 days. Sterility test performed on solid medium without any additional technology could be completed in 7 days, as compared to the 14 days required for the current compendial method.
Collapse
Affiliation(s)
- Neetu Raghav
- Division of Biological Standards and Quality Control, Office of Compliance and Biologics Quality, Center for Biologics Evaluation and Research, FDA, White Oak, MD, United States
| | - Seema Parveen
- Division of Biological Standards and Quality Control, Office of Compliance and Biologics Quality, Center for Biologics Evaluation and Research, FDA, White Oak, MD, United States
| | - Simleen Kaur
- Division of Biological Standards and Quality Control, Office of Compliance and Biologics Quality, Center for Biologics Evaluation and Research, FDA, White Oak, MD, United States
| | - Selwyn A Wilson David
- Division of Biological Standards and Quality Control, Office of Compliance and Biologics Quality, Center for Biologics Evaluation and Research, FDA, White Oak, MD, United States
| | - Hyesuk Kong
- Division of Biological Standards and Quality Control, Office of Compliance and Biologics Quality, Center for Biologics Evaluation and Research, FDA, White Oak, MD, United States
| | - James L Kenney
- Division of Biological Standards and Quality Control, Office of Compliance and Biologics Quality, Center for Biologics Evaluation and Research, FDA, White Oak, MD, United States
| | - Rajesh K Gupta
- Division of Biological Standards and Quality Control, Office of Compliance and Biologics Quality, Center for Biologics Evaluation and Research, FDA, White Oak, MD, United States.
| |
Collapse
|
2
|
Pasqua S, Monaco F, Cardinale F, Bonelli S, Conaldi PG, D’Apolito D. Growth Performance and Recovery of Nosocomial Aspergillus spp. in Blood Culture Bottles. Microorganisms 2022; 10:microorganisms10102026. [PMID: 36296302 PMCID: PMC9608713 DOI: 10.3390/microorganisms10102026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 10/05/2022] [Accepted: 10/11/2022] [Indexed: 11/21/2022] Open
Abstract
Theoretically, Aspergillus spp. grow in culture media, but frequently, blood cultures of patients with invasive Aspergillosis are negative, even if until now, the reasons are not clear. This aspect underlines the lack of a good strategy for the cultivation and isolation of Aspergillus spp. In order to develop a complete analytical method to detect Aspergillus in clinical and pharmaceutical samples, we investigated the growth performance of two blood culture systems versus the pharmacopeia standard method. At <72 h, all test systems showed comparable sensitivity, about 1−2 conidia. However, the subculture analysis showed a suboptimal recovery for the methods, despite the positive growth and the visualization of the “Aspergillus balls” in the culture media. To investigate this issue, we studied three different subculture approaches: (i) the use of a sterile subculture unit, (ii) the use of a sterile subculture unit and the collection of a larger aliquot (100 µL), following vigorous agitation of the vials, and (iii) to decapsulate the bottle, withdrawing and centrifuging the sample, and aliquot the pellet onto SDA plates. Our results showed that only the third procedure recovered Aspergillus from all positive culture bottles. This work confirmed that our strategy is a valid and faster method to culture and isolate Aspergillus spp. from blood culture bottles.
Collapse
Affiliation(s)
- Salvatore Pasqua
- Unità Prodotti Cellulari (GMP), Fondazione Ri.MED c/o IRCCS-ISMETT, Via E. Tricomi 5, 90127 Palermo, Italy
| | - Francesco Monaco
- Unità di Medicina di Laboratorio e Biotecnologie Avanzate, IRCCS-ISMETT (Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione), Via E. Tricomi 5, 90127 Palermo, Italy
| | - Francesca Cardinale
- Unità di Medicina di Laboratorio e Biotecnologie Avanzate, IRCCS-ISMETT (Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione), Via E. Tricomi 5, 90127 Palermo, Italy
| | - Simone Bonelli
- Department of Biological, Chemical and Pharmaceutical Sciences and Technologies (STEBICEF), University of Palermo, Viale delle Scienze, Edificio 16, 90128 Palermo, Italy
- Proteomics Group of Fondazione Ri.MED, Department of Research IRCCS ISMETT, Via Ernesto Tricomi 5, 90145 Palermo, Italy
| | - Pier Giulio Conaldi
- Unità di Medicina di Laboratorio e Biotecnologie Avanzate, IRCCS-ISMETT (Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione), Via E. Tricomi 5, 90127 Palermo, Italy
| | - Danilo D’Apolito
- Unità Prodotti Cellulari (GMP), Fondazione Ri.MED c/o IRCCS-ISMETT, Via E. Tricomi 5, 90127 Palermo, Italy
- Unità di Medicina di Laboratorio e Biotecnologie Avanzate, IRCCS-ISMETT (Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione), Via E. Tricomi 5, 90127 Palermo, Italy
- Correspondence: mailto: or ; Tel.: +39-091-2192472
| |
Collapse
|
3
|
Technical challenges for complete implementation of automated growth-based methods for microbiological examination of advanced therapy medicinal products. What's wrong with Candida albicans? Cytotherapy 2022; 24:320-333. [DOI: 10.1016/j.jcyt.2021.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 11/10/2021] [Accepted: 11/15/2021] [Indexed: 11/22/2022]
|
4
|
Mukherjee S, Mukherjee S, Mahto R, Basu D, Javed R, Goel G, Bhattacharya S, Basu S, Chandy M. Importance and results of sterility testing of various products in a microbiology laboratory of eastern India. Indian J Med Microbiol 2021; 40:138-140. [PMID: 34740414 DOI: 10.1016/j.ijmmb.2021.10.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 05/27/2021] [Accepted: 10/24/2021] [Indexed: 11/17/2022]
Abstract
Components of blood products from Blood bank, stem cells products from Haemotapoietic Stem Cell Transplant unit, CSSD (Central Sterile Supply Department) items, and pharrrmaceutical products, were sterility tested by liquid culture. 2.91% of the total 3122 samples sent for sterility testing from various departments were positive (i.e. showing contamination). CSSD products showed no contamination (0/37); products from blood bank and bone marrow transplant unit showed a contamination rate of 2.03% (47/2307) and 4.64% (31/667) respectively. The average cost of sterility test was Rs. 302 (INR). Sterility test requires stringent aseptic precautions which is resource intensive.
Collapse
Affiliation(s)
| | | | - Rajkumar Mahto
- Department of Microbiology, Tata Medical Center, Kolkata, India
| | - Debabrata Basu
- Central Sterile Supply Department, Tata Medical Center, Kolkata, India
| | - Rizwan Javed
- Department of Clinical Hematology and Celular Therapy, Tata Medical Center, Kolkata, India
| | - Gaurav Goel
- Department of Microbiology, Tata Medical Center, Kolkata, India
| | | | - Sabita Basu
- Department of Transfusion Medicine, Tata Medical Center, Kolkata, India
| | - Mammen Chandy
- Department of Clinical Hematology and Celular Therapy, Tata Medical Center, Kolkata, India
| |
Collapse
|
5
|
Comprehensive Study Identifies a Sensitive, Low-Risk, Closed-System Model for Detection of Fungal Contaminants in Cell and Gene Therapy Products. J Clin Microbiol 2021; 59:e0135721. [PMID: 34406794 DOI: 10.1128/jcm.01357-21] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The U.S. Food and Drug Administration (FDA) regulates manufacturing and testing of advanced therapeutic medicinal products (ATMPs) to ensure the safety of each product for human use. Gold-standard sterility testing (USP<71>) and alternative blood culture systems have major limitations for the detection of fungal contaminants. In this study, we evaluated the performance of iLYM (lactic acid-fermenting organisms, yeasts, and mold) medium (designed originally for the food and beverage industry) to assess its potential for use in the biopharmaceutical field for ATMP sterility testing. We conducted a parallel evaluation of four different test systems (USP<71>, BacT/Alert, Bactec, and Sabouraud dextrose agar [SDA] culture), three different bottle media formulations (iLYM, iFA Plus, and Myco/F Lytic), and two incubation temperatures (22.5°C and 32.5 to 35°C) using a diverse set of fungi (n = 51) isolated from NIH cleanroom environments and previous product contaminants. Additionally, we evaluated the effect of agitation versus delayed-entry static preincubation on test sensitivity and time to detection (TTD). Overall, delayed entry of bottles onto the BacT/Alert or Bactec instruments (with agitation) did not improve test performance. USP<71> and SDA culture continued to significantly outperform each automated culture condition alone. However, we show, for the first time, that a closed-system, dual-bottle combination of iLYM 22.5°C and iFA Plus 32.5°C can provide high fungal sensitivity, statistically comparable to USP<71>, when tested against a diverse range of environmental fungi. Our study fills a much-needed gap in biopharmaceutical testing and offers a favorable testing algorithm that maximizes bacterial and fungal test sensitivity while minimizing risk of product contamination associated with laboratory handling.
Collapse
|
6
|
Pasqua S, Vitale G, Pasquariello A, Douradinha B, Tuzzolino F, Cardinale F, Cusimano C, Di Bartolo C, Conaldi PG, D'Apolito D. Use of 27G needles improves sensitivity and performance of ATCC anaerobe reference microorganism detection in BacT/Alert system. MOLECULAR THERAPY-METHODS & CLINICAL DEVELOPMENT 2021; 20:542-550. [PMID: 33665224 PMCID: PMC7890369 DOI: 10.1016/j.omtm.2021.01.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Accepted: 01/18/2021] [Indexed: 11/26/2022]
Abstract
Effective detection of microbiological contaminations present in medicinal cellular products is a crucial step to ensure patients' safety. In recent decades, several rapid microbiological methods have been developed and validated, but variabilities linked to the use of different resources have led to discordant validation of methods and performance results. Considering this, while developing an in-house BacT/Alert-based method, we evaluated all of the materials used in its validation. Of particular importance, we noticed that the syringe gauge used to inject the samples into the bottles was crucial to obtain robust results. We chose to conduct a comparative test between the BacT/Alert system and the compendial method described in the European Pharmacopoeia, using five dilutions of nine reference microorganism strains and 21G or 27G needles. Our results confirmed that the BacT/Alert system is a valid and faster alternative method to assess sterility of clinical cell therapy products, and that the use of 27G needles increases its sensitivity to detect reference anaerobe microorganisms.
Collapse
Affiliation(s)
- Salvatore Pasqua
- Unità Prodotti Cellulari (GMP), Fondazione Ri.MED c/o IRCCS-ISMETT (Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione), Via E. Tricomi 5, 90127 Palermo, Italy
| | - Giampiero Vitale
- Unità Prodotti Cellulari (GMP), Fondazione Ri.MED c/o IRCCS-ISMETT (Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione), Via E. Tricomi 5, 90127 Palermo, Italy
| | - Anna Pasquariello
- Unità di Medicina di Laboratorio e Biotecnologie Avanzate, IRCCS-ISMETT, Via E. Tricomi 5, 90127 Palermo, Italy
| | - Bruno Douradinha
- Unità di Medicina di Laboratorio e Biotecnologie Avanzate, IRCCS-ISMETT, Via E. Tricomi 5, 90127 Palermo, Italy.,Unità Medicina Rigenerativa ed Immunologia, Fondazione Ri.MED c/o IRCCS-ISMETT, Via E. Tricomi 5, 90127 Palermo, Italy
| | - Fabio Tuzzolino
- Ufficio Ricerca, IRCCS-ISMETT, Via E. Tricomi 5, 90127 Palermo, Italy
| | - Francesca Cardinale
- Unità di Medicina di Laboratorio e Biotecnologie Avanzate, IRCCS-ISMETT, Via E. Tricomi 5, 90127 Palermo, Italy
| | - Chiara Cusimano
- Unità di Medicina di Laboratorio e Biotecnologie Avanzate, IRCCS-ISMETT, Via E. Tricomi 5, 90127 Palermo, Italy
| | - Chiara Di Bartolo
- Unità Prodotti Cellulari (GMP), Fondazione Ri.MED c/o IRCCS-ISMETT (Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione), Via E. Tricomi 5, 90127 Palermo, Italy.,Unità di Medicina di Laboratorio e Biotecnologie Avanzate, IRCCS-ISMETT, Via E. Tricomi 5, 90127 Palermo, Italy
| | - Pier Giulio Conaldi
- Unità di Medicina di Laboratorio e Biotecnologie Avanzate, IRCCS-ISMETT, Via E. Tricomi 5, 90127 Palermo, Italy
| | - Danilo D'Apolito
- Unità Prodotti Cellulari (GMP), Fondazione Ri.MED c/o IRCCS-ISMETT (Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione), Via E. Tricomi 5, 90127 Palermo, Italy.,Unità di Medicina di Laboratorio e Biotecnologie Avanzate, IRCCS-ISMETT, Via E. Tricomi 5, 90127 Palermo, Italy
| |
Collapse
|
7
|
Gebo JET, Lau AF. Sterility Testing for Cellular Therapies: What Is the Role of the Clinical Microbiology Laboratory? J Clin Microbiol 2020; 58:e01492-19. [PMID: 32321785 PMCID: PMC7315024 DOI: 10.1128/jcm.01492-19] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Sterility testing of cellular therapy products along with the associated environmental monitoring requirements for aseptic facilities, including compounding pharmacies, continues to impact clinical microbiology laboratories, as evidenced by the numerous discussions recurring on American Society for Microbiology Division C and ClinMicroNet listservs. This minireview provides an overview of this complex field of current good manufacturing practices (cGMP) based on biopharmaceutical industry standards and summarizes the compendial and alternative rapid microbial test methods available for product sterility and Mycoplasma testing. In addition, this minireview highlights major overarching regulatory requirements governing any laboratory performing product testing as regulated by the United States Food and Drug Administration (FDA). These requirements are different from the more familiar clinical requirements of the Clinical Laboratory Improvement Act of 1988 (CLIA '88), the College of American Pathologists (CAP), and the Joint Commission on Accreditation of Healthcare Organizations (JCAHO), all of which have no jurisdiction in this area. As the cellular therapy field continues to advance and an increasing number of medical centers participate in clinical trials of these novel therapies, it is critical that laboratories have a sound understanding of the major regulations and cGMP practices governing microbiological testing in the biopharmaceutical industry.
Collapse
Affiliation(s)
- James E T Gebo
- Sterility Testing Service, Department of Laboratory Medicine, Clinical Center, National Institutes of Health, Bethesda, Maryland, USA
| | - Anna F Lau
- Sterility Testing Service, Department of Laboratory Medicine, Clinical Center, National Institutes of Health, Bethesda, Maryland, USA
| |
Collapse
|
8
|
Microbial contamination risk in hematopoietic stem cell products: retrospective analysis of 1996–2016 data. ACTA ACUST UNITED AC 2020. [DOI: 10.2478/ahp-2020-0007] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
AbstractQuality assurance and safety of hematopoietic stem cells (HSC) with special emphasis on bacterial and fungal contamination is the prerequisite for any transplantation procedure. The aim was to determine the incidence rate of such contamination during processing of transplantation material with regard to HSC source: peripheral blood stem cell (PBSC), bone marrow (BM), or cord blood (CB). Analysis involved autologous and allogenic products dedicated for patients and comprised in all 4135 donations, including 112 BM (2.70%), 3787 PBSC (91.60%), and 236 CB (5.70%) processed in cell bank over the period 1996–2016. Aerobic and anaerobic contamination was determined.Analysis of the 20-year data revealed 42 contaminated products: 25 PBSC (0.66% of tested units) and 17 CB (7.20% of tested units). No microbial contamination of BM products was detected. Overall percentage of contaminated products was 1.01%, mostly with Staphylococcus epidermidis (61.36%). Bacterial contamination rate at cell bank is relatively low and processing in a closed system does not seem as crucial as might be expected. This is particularly true for BM components. Equally important are evaluation of donor’s medical status and condition of the puncture site for collection of source material. Implementation of appropriate sample collection procedures should help minimize the risk of false-positive results due to environmental contamination.
Collapse
|
9
|
Drews SJ, Lesley P, Detsky ME, Distefano L, Ilagan C, Mehta S, McGeer A, Shehata N, Skeate R, Ramirez-Arcos S. A suspected septic transfusion reaction associated with posttransfusion contamination of a platelet pool by vancomycin-resistant Enterococcus faecium. Transfusion 2019; 60:430-435. [PMID: 31859413 DOI: 10.1111/trf.15644] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Revised: 11/04/2019] [Accepted: 11/21/2019] [Indexed: 12/19/2022]
Abstract
BACKGROUND Vancomycin-resistant enterococci (VRE) are antibiotic-resistant organisms associated with both colonization and serious life-threatening infection in health care settings. Contamination of platelet concentrates (PCs) with Enterococcus can result in transfusion-transmitted infection. CASE PRESENTATION This report describes the investigation of a septic transfusion case involving a 27-year-old male patient with relapsed acute leukemia who was transfused with a 5-day-old buffy coat PC pool and developed fever and rigors. DISCUSSION Microbiology testing and pulse-field gel electrophoresis (PFGE) was done on patient blood cultures obtained from peripheral and central lines. Microbiology and molecular testing were also performed on the remaining posttransfusion PC pool, which was refrigerated for 24 hours before microbiology testing. Red blood cell (RBC) and plasma units associated with the implicated PCs were screened for microbial contamination. Patient blood cultures obtained from peripheral and central lines yielded vancomycin-resistant Enterococcus faecium. Gram stain of a sample from the platelet pool was negative but coagulase-negative Staphylococcus (CNST) and VRE were isolated on culture. Antibiotic sensitivity and PFGE profiles of several VRE isolates from the patient before and after transfusion, and the PC pool, revealed that all were closely related. Associated RBC and plasma components tested negative for microbial contamination. CONCLUSIONS Microbiological and molecular investigations showed a relationship between VRE isolated from the patient before and after transfusion, and therefore it is postulated that a patient-to-PC retrograde contamination (from either blood or skin) occurred. As the CNST isolated from the PC pool was not isolated from patient samples, its implication in the transfusion event is unknown.
Collapse
Affiliation(s)
- Steven J Drews
- Canadian Blood Services, Edmonton, Alberta, Canada.,Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, Alberta, Canada
| | - Peter Lesley
- Canadian Blood Services, Ottawa, Ontario, Canada
| | - Michael E Detsky
- Mount Sinai Hospital, Toronto, Ontario, Canada.,Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada
| | | | | | - Sangeeta Mehta
- Mount Sinai Hospital, Toronto, Ontario, Canada.,Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Allison McGeer
- Mount Sinai Hospital, Toronto, Ontario, Canada.,Department of Medicine and Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
| | - Nadine Shehata
- Mount Sinai Hospital, Toronto, Ontario, Canada.,Department of Medicine and Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada.,Canadian Blood Services, Toronto, Ontario, Canada
| | - Robert Skeate
- Department of Medicine and Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada.,Canadian Blood Services, Toronto, Ontario, Canada
| | - Sandra Ramirez-Arcos
- Canadian Blood Services, Ottawa, Ontario, Canada.,Department of Biochemistry, Microbiology, and Immunology, University of Ottawa, Ottawa, Ontario, Canada
| |
Collapse
|
10
|
Taha M, Kyluik‐Price D, Kumaran D, Scott MD, Toyofuku W, Ramirez‐Arcos S. Bacterial survival in whole blood depends on plasma sensitivity and resistance to neutrophil killing. Transfusion 2019; 59:3674-3682. [DOI: 10.1111/trf.15550] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Revised: 09/10/2019] [Accepted: 09/10/2019] [Indexed: 12/17/2022]
Affiliation(s)
- Mariam Taha
- Centre for Innovation, Canadian Blood Services Ottawa Ontario
| | - Dana Kyluik‐Price
- Centre for Blood Research, University of British Columbia Vancouver British Columbia
| | - Dilini Kumaran
- Centre for Innovation, Canadian Blood Services Ottawa Ontario
| | - Mark D. Scott
- Centre for Innovation, Canadian Blood Services Ottawa Ontario
- Centre for Blood Research, University of British Columbia Vancouver British Columbia
| | - Wendy Toyofuku
- Centre for Innovation, Canadian Blood Services Ottawa Ontario
| | - Sandra Ramirez‐Arcos
- Centre for Innovation, Canadian Blood Services Ottawa Ontario
- Department of Biochemistry, Microbiology and ImmunologyUniversity of Ottawa Ottawa Ontario Canada
| |
Collapse
|
11
|
Comprehensive Evaluation of Compendial USP<71>, BacT/Alert Dual-T, and Bactec FX for Detection of Product Sterility Testing Contaminants. J Clin Microbiol 2019; 57:JCM.01548-18. [PMID: 30541938 DOI: 10.1128/jcm.01548-18] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Accepted: 11/28/2018] [Indexed: 01/13/2023] Open
Abstract
The emergence of cell therapy programs in large academic centers has led to an increasing demand for clinical laboratories to assist with product sterility testing. Automated blood culture systems have shown promise as alternatives to the manual USP<71> compendial method, but current published data are limited by small organism test sets, particularly for molds. In 2015, failure of the Bactec FX system to detect mold contamination in two products prompted us to evaluate three test systems (compendial USP<71>, Bactec FX, and BacT/Alert Dual-T) over seven different culture combinations, using 118 challenge organisms representative of the NIH current good manufacturing practice (cGMP) environment. At <96 h and <144 h for bacterial and fungal detection, respectively, the compendial USP<71> method significantly outperformed the Bactec FX system (84.7% versus 64.4%; P = 0.0006) but not the BacT/Alert system at 32.5°C (78.8%; P = 0.3116). Extended incubation to 360 h with terminal visual inspection improved sensitivity, without a significant difference between compendial USP<71> and BacT/Alert testing (95.7% versus 89.0%; P = 0.0860); both systems were better than the Bactec FX system (71.2%; P < 0.0001 and P = 0.0003, respectively). The Bactec FX and BacT/Alert systems performed equivalently for 30 isolates derived from clinical bloodstream infections, confirming system optimization for clinical organisms rather than environmental contaminants. Paired Sabouraud dextrose agar (SDA) plates were always positive for fungi within the acceptable time frame. This study shows that the Bactec FX system is suboptimal for product sterility testing, and it provides strong data to support the use of BacT/Alert testing at 32.5°C paired with a supplemental SDA plate as an acceptable alternative to the compendial USP<71> method for product sterility testing.
Collapse
|
12
|
Detection of Bacillus Cereus Using Bioluminescence Assay with Cell Wall-binding Domain Conjugated Magnetic Nanoparticles. BIOCHIP JOURNAL 2018. [DOI: 10.1007/s13206-018-2408-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
|
13
|
Benjamin RJ, Braschler T, Weingand T, Corash LM. Hemovigilance monitoring of platelet septic reactions with effective bacterial protection systems. Transfusion 2017; 57:2946-2957. [PMID: 28840603 DOI: 10.1111/trf.14284] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Revised: 07/01/2017] [Accepted: 07/02/2017] [Indexed: 02/05/2023]
Abstract
BACKGROUND Delayed, large-volume bacterial culture and amotosalen/ultraviolet-A light pathogen reduction are effective at reducing the risk of bacterial proliferation in platelet concentrates (PCs). Hemovigilance programs continue to receive reports of suspected septic transfusion reactions, most with low imputability. Here, we compile national hemovigilance data to determine the relative efficacy of these interventions. STUDY DESIGN AND METHODS Annual reports from the United Kingdom, France, Switzerland, and Belgium were reviewed between 2005 and 2016 to assess the risk of bacterial contamination and septic reactions. RESULTS Approximately 1.65 million delayed, large-volume bacterial culture-screened PCs in the United Kingdom and 2.3 million amotosalen/ultraviolet-A-treated PCs worldwide were issued with no reported septic fatalities. One definite, one possible, and 12 undetermined/indeterminate septic reactions and eight contaminated "near misses" were reported with delayed, large-volume bacterial cultures between 2011 and 2016, for a lower false-negative culture rate than that in the previous 5 years (5.4 vs. 16.3 per million: odds ratio, 3.0; 95% confidence interval, 1.4-6.5). Together, the Belgian, Swiss, and French hemovigilance programs documented zero probable or definite/certain septic reactions with 609,290 amotosalen/ultraviolet-A-treated PCs (<1.6 per million). The rates were significantly lower than those reported with concurrently transfused, nonpathogen-reduced PCs in Belgium (<4.4 vs. 35.6 per million: odds ratio, 8.1; 95% confidence interval,1.1-353.3) and with historic septic reaction rates in Switzerland (<6.0 vs. 82.9 per million: odds ratio, 13.9; 95% confidence interval, 2.1-589.2), and the rates tended to be lower than those from concurrently transfused, nonpathogen-reduced PCs in France (<4.7 vs. 19.0 per million: odds ratio, 4.1; 95% confidence interval, 0.7-164.3). CONCLUSION Pathogen reduction and bacterial culture both reduced the incidence of septic reactions, although under-reporting and strict imputability criteria resulted in an underestimation of risk.
Collapse
Affiliation(s)
| | | | - Tina Weingand
- Blutspendedienst Zentralschweiz SRK, Luzern, Switzerland
| | | |
Collapse
|
14
|
Girard M, Laforce-Lavoie A, de Grandmont MJ, Cayer MP, Fournier D, Delage G, Thibault L. Optimization of cord blood unit sterility testing: impact of dilution, analysis delay, and inhibitory substances. Transfusion 2017; 57:1956-1967. [PMID: 28474347 DOI: 10.1111/trf.14147] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Revised: 03/22/2017] [Accepted: 03/27/2017] [Indexed: 12/17/2022]
Abstract
BACKGROUND Different methods are used by cord blood banks to prepare samples for sterility testing. Suboptimal methods can result in the release of contaminated products. In our organization, samples are prepared by diluting the final product in RPMI-1640 medium. In this work, we have compared our method with different approaches to verify whether optimization should be sought. STUDY DESIGN AND METHODS Cord blood units (n = 6 units per bacterial strain) characterized to contain inhibitory substances or not were inoculated (10 colony-forming units/mL) with Streptococcus agalactiae, Staphylococcus epidermidis, Klebsiella pneumoniae, Escherichia coli, or Bacteroides fragilis. After plasma and red blood cell removal, stem cell concentrates were diluted in RPMI-1640, thioglycollate, or the unit's plasma. These products, as well as final product, plasma, and red blood cell fractions, were held from 0 to 72 hours at 20 to 24°C before inoculation in culture bottles and detection using the BacT/ALERT 3D system. RESULTS Dilution of cell concentrates in RPMI-1640 allowed bacterial detection in 93.3% of noninhibitory cord blood samples after a 24-hour storage period. Thioglycollate medium better promoted bacterial growth in inhibitory cord blood samples that were held for 72 hours before testing (66.7%) compared with RPMI-1640 (45.0%). Less than 33% of all spiked plasma samples were detected by the BacT/ALERT 3D system. CONCLUSION Diluting cord blood samples in culture medium containing bacterial growth promoting substances is a suitable option for sterility testing, whereas the use of plasma should be proscribed, because it might lead to false-negative results. Because inhibitory substances affect bacterial growth, inoculation of culture bottles should be done rapidly after sample preparation.
Collapse
Affiliation(s)
- Mélissa Girard
- Research and Development, Héma-Québec, Québec, Québec, Canada
| | | | | | | | | | - Gilles Delage
- Medical Affairs, Héma-Québec, Montréal, Québec, Canada
| | - Louis Thibault
- Research and Development, Héma-Québec, Québec, Québec, Canada
| |
Collapse
|
15
|
Taha M, Kalab M, Yi QL, Maurer E, Jenkins C, Schubert P, Ramirez-Arcos S. Bacterial survival and distribution during buffy coat platelet production. Vox Sang 2016; 111:333-340. [PMID: 27432557 DOI: 10.1111/vox.12427] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Revised: 05/09/2016] [Accepted: 06/03/2016] [Indexed: 01/11/2023]
Abstract
BACKGROUND AND OBJECTIVES At Canadian Blood Services, buffy coat (BC) platelet concentrates (BC-PCs) show a generally lower bacterial contamination rate than apheresis PCs. This study investigated whether the PC production method contributes to this observation. MATERIALS AND METHODS Whole blood (WB) inoculated with eight bacterial strains was processed using the BC method. Bacteria were enumerated throughout BC-PC production and subsequent PC storage. Endotoxin production and bacterial adhesion to PC bags were evaluated during PC storage. PC quality was monitored by CD62P expression (flow cytometry) and changes in dynamic light scattering (ThromboLUX® ). RESULTS During overnight WB hold, Staphylococcus epidermidis titres remained unchanged, commercial Escherichia coli and Klebsiella pneumoniae were eliminated and the remaining organisms proliferated to high concentrations. Through BC-PC production, bacteria segregated preferentially towards the cellular fractions compared to plasma (P < 0·05). During PC storage, most bacteria adhered to the PC bags and Gram negatives produced clinically significant endotoxin levels. Changes in CD62P expression or ThromboLUX scoring did not consistently reflect bacterial contamination in BC-PCs. CONCLUSION WB hold during BC-PC production does not have a broad-spectrum bactericidal effect, and therefore, other factors contribute to low rates of contamination in BC-PCs.
Collapse
Affiliation(s)
- M Taha
- Canadian Blood Services, Ottawa, ON, Canada
| | - M Kalab
- Agriculture and Agri-Food Canada, Ottawa, ON, Canada
| | - Q-L Yi
- Canadian Blood Services, Ottawa, ON, Canada
| | - E Maurer
- LightIntegra, Vancouver, BC, Canada
| | - C Jenkins
- Canadian Blood Services, Ottawa, ON, Canada
| | - P Schubert
- Canadian Blood Services, Ottawa, ON, Canada
| | | |
Collapse
|
16
|
Ramirez-Arcos S, Kou Y, Yang L, Perkins H, Taha M, Halpenny M, Elmoazzen H. Validation of sterility testing of cord blood: challenges and results. Transfusion 2015; 55:1985-92. [DOI: 10.1111/trf.13050] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2014] [Revised: 01/13/2015] [Accepted: 01/15/2015] [Indexed: 11/28/2022]
Affiliation(s)
| | - Yuntong Kou
- Product and Process Development; Canadian Blood Services Centre for Innovation
| | - Lin Yang
- National Public Cord Blood Bank; Canadian Blood Services; Ottawa Ontario Canada
| | - Heather Perkins
- Product and Process Development; Canadian Blood Services Centre for Innovation
| | - Mariam Taha
- Product and Process Development; Canadian Blood Services Centre for Innovation
| | - Mike Halpenny
- National Public Cord Blood Bank; Canadian Blood Services; Ottawa Ontario Canada
| | - Heidi Elmoazzen
- National Public Cord Blood Bank; Canadian Blood Services; Ottawa Ontario Canada
| |
Collapse
|
17
|
Störmer M, Radojska S, Hos NJ, Gathof BS. Protocol for the validation of microbiological control of cellular products according to German regulators recommendations - Boon and Bane for the manufacturer. Vox Sang 2014; 108:314-7. [DOI: 10.1111/vox.12222] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2014] [Revised: 10/10/2014] [Accepted: 10/20/2014] [Indexed: 11/27/2022]
Affiliation(s)
- M. Störmer
- Transfusion Medicine; University Hospital of Cologne; Cologne Germany
| | - S. Radojska
- Transfusion Medicine; University Hospital of Cologne; Cologne Germany
| | - N. J. Hos
- Institute for Medical Microbiology, Immunology and Hygiene; University Hospital of Cologne; Cologne Germany
| | - B. S. Gathof
- Transfusion Medicine; University Hospital of Cologne; Cologne Germany
| |
Collapse
|
18
|
Klarmann D, Sireis W, Hogardt M, Kempf VAJ, Seifried E, Bonig H. A validation protocol and evaluation algorithms to determine compatibility of cell therapy product matrices in microbiological testing. Cell Tissue Bank 2014; 16:311-8. [PMID: 25204399 DOI: 10.1007/s10561-014-9474-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2014] [Accepted: 08/30/2014] [Indexed: 12/20/2022]
Abstract
As part of product release testing, "sterility" of cellular therapy products, using formally validated methods, must be demonstrated, irrespective of whether products are released and administered while microbiological results are pending or whether these can be awaited. Components of the matrix, i.e. the carrier fluid and the therapeutic cells, could potentially inhibit bacterial growth and may thus obscure their presence, resulting in false-negative data. The European Pharmacopoeia and equivalent guidelines therefore specify that for each cell therapy product the specific matrix' compatibility with validated detection methods is formally established. There for, matrix is spiked with known numbers of representative aerobic and anaerobic agents, cultured in automated systems such as BacT/ALERT, followed by microbiological species identification from culture-positive bottles. We here propose an easy-to-follow protocol for matrix validation and demonstrate its successful execution with a panel of novel advanced therapy medicinal products and standard cell therapy products, as well as algorithms for interpretation of conflicting results between BacT/Alert and culture methods. This protocol can serve as a basis for microbiological method (matrix) validations for cellular preparations.
Collapse
Affiliation(s)
- Dieter Klarmann
- German Red Cross Blood Service Baden-Württemberg-Hessen, Frankfurt, Germany
| | | | | | | | | | | |
Collapse
|
19
|
Validation of an automated blood culture system for sterility testing of cell therapy products. Cytotherapy 2014; 16:692-8. [DOI: 10.1016/j.jcyt.2013.09.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2013] [Revised: 09/03/2013] [Accepted: 09/17/2013] [Indexed: 11/18/2022]
|
20
|
Cayer MP, Girard M, Fournier D, Delage G, Thibault L. Antimicrobial activity in cord blood units: occurrence and levels of antibiotics. Transfusion 2014; 54:2505-13. [PMID: 24724982 DOI: 10.1111/trf.12655] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2013] [Revised: 02/17/2014] [Accepted: 02/18/2014] [Indexed: 11/28/2022]
Abstract
BACKGROUND Antibiotic prophylaxis treatment at delivery is highly recommended for reducing the risk of infection for mothers positive for group B streptococcus. It is therefore expected that some cord blood (CB) products will contain residual antibiotics. This study aimed to determine the incidence and level of β-lactam antibiotics in CB products. STUDY DESIGN AND METHODS The antimicrobial activity of 60 CB plasma by-products was evaluated using disk diffusion assays on 10 bacteria species. Plasma samples showing antimicrobial activity were either treated with β-lactamase enzyme to inhibit β-lactam antibiotics or heated to 56°C for 30 minutes to inhibit complement proteins. β-Lactam antibiotic concentrations were determined by comparison with a standard curve obtained with known concentrations of antibiotics. RESULTS Antimicrobial activity against mostly Gram-positive microorganisms was observed in 33% of CB units. The β-lactamase enzyme abolished the antimicrobial activity in the majority of these CB products. Up to 5 μg/mL penicillin and 14 μg/mL ampicillin were measured in these products. CONCLUSION Approximately one-third of CB products contain significant amounts of plasma with residual antibiotics, which can affect the survival and growth of bacterial contaminants when performing the sterility test and potentially lead to false-negative results. Additional work is required to better understand whether residual antibiotics in CB affect penicillin-allergic patients.
Collapse
|
21
|
Kumaran D, Kalab M, Rood IGH, de Korte D, Ramirez-Arcos S. Adhesion of anaerobic bacteria to platelet containers. Vox Sang 2014; 107:188-91. [DOI: 10.1111/vox.12141] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2013] [Revised: 01/20/2014] [Accepted: 02/04/2014] [Indexed: 11/28/2022]
Affiliation(s)
- D. Kumaran
- Canadian Blood Services; Ottawa ON Canada
| | - M. Kalab
- Agriculture and Agri-Food Canada; Ottawa ON Canada
| | - I. G. H. Rood
- Sanquin Blood Supply Foundation; Amsterdam the Netherlands
| | - D. de Korte
- Sanquin Blood Supply Foundation; Amsterdam the Netherlands
| | | |
Collapse
|
22
|
Störmer M, Wood EM, Schurig U, Karo O, Spreitzer I, McDonald CP, Montag T. Bacterial safety of cell-based therapeutic preparations, focusing on haematopoietic progenitor cells. Vox Sang 2013; 106:285-96. [PMID: 24697216 DOI: 10.1111/vox.12097] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2013] [Revised: 02/14/2013] [Accepted: 09/03/2013] [Indexed: 11/28/2022]
Abstract
Bacterial safety of cellular preparations, especially haematopoietic progenitor cells (HPCs), as well as advanced therapy medicinal products (ATMPs) derived from stem cells of various origins, present a challenge for physicians, manufacturers and regulators. The article describes the background and practical issues in this area and illustrates why sterility of these products cannot currently be guaranteed. Advantages and limitations of approaches both for classical sterility testing and for microbiological control using automated culture systems are discussed. The review considers novel approaches for growth-based rapid microbiological control with high sensitivity and faster availability of results, as well as new methods for rapid bacterial detection in cellular preparations enabling meaningful information about product contamination within one to two hours. Generally, however, these direct rapid methods are less sensitive and have greater sampling error compared with the growth-based methods. Opportunities for pyrogen testing of cell therapeutics are also discussed. There is an urgent need for development of novel principles and methods applicable to bacterial safety of cellular therapeutics. We also need a major shift in approach from the traditional view of sterility evaluation (identify anything and everything) to a new thinking about how to find what is clinically relevant within the time frame available for the special clinical circumstances in which these products are used. The review concludes with recommendations for optimization of microbiological control of cellular preparations, focusing on HPCs.
Collapse
Affiliation(s)
- M Störmer
- Department of Transfusion Medicine, University of Cologne, Cologne, Germany; Paul-Ehrlich-Institut, Federal Institute for Vaccines and Biomedicines, Langen, Germany
| | | | | | | | | | | | | |
Collapse
|
23
|
Zhu L, Lv H, Wang Y, Yang J, Ni B, Meng Z. Microbial screening of unrelated cord blood units in a Chinese cord blood bank. Transfus Med 2013; 23:438-41. [PMID: 24118280 DOI: 10.1111/tme.12079] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2013] [Revised: 07/23/2013] [Accepted: 08/18/2013] [Indexed: 12/01/2022]
Abstract
BACKGROUND Given limited sample volume available for sterility testing, optimal testing methods and algorithms of cord blood (CB) have not been established according to standards. STUDY DESIGN AND METHODS The volume of CB unit was reduced to 20 mL in a closed system. Hetastarch and cryopreservation solution was added to the processed CB unit in Class 100 environment. In the routine sterility testing, 20 mL of red blood cells (RBC) sample was cultured in aerobic and anaerobic culture bottles. In verification post-thaw culture of the final product, some of the discarded final product units were also sampled and cultured after thaw. All the culture bottles were incubated in the BacT/ALERT 3D system. RESULTS In the routine sterility testing, 139 of 7032 CB units (1·98%) were contaminated with microorganism. In 84 of these 139 units (60·4%) only the anaerobic bottle was positive. Lactobacillus spp. were the most prevalent contaminant. Sixty-two discarded CB stem cell units were recultured after thaw. Of these, 10 of 48 units with a positive culturing of RBC sample were negative in the post-thaw reculture. One of 14 units with negative culturing of RBC sample was contaminated with Bifidobacterium breve in special verification test. CONCLUSION Our study demonstrates the predominant organisms implicated in CB microbial contamination were part of the human intestinal and vaginal flora. The larger sample volume and anaerobic culture would significantly increase the detection rate of microbial contaminated CB. We also found that potential transfusion-transmitted bacterial infection risk still existed in final product although microbial screening was performed.
Collapse
Affiliation(s)
- L Zhu
- Blood Center of Zhejiang Province, Hangzhou, Zhejiang, China; Key Laboratory of Blood Safety Research, Ministry of Health, Hangzhou, Zhejiang, China
| | | | | | | | | | | |
Collapse
|
24
|
Liu C, Weber C, Sempek DS, Grossman BJ, Burnham CAD. Sterility testing of apheresis hematopoietic progenitor cell products using an automated blood culture system. Transfusion 2013; 53:2659-66. [DOI: 10.1111/trf.12115] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2012] [Revised: 11/21/2012] [Accepted: 12/03/2012] [Indexed: 11/29/2022]
Affiliation(s)
- Chang Liu
- Department of Pathology & Immunology; Washington University; St Louis Missouri
- Barnes-Jewish Hospital; St Louis Missouri
| | - Carol Weber
- Department of Pathology & Immunology; Washington University; St Louis Missouri
- Barnes-Jewish Hospital; St Louis Missouri
| | - Diane S. Sempek
- Department of Pathology & Immunology; Washington University; St Louis Missouri
- Barnes-Jewish Hospital; St Louis Missouri
| | - Brenda J. Grossman
- Department of Pathology & Immunology; Washington University; St Louis Missouri
- Barnes-Jewish Hospital; St Louis Missouri
| | - Carey-Ann D. Burnham
- Department of Pathology & Immunology; Washington University; St Louis Missouri
- Barnes-Jewish Hospital; St Louis Missouri
| |
Collapse
|