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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] [What about the content of this article? (0)] [Affiliation(s)] [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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O’Flaherty N, Bryce L, Nolan J, Lambert M. Changing Strategies for the Detection of Bacteria in Platelet Components in Ireland: From Primary and Secondary Culture (2010-2020) to Large Volume Delayed Sampling (2020-2023). Microorganisms 2023; 11:2765. [PMID: 38004776 PMCID: PMC10673373 DOI: 10.3390/microorganisms11112765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Revised: 11/07/2023] [Accepted: 11/07/2023] [Indexed: 11/26/2023] Open
Abstract
Bacterial contamination of platelet components (PC) poses the greatest microbial risk to recipients, as bacteria can multiply over the course of PC storage at room temperature. Between 2010 and 2020, the Irish Blood Transfusion Service (IBTS) screened over 170,000 buffy coat-derived pooled (BCDP) and single-donor apheresis platelets (SDAPs) with the BACT/ALERT 3D microbial detection system (Biomerieux, L'Etoile, France), using a two-step screening protocol which incorporated primary and secondary cultures. Although the protocol was successful in averting septic transfusion reactions (STRs), testing large sample volumes at later time points was reported to improve detection of bacterial contamination. A modified large-volume delayed sampling (LVDS)-type protocol was adopted in 2020, which in the case of SDAP was applied to collections rather than individual splits (2020-2023, 44,642 PC screened). Rates of bacterial contamination for BCDP were 0.125% on Day-2, 0.043% on Day-4 vs. 0.191% in the post-LVDS period. SDAP contamination rates in the pre-LVDS period were 0.065% on Day-1, 0.017% on Day-4 vs. 0.072% in the post-LVDS period. Confirmed STRs were absent, and the interdiction rate for possibly contaminated SDAP was over 70%. In the post-LVDS period, BCDPs had a higher total positivity rate than SDAPs, 0.191% (1:525) versus 0.072% (1:1385), respectively, (chi-squared 12.124, 1 df, p = 0.0005). The majority of organisms detected were skin-flora-type, low pathogenicity organisms, including coagulase-negative staphylococci and Cutibacterium acnes, with little change in the frequency of clinically significant organisms identified over time. Both protocols prevented the issue of potentially harmful components contaminated (rarely) with a range of pathogenic bacteria, including Escherichia coli, Serratia marcesens, Staphylococcus aureus, and streptococci. Culture positivity of outdates post-LVDS whereby 100% of expired platelets are retested provides a residual risk estimate of 0.06% (95% CI 0.016-0.150). However, bacterial contamination rates in expired platelets did not demonstrate a statistically significant difference between the pre-LVDS 0.100% (CI 0.033-0.234) and post-LVDS 0.059% (0.016-0.150) periods (chi-squared = 0.651, 1 df, p = 0.42).
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Affiliation(s)
- Niamh O’Flaherty
- Irish Blood Transfusion Service, National Blood Centre, D08 NH5R Dublin, Ireland; (L.B.); (M.L.)
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3
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Ramli SR, Abdul Hadi FS, Nor Amdan NA, Kamaradin IH, Zabari N, Maniam S, Sulaiman NS, Ghazali S, Seman Z, Hashim R, Ahmad N. Secondary and Co-Infections in Hospitalized COVID-19 Patients: A Multicenter Cross-Sectional Study in Malaysia. Antibiotics (Basel) 2023; 12:1547. [PMID: 37887248 PMCID: PMC10604684 DOI: 10.3390/antibiotics12101547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Revised: 08/14/2023] [Accepted: 08/17/2023] [Indexed: 10/28/2023] Open
Abstract
Bacterial and fungal secondary and co-infections are commonly identified with viral respiratory infections. This study was undertaken to determine the incidence and factors associated with bacterial and fungal infections in patients with COVID-19 as well as antibiotics prescription patterns within the first and second waves of the outbreak in Malaysia. Clinical records of 3532 COVID-19 patients admitted to hospitals in Malaysia between 4 February and 4 August 2020 were analyzed. Co-morbidities, clinical features, investigations, treatment, and complications were captured using the REDCap database. Culture and sensitivity test results were retrieved from the WHONET database. Univariate and multivariate regression analyses were used to identify associated determinants. A total of 161 types of bacterial and fungal infections were found in 81 patients, i.e., 2.3%. The most common bacterial cultures were Gram-negative, i.e., Pseudomonas aeruginosa (15.3%) and Klebsiella pneumoniae (13.9%). The most common fungal isolate was Candida albicans (41.2%). Augmentin, ceftriaxone, tazocin, meropenem, and azithromycin were the five most frequently prescribed antibiotics. The latter four were classified under the "Watch" category in the WHO AwaRe list. Our data showed that bacterial and fungal secondary and co-infections were frequently found in severely ill COVID-19 patients and were associated with a higher mortality rate.
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Affiliation(s)
- Siti Roszilawati Ramli
- Infectious Diseases Research Centre, Institute for Medical Research, National Institutes of Health, Setia Alam, Shah Alam 40170, Malaysia
| | - Fashihah Sherina Abdul Hadi
- Infectious Diseases Research Centre, Institute for Medical Research, National Institutes of Health, Setia Alam, Shah Alam 40170, Malaysia
| | - Nur Asyura Nor Amdan
- Infectious Diseases Research Centre, Institute for Medical Research, National Institutes of Health, Setia Alam, Shah Alam 40170, Malaysia
| | - Insyirah Husna Kamaradin
- Infectious Diseases Research Centre, Institute for Medical Research, National Institutes of Health, Setia Alam, Shah Alam 40170, Malaysia
| | - Noraliza Zabari
- Infectious Diseases Research Centre, Institute for Medical Research, National Institutes of Health, Setia Alam, Shah Alam 40170, Malaysia
| | - Saraswathiy Maniam
- Infectious Diseases Research Centre, Institute for Medical Research, National Institutes of Health, Setia Alam, Shah Alam 40170, Malaysia
| | - Nur Suffia Sulaiman
- Nutrition, Metabolism & Cardiovascular Research Centre, Institute for Medical Research, National Institutes of Health, Setia Alam, Shah Alam 40170, Malaysia
| | - Sumarni Ghazali
- Special Resource Centre, Institute for Medical Research, National Institutes of Health, Setia Alam, Shah Alam 40170, Malaysia
| | - Zamtira Seman
- Sector for Biostatistics & Data Repository, National Institutes of Health, Setia Alam, Shah Alam 40170, Malaysia
| | - Rohaidah Hashim
- Infectious Diseases Research Centre, Institute for Medical Research, National Institutes of Health, Setia Alam, Shah Alam 40170, Malaysia
| | - Norazah Ahmad
- Infectious Diseases Research Centre, Institute for Medical Research, National Institutes of Health, Setia Alam, Shah Alam 40170, Malaysia
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4
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Vollmer T, Knabbe C, Dreier J. Dual-Temperature Microbiological Control of Cellular Products: A Potential Impact for Bacterial Screening of Platelet Concentrates? Microorganisms 2023; 11:2350. [PMID: 37764194 PMCID: PMC10534585 DOI: 10.3390/microorganisms11092350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 09/12/2023] [Accepted: 09/14/2023] [Indexed: 09/29/2023] Open
Abstract
An experimental study by the Paul-Ehrlich Institute (PEI) demonstrated that temperatures between 35 and 37 °C are too high for the growth of some bacterial strains (e.g., Pseudomonas fluorescens), leading to false negative results. Thus, the question of whether it is necessary to adapt incubation temperatures for the microbiological control of blood products, especially platelet concentrates (PCs), to enhance safety and regulatory compliance has arisen. In order to further elucidate this issue, the growth capability of different bacterial strains of interest in PCs and the detection efficacy of cultivation of these at different incubation temperatures must be taken into account. Therefore, we inoculated PCs with 46 different strains (3-6 PCs from different donors per strain) from different origins (PC isolates, reference strains) and stored PCs at 20-22 °C under constant agitation. On day three of storage, the inoculated PCs were sampled; aerobic and anaerobic culture bottles (BacT/Alert AST/NST) were each inoculated with 5 mL of sample, and culture bottles were incubated at 25 and 35 °C using the automated BacT/Alert Dual-temperature system. Bacterial proliferation was enumerated using a colony-forming assay. All strains of Enterobacteriacae (n = 5), Staphy-lococcus spp. (n = 11), Streptococcus spp. (n = 5), and Bacillus spp. (n = 4) and most Pseudomonas aeruginosa strains (4 of 5) tested showed the capability to grow in most inoculated PCs, revealing a faster time to detection (TTD) at an incubation temperature of 35 °C. The tested Pseudomonas putida (n = 3) strains showed a noticeably reduced capability to grow in PCs. Nonetheless, those with a notable growth capability revealed a faster TTD at an incubation temperature of 35 °C. Only one of the four Pseudomonas fluorescens strains tested (strain ATCC 13525) was able to grow in PCs, showing a faster TTD at an incubation temperature of 25 °C but also detection at 35 °C. The commonly detected bacteria involved in the bacterial contamination of PCs showed a superior TTD at 35 °C incubation. Only one P. fluorescens strain showed superior growth at 25 °C; however, the microbiological control at 35 °C did not fail to identify this contamination. In conclusion, the use of PC screening using a dual-temperature setting for microbiological control is presently not justified according to the observed kinetics.
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Affiliation(s)
- Tanja Vollmer
- Herz- und Diabeteszentrum Nordrhein-Westfalen, Universitätsklinik der Ruhr-Universität Bochum, 32545 Bad Oeynhausen, Germany
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5
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Cloutier M, De Korte D. Residual risks of bacterial contamination for
pathogen‐reduced
platelet components. Vox Sang 2022; 117:879-886. [DOI: 10.1111/vox.13272] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 12/22/2021] [Accepted: 02/10/2022] [Indexed: 12/14/2022]
Affiliation(s)
- Marc Cloutier
- Medical Affairs and Innovation Héma‐Québec Québec Canada
- Biochemistry, Microbiology and Bio‐informatics Université Laval Québec Canada
| | - Dirk De Korte
- Blood Cell Research Sanquin Research Amsterdam The Netherlands
- Product and Process Development Sanquin Blood Bank Amsterdam The Netherlands
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6
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Fonseca S, Cayer MP, Ahmmed KMT, Khadem-Mohtaram N, Charette SJ, Brouard D. Characterization of the Antibacterial Activity of an SiO2 Nanoparticular Coating to Prevent Bacterial Contamination in Blood Products. Antibiotics (Basel) 2022; 11:antibiotics11010107. [PMID: 35052984 PMCID: PMC8773057 DOI: 10.3390/antibiotics11010107] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 01/10/2022] [Accepted: 01/10/2022] [Indexed: 11/16/2022] Open
Abstract
Technological innovations and quality control processes within blood supply organizations have significantly improved blood safety for both donors and recipients. Nevertheless, the risk of transfusion-transmitted infection remains non-negligible. Applying a nanoparticular, antibacterial coating at the surface of medical devices is a promising strategy to prevent the spread of infections. In this study, we characterized the antibacterial activity of an SiO2 nanoparticular coating (i.e., the “Medical Antibacterial and Antiadhesive Coating” [MAAC]) applied on relevant polymeric materials (PM) used in the biomedical field. Electron microscopy revealed a smoother surface for the MAAC-treated PM compared to the reference, suggesting antiadhesive properties. The antibacterial activity was tested against selected Gram-positive and Gram-negative bacteria in accordance with ISO 22196. Bacterial growth was significantly reduced for the MAAC-treated PVC, plasticized PVC, polyurethane and silicone (90–99.999%) in which antibacterial activity of ≥1 log reduction was reached for all bacterial strains tested. Cytotoxicity was evaluated following ISO 10993-5 guidelines and L929 cell viability was calculated at ≥90% in the presence of MAAC. This study demonstrates that the MAAC could prevent bacterial contamination as demonstrated by the ISO 22196 tests, while further work needs to be done to improve the coating processability and effectiveness of more complex matrices.
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Affiliation(s)
- Sahra Fonseca
- Héma-Québec, Medical Affairs and Innovation, 1070, Avenue des Sciences-de-la-Vie, Quebec, QC G1V 5C3, Canada; (S.F.); (M.-P.C.)
- Department of Biochemistry, Microbiology and Bioinformatics, Faculty of Science and Engineering, Laval University, Quebec, QC G1V 0A6, Canada;
| | - Marie-Pierre Cayer
- Héma-Québec, Medical Affairs and Innovation, 1070, Avenue des Sciences-de-la-Vie, Quebec, QC G1V 5C3, Canada; (S.F.); (M.-P.C.)
| | | | | | - Steve J. Charette
- Department of Biochemistry, Microbiology and Bioinformatics, Faculty of Science and Engineering, Laval University, Quebec, QC G1V 0A6, Canada;
| | - Danny Brouard
- Héma-Québec, Medical Affairs and Innovation, 1070, Avenue des Sciences-de-la-Vie, Quebec, QC G1V 5C3, Canada; (S.F.); (M.-P.C.)
- Department of Chemistry, Faculty of Science and Engineering, Laval University, Quebec, QC G1V 0A6, Canada
- Correspondence:
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7
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Fachini RM, Fontão-Wendel R, Achkar R, Scuracchio P, Brito M, Amaral M, Wendel S. The 4-Year Experience with Implementation and Routine Use of Pathogen Reduction in a Brazilian Hospital. Pathogens 2021; 10:pathogens10111499. [PMID: 34832654 PMCID: PMC8621808 DOI: 10.3390/pathogens10111499] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 11/09/2021] [Accepted: 11/11/2021] [Indexed: 11/16/2022] Open
Abstract
(1) Background: We reviewed the logistics of the implementation of pathogen reduction (PR) using the INTERCEPT Blood System™ for platelets and the experience with routine use and clinical outcomes in the patient population at the Sírio-Libanês Hospital of São Paulo, Brazil. (2) Methods: Platelet concentrate (PC), including pathogen reduced (PR-PC) production, inventory management, discard rates, blood utilization, and clinical outcomes were analyzed over the 40 months before and after PR implementation. Age distribution and wastage rates were compared over the 10 months before and after approval for PR-PC to be stored for up to seven days. (3) Results: A 100% PR-PC inventory was achieved by increasing double apheresis collections and production of double doses using pools of two single apheresis units. Discard rates decreased from 6% to 3% after PR implementation and further decreased to 1.2% after seven-day storage extension for PR-PCs. The blood utilization remained stable, with no increase in component utilization. A significant decrease in adverse transfusion events was observed after the PR implementation. (4) Conclusion: Our experience demonstrates the feasibility for Brazilian blood centers to achieve a 100% PR-PC inventory. All patients at our hospital received PR-PC and showed no increase in blood component utilization and decreased rates of adverse transfusion reactions.
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8
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Savinkina AA, Haass KA, Sapiano MRP, Henry RA, Berger JJ, Basavaraju SV, Jones JM. Transfusion-associated adverse events and implementation of blood safety measures - findings from the 2017 National Blood Collection and Utilization Survey. Transfusion 2021; 60 Suppl 2:S10-S16. [PMID: 32134123 DOI: 10.1111/trf.15654] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Revised: 12/13/2019] [Accepted: 12/13/2019] [Indexed: 12/18/2022]
Abstract
BACKGROUND Serious transfusion-associated adverse events are rare in the United States. To enhance blood safety, various measures have been developed. With use of data from the 2017 National Blood Collection and Utilization Survey (NBCUS), we describe the rate of transfusion-associated adverse events and the implementation of specific blood safety measures. STUDY DESIGN AND METHODS Data from the 2017 NBCUS were used with comparison to already published estimates from 2015. Survey weighting and imputation were used to obtain national estimates of transfusion-associated adverse events, and the number of units treated with pathogen reduction technology (PRT), screened for Babesia, and leukoreduced. RESULTS The rate of transfusion-associated adverse events requiring any diagnostic or therapeutic interventions was stable (275 reactions per 100,000 transfusions in 2015 and 282 reactions per 100,000 transfusions in 2017). In 2017 among US blood collection centers, 16 of 141 (11.3%) reported screening units for Babesia and 28 of 144 (19.4%) reported PRT implementation; 138 of 2279 (6.1%) hospitals reported transfusing PRT-treated platelets. In 2017, 134 of 2336 (5.7%) hospitals reported performing secondary bacterial testing of platelets (50,922 culture-based and 63,220 rapid immunoassay tests); in 2015, 71 of 1877 (3.8%) hospitals performed secondary testing (87,155 culture-based and 21,779 rapid immunoassay tests). Nearly all whole blood/red blood cell units and platelet units were leukoreduced. CONCLUSIONS Besides leukoreduction, implementation of most blood safety measures reported in this study remains low. Nationally, hospitals might be shifting from culture-based secondary bacterial testing to rapid immunoassays.
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Affiliation(s)
- Alexandra A Savinkina
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia.,Oak Ridge Institute for Science and Education, Oak Ridge, Tennessee
| | - Kathryn A Haass
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Mathew R P Sapiano
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Richard A Henry
- Office of HIV/AIDS and Infectious Disease Policy, Office of the Assistant Secretary for Health, U.S. Department of Health and Human Services, Washington, District of Columbia
| | - James J Berger
- Office of HIV/AIDS and Infectious Disease Policy, Office of the Assistant Secretary for Health, U.S. Department of Health and Human Services, Washington, District of Columbia
| | - Sridhar V Basavaraju
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Jefferson M Jones
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
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Hayashi T, Oguma K, Fujimura Y, Furuta RA, Tanaka M, Masaki M, Shinbata Y, Kimura T, Tani Y, Hirayama F, Takihara Y, Takahashi K. UV light-emitting diode (UV-LED) at 265 nm as a potential light source for disinfecting human platelet concentrates. PLoS One 2021; 16:e0251650. [PMID: 34014978 PMCID: PMC8136854 DOI: 10.1371/journal.pone.0251650] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 04/30/2021] [Indexed: 12/20/2022] Open
Abstract
The risk of sepsis through bacterial transmission is one of the most serious problems in platelet transfusion. In processing platelet concentrates (PCs), several methods have been put into practice to minimize the risk of bacterial transmission, such as stringent monitoring by cultivation assays and inactivation treatment by photoirradiation with or without chemical agents. As another potential option, we applied a light-emitting diode (LED) with a peak emission wavelength of 265 nm, which has been shown to be effective for water, to disinfect PCs. In a bench-scale UV-LED exposure setup, a 10-min irradiation, corresponding to an average fluence of 9.2 mJ/cm2, resulted in >2.0 log, 1.0 log, and 0.6 log inactivation (mean, n = 6) of Escherichia coli, Staphylococcus aureus, and Bacillus cereus, respectively, in non-diluted plasma PCs. After a 30-min exposure, platelet counts decreased slightly (18 ± 7%: mean ± SD, n = 7); however, platelet surface expressions of CD42b, CD61, CD62P, and PAC-1 binding did not change significantly (P>0.005), and agonist-induced aggregation and adhesion/aggregation under flow conditions were well maintained. Our findings indicated that the 265 nm UV-LED has high potential as a novel disinfection method to ensure the microbial safety of platelet transfusion.
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Affiliation(s)
- Tomoya Hayashi
- Japanese Red Cross Kinki Block Blood Centre, Ibaraki, Osaka, Japan
- * E-mail:
| | | | | | - Rika A. Furuta
- Central Blood Institute, Japanese Red Cross, Tokyo, Japan
| | - Mitsunobu Tanaka
- Japanese Red Cross Kinki Block Blood Centre, Ibaraki, Osaka, Japan
| | - Mikako Masaki
- Japanese Red Cross Kinki Block Blood Centre, Ibaraki, Osaka, Japan
| | | | - Takafumi Kimura
- Japanese Red Cross Kinki Block Blood Centre, Ibaraki, Osaka, Japan
| | - Yoshihiko Tani
- Central Blood Institute, Japanese Red Cross, Tokyo, Japan
| | - Fumiya Hirayama
- Japanese Red Cross Kinki Block Blood Centre, Ibaraki, Osaka, Japan
| | | | - Koki Takahashi
- Blood Service Headquarters, Japanese Red Cross, Tokyo, Japan
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10
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Koepsell S. Complications of Transfusion. Transfus Med 2021. [DOI: 10.1002/9781119599586.ch16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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11
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Buren N. Laboratory Testing of Donated Blood. Transfus Med 2021. [DOI: 10.1002/9781119599586.ch7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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12
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Ramirez‐Arcos S, Evans S, McIntyre T, Pang C, Yi Q, DiFranco C, Goldman M. Extension of platelet shelf life with an improved bacterial testing algorithm. Transfusion 2020; 60:2918-2928. [DOI: 10.1111/trf.16112] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 08/14/2020] [Accepted: 08/18/2020] [Indexed: 12/15/2022]
Affiliation(s)
- Sandra Ramirez‐Arcos
- Canadian Blood Services Ottawa Ontario Canada
- Department of Biochemistry, Microbiology and Immunology University of Ottawa Ottawa Ontario Canada
| | | | | | | | - Qi‐Long Yi
- Canadian Blood Services Ottawa Ontario Canada
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13
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Fenwick AJ, Gehrie EA, Marshall CE, Tobian AAR, Shrestha R, Kacker S, Brunker PAR, Shifflett L, Carroll KC, Gozelanczyk D, Goel R, Ness PM, Bloch EM. Secondary bacterial culture of platelets to mitigate transfusion-associated sepsis: A 3-year analysis at a large academic institution. Transfusion 2020; 60:2021-2028. [PMID: 32750171 PMCID: PMC10007897 DOI: 10.1111/trf.15978] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Revised: 05/16/2020] [Accepted: 05/20/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND In 2019, the United States Food and Drug Administration published its final recommendations to mitigate bacterial contamination of platelets. We sought to evaluate our secondary bacterial culture (SBC) strategy in light of those recommendations. STUDY DESIGN AND METHODS A retrospective analysis was conducted of SBC data (October 2016-2019) at our institution. SBC was performed upon receipt (Day 3 after collection); 5 mL of platelet product was inoculated aseptically into an aerobic bottle and incubated at 35°C for 3 days. For 8 months, a 10-mL inoculum was trialed. No quarantine was applied. All positive cultures underwent Gram staining and repeat culture of the platelet product (if available). A probable true positive was defined as concordant positive culture between the initial and repeat culture. The incidence of probable true- and false-positive cultures were reported descriptively and differences evaluated by sampling volume. RESULTS Over 3 years, 55 896 platelet products underwent SBC, yielding 30 initial positive results (approx. 1/1863 platelets); 25 (83.3%) signaled within 24 hours of SBC. The rates of probable true positive, false positive, and indeterminate for 5 mL were 0.027% (1/3771), 0.002% (1/45 251) and 0.018% (1/5656), respectively. The respective rates for 10 mL were 0.018% (1/5323), 0.07% (1/1521), and 0%. Seven of eight (87.5%) false-positive SBCs occurred with a 10-mL inoculum. No septic transfusion reactions were reported. CONCLUSION SBC continues to interdict bacterially contaminated units of platelets. Our findings suggest higher rates of false positivity using large-volume inocula.
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Affiliation(s)
- Alexander J Fenwick
- Division of Transfusion Medicine, Department of Pathology, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Eric A Gehrie
- Division of Transfusion Medicine, Department of Pathology, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Christi E Marshall
- Division of Transfusion Medicine, Department of Pathology, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Aaron A R Tobian
- Division of Transfusion Medicine, Department of Pathology, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Ruchee Shrestha
- Division of Transfusion Medicine, Department of Pathology, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Seema Kacker
- Division of Transfusion Medicine, Department of Pathology, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Patricia A R Brunker
- Division of Transfusion Medicine, Department of Pathology, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.,American Red Cross Biomedical Services, Greater Chesapeake & Potomac Region, Baltimore, Maryland, USA
| | - Lisa Shifflett
- Division of Transfusion Medicine, Department of Pathology, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Karen C Carroll
- Division of Microbiology, Department of Pathology, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Donna Gozelanczyk
- American Red Cross Biomedical Services, Greater Chesapeake & Potomac Region, Baltimore, Maryland, USA
| | - Ruchika Goel
- Division of Transfusion Medicine, Department of Pathology, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.,Mississippi Valley Regional Blood Center, Springfield, IL, USA
| | - Paul M Ness
- Division of Transfusion Medicine, Department of Pathology, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Evan M Bloch
- Division of Transfusion Medicine, Department of Pathology, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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14
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Walker BS, White SK, Schmidt RL, Metcalf RA. Residual bacterial detection rates after primary culture as determined by secondary culture and rapid testing in platelet components: A systematic review and meta-analysis. Transfusion 2020; 60:2029-2037. [PMID: 32757411 DOI: 10.1111/trf.16001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 06/09/2020] [Accepted: 06/10/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND Primary culture alone was a bacterial risk control strategy intended to facilitate interdiction of contaminated platelets (PLTs). A September 2019 FDA guidance includes secondary testing options to enhance safety. Our objective was to use meta-analysis to determine residual contamination risk after primary culture using secondary culture and rapid testing. STUDY DESIGN AND METHODS A December 2019 literature search identified articles on PLT bacterial detection rates using primary culture and a secondary testing method. We used meta-analysis to estimate secondary testing detection rates after a negative primary culture. We evaluated collection method, sample volume, sample time, and study date as potential sources of heterogeneity. RESULTS The search identified 6102 articles; 16 were included for meta-analysis. Of these, 12 used culture and five used rapid testing as a secondary testing method. Meta-analysis was based on a total of 103 968 components tested by secondary culture and 114 697 by rapid testing. The residual detection rate using secondary culture (DRSC ) was 0.93 (95% CI, 0.24-0.6) per 1000 components, while residual detection rate using rapid testing (DRRT ) was 0.09 (95% CI, 0.01-0.25) per 1000 components. Primary culture detection rate was the only statistically significant source of heterogeneity. CONCLUSION We evaluated bacterial detection rates after primary culture using rapid testing and secondary culture. These results provide a lower and upper bound on real-world residual clinical risk because these methods are designed to detect high-level exposures or any level of exposure, respectively. Rapid testing may miss some harmful exposures and secondary culture may identify some clinically insignificant exposures.
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Affiliation(s)
| | - Sandra K White
- Department of Pathology, University of Utah, Salt Lake City, Utah, USA
| | - Robert L Schmidt
- ARUP Laboratories, Salt Lake City, Utah, USA.,Department of Pathology, University of Utah, Salt Lake City, Utah, USA
| | - Ryan A Metcalf
- ARUP Laboratories, Salt Lake City, Utah, USA.,Department of Pathology, University of Utah, Salt Lake City, Utah, USA
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15
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Walker BS, Schmidt RL, Fisher MA, White SK, Blaylock RC, Metcalf RA. The comparative safety of bacterial risk control strategies for platelet components: a simulation study. Transfusion 2020; 60:1723-1731. [PMID: 32632927 DOI: 10.1111/trf.15919] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Revised: 05/07/2020] [Accepted: 05/13/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Bacterial contamination of platelets is a problem that can lead to harmful septic transfusion reactions. The US Food and Drug Administration published a guidance in September 2019 detailing several permissible risk control strategies. Our objective was to compare the safety of each bacterial testing strategy for apheresis platelets. STUDY DESIGN AND METHODS We used simulation to compare safety of the nine risk control strategies involving apheresis platelet testing. The primary outcome was the risk of exposure. An exposure event occurred if a patient received platelets exceeding a specific contamination threshold (>0, 103 , and 105 colony-forming units (CFU/mL). We generated a range of bacterial contamination scenarios (inoculum size, doubling time, lag time) and compared risk of exposure for each policy in each contamination scenario. We then computed the average risk difference over all scenarios. RESULTS At the 0 CFU/mL exposure threshold, two-step policies that used secondary culture ranked best (all top three), while single-step 24-hour culture with 3-day expiration ranked last (ninth). This latter policy performed well (median rank of 1) at both the 103 and 105 CFU/mL thresholds, but 48-hour culture with 7-day expiration performed relatively poorly. At these higher thresholds, median ranks of two-step policies that used secondary culture were again top three. Two-step policies that used rapid testing improved at the higher (105 CFU/mL) harm threshold, with median rankings between 1 and 5. CONCLUSION Two-step policies that used secondary culture were generally safer than single-step policies. Performance of two-step policies that used rapid testing depended on the CFU per milliter threshold of exposure used.
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Affiliation(s)
- Brandon S Walker
- Department of Pathology and ARUP Laboratories, University of Utah, Salt Lake City, Utah, USA
| | - Robert L Schmidt
- Department of Pathology and ARUP Laboratories, University of Utah, Salt Lake City, Utah, USA
| | - Mark A Fisher
- Department of Pathology and ARUP Laboratories, University of Utah, Salt Lake City, Utah, USA
| | - Sandra K White
- Department of Pathology and ARUP Laboratories, University of Utah, Salt Lake City, Utah, USA
| | - Robert C Blaylock
- Department of Pathology and ARUP Laboratories, University of Utah, Salt Lake City, Utah, USA
| | - Ryan A Metcalf
- Department of Pathology and ARUP Laboratories, University of Utah, Salt Lake City, Utah, USA
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16
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Kundrapu S, Srivastava S, Good CE, Lazarus HM, Maitta RW, Jacobs MR. Bacterial contamination and septic transfusion reaction rates associated with platelet components before and after introduction of primary culture: experience at a US Academic Medical Center 1991 through 2017. Transfusion 2020; 60:974-985. [PMID: 32357261 DOI: 10.1111/trf.15780] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Revised: 01/27/2020] [Accepted: 02/20/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND The high incidence of septic transfusion reactions (STRs) led to testing being mandated by AABB from 2004. This was implemented by primary culture of single-donor apheresis platelets (APs) from 2004 and prestorage pooled platelets (PSPPs) from 2007. STUDY DESIGN/METHODS Platelet (PLT) aliquots were cultured at issue and transfusion reactions evaluated at our hospital. Bacterial contamination and STR rates (shown as rates per million transfusions in Results) were evaluated before and after introduction of primary culture by blood centers that used a microbial detection system (BacT/ALERT, bioMerieux) or enhanced bacterial detection system (eBDS, Haemonetics). RESULTS A total of 28,457 PLTs were cultured during pre-primary culture periods (44.7% APs; 55.3% at-issue pooled PLTs [AIPPs]) and 97,595 during post-primary culture periods (79.3% APs; 20.7% PSPPs). Forty-three contaminated units were identified in preculture and 34 in postculture periods (rates, 1511 vs. 348; p < 0.0001). Contamination rates of APs were significantly lower than AIPPs in the preculture (393 vs. 2415; p < 0.0001) but not postculture period compared to PSPPs (387 vs. 198; p = 0.9). STR rates (79 vs. 90; p = 0.98) were unchanged with APs but decreased considerably with pooled PLTs (826 vs. 50; p = 0.0006). Contamination (299 vs. 324; p = 0.84) and STR rates (25 vs. 116; p = 0.22) were similar for PLTs tested by BacT/ALERT and eBDS primary culture methods. A change in donor skin preparation method in 2012 was associated with decreased contamination and STR rates. CONCLUSION Primary culture significantly reduced bacterial contamination and STR associated with pooled but not AP PLTs. Measures such as secondary testing near time of use or pathogen reduction are needed to further reduce STRs.
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Affiliation(s)
- Sirisha Kundrapu
- Department of Pathology and Medicine, University Hospitals Cleveland Medical Center and Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Swati Srivastava
- Department of Pathology and Medicine, University Hospitals Cleveland Medical Center and Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Caryn E Good
- Department of Pathology and Medicine, University Hospitals Cleveland Medical Center and Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Hillard M Lazarus
- Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Robert W Maitta
- Department of Pathology and Medicine, University Hospitals Cleveland Medical Center and Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Michael R Jacobs
- Department of Pathology and Medicine, University Hospitals Cleveland Medical Center and Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
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17
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Galli L, Bruschi F. New strategies for the control of infectious and parasitic diseases in blood donors: the impact of pathogen inactivation methods. The EuroBiotech Journal 2020; 4:53-66. [DOI: 10.2478/ebtj-2020-0007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Abstract
Around 70 infectious agents are possible threats for blood safety.
The risk for blood recipients is increasing because of new emergent agents like West Nile, Zika and Chikungunya viruses, or parasites such as Plasmodium and Trypanosoma cruzi in non-endemic regions, for instance.
Screening programmes of the donors are more and more implemented in several Countries, but these cannot prevent completely infections, especially when they are caused by new agents.
Pathogen inactivation (PI) methods might overcome the limits of the screening and different technologies have been set up in the last years.
This review aims to describe the most widely used methods focusing on their efficacy as well as on the preservation integrity of blood components.
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18
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Abe H, Endo K, Shiba M, Niibe Y, Miyata S, Satake M. Flow path system of ultraviolet C irradiation from xenon flash to reduce bacteria survival in platelet products containing a platelet additive solution. Transfusion 2020; 60:1050-1059. [DOI: 10.1111/trf.15757] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Revised: 01/09/2020] [Accepted: 02/12/2020] [Indexed: 11/26/2022]
Affiliation(s)
- Hideki Abe
- Central Blood Institute, Blood Service Headquarters, Japanese Red Cross Society Tokyo Japan
| | - Kimika Endo
- Central Blood Institute, Blood Service Headquarters, Japanese Red Cross Society Tokyo Japan
| | - Masayuki Shiba
- Central Blood Institute, Blood Service Headquarters, Japanese Red Cross Society Tokyo Japan
| | | | - Shigeki Miyata
- Central Blood Institute, Blood Service Headquarters, Japanese Red Cross Society Tokyo Japan
| | - Masahiro Satake
- Central Blood Institute, Blood Service Headquarters, Japanese Red Cross Society Tokyo Japan
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19
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Kaur SJ, Gilman V, Duong M, Asher DM, Gregori L. Rapid selection of single-stranded DNA aptamers binding Staphylococcus epidermidis in platelet concentrates. Biotechniques 2019; 65:331-338. [PMID: 30477331 DOI: 10.2144/btn-2018-0081] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Staphylococcus epidermidis is the most common transfusion-associated pathogen contaminating platelet concentrates. Methods to reduce or eliminate contaminating bacteria from platelet units are critical for improving the safety of blood transfusions. We used rapid isolation of DNA aptamers (RIDA) to identify single-stranded (ss)DNA aptamers as ligands that specifically bind to S. epidermidis. Five target-specific ssDNA aptamers (76 mer) were obtained under stringent selection conditions. Aptamer SE43 demonstrated higher binding affinity compared with scrambled control. Furthermore, when binding assays were conducted in platelet concentrate, there was a twofold increase in binding affinity compared with the SE43 binding in buffer alone. Our data identified an aptamer that may be useful as a ligand to capture, detect or remove S. epidermidis contaminant from platelet concentrates.
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Affiliation(s)
- Simran J Kaur
- Division of Emerging & Transfusion-Transmitted Diseases, Laboratory of Bacterial & Transmissible Spongiform Encephalopathy Agents, Center for Biologics Evaluation & Research, Office of Blood Research & Review, US Food & Drug Administration, 10903 New Hampshire Avenue, Silver Spring, MD 20993, USA.,Current Address: Department of Microbiology and Immunology, University of Maryland School of Medicine, 20 Penn Street, Baltimore, MD 21201, USA
| | - Vladimir Gilman
- Engineering Center of Excellence, 267 Farley Road, Hollis, NH 03049, USA
| | - Minh Duong
- Engineering Center of Excellence, 267 Farley Road, Hollis, NH 03049, USA
| | - David M Asher
- Division of Emerging & Transfusion-Transmitted Diseases, Laboratory of Bacterial & Transmissible Spongiform Encephalopathy Agents, Center for Biologics Evaluation & Research, Office of Blood Research & Review, US Food & Drug Administration, 10903 New Hampshire Avenue, Silver Spring, MD 20993, USA
| | - Luisa Gregori
- Division of Emerging & Transfusion-Transmitted Diseases, Laboratory of Bacterial & Transmissible Spongiform Encephalopathy Agents, Center for Biologics Evaluation & Research, Office of Blood Research & Review, US Food & Drug Administration, 10903 New Hampshire Avenue, Silver Spring, MD 20993, USA
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20
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Wagner SJ, Leiby DA, Roback JD. Existing and Emerging Blood-Borne Pathogens: Impact on the Safety of Blood Transfusion for the Hematology/Oncology Patient. Hematol Oncol Clin North Am 2019; 33:739-48. [PMID: 31466601 DOI: 10.1016/j.hoc.2019.05.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Despite measures to mitigate risk of transfusion-transmitted infections, emerging agents contribute to morbidity and mortality. We outline the epidemiology, risk mitigation strategies, and impact on patients for Zika virus, bacteria, Babesia, and cytomegalovirus. Nucleic acid testing of blood has reduced risk of Zika infection and reduced transfusion-transmitted risk of Babesia. Other collection and testing measures have reduced but not eliminated the risk of sepsis from bacterially contaminated blood components. Cytomegalovirus has almost been eliminated by high-efficiency leukoreduction, but residual transmissions are difficult to distinguish from community-acquired infections and additional antibody testing of blood may confer further safety of susceptible recipients.
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21
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Prax M, Bekeredjian-Ding I, Krut O. Microbiological Screening of Platelet Concentrates in Europe. Transfus Med Hemother 2019; 46:76-86. [PMID: 31191193 DOI: 10.1159/000499349] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Accepted: 02/27/2019] [Indexed: 01/05/2023] Open
Abstract
The risk of transfusion-associated sepsis due to transmission of bacteria is a persistent problem in the transfusion field. Despite numerous interventions to reduce the risk, cases of bacterial sepsis following transfusion are repeatedly being reported. Especially platelet concentrates are highly susceptible to bacterial contaminations due to the growth-promoting storage conditions. In Europe, blood establishments and national authorities have implemented individual precaution measures to mitigate the risk of bacterial transmission. To obtain an overview of the different approaches, we compiled information from national authorities, blood establishments, and the current literature. Several aspects such as the shelf life of platelets, time of sampling and the applied control measures are compared between the member states. The analysis of the data revealed a broad heterogeneity of procedures on a national level ranging from platelet release without any safety testing up to mandatory screening of all platelet concentrates prior to transfusion. Despite the substantial progress made in recent years, several bacterial reports on transfusion-associated sepsis indicate that further efforts are needed to increase the safety of blood transfusions in the long term.
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Affiliation(s)
- Marcel Prax
- Division of Microbiology, Paul Ehrlich Institute, Langen, Germany
| | | | - Oleg Krut
- Division of Microbiology, Paul Ehrlich Institute, Langen, Germany
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22
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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23
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Kacker S, Bloch EM, Ness PM, Gehrie EA, Marshall CE, Lokhandwala PM, Tobian AAR. Financial impact of alternative approaches to reduce bacterial contamination of platelet transfusions. Transfusion 2019; 59:1291-1299. [PMID: 30623459 DOI: 10.1111/trf.15139] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Revised: 11/26/2018] [Accepted: 11/27/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND Bacterial contamination of platelets remains the leading infectious risk from blood transfusion. Pathogen reduction (PR), point-of-release testing (PORt), and secondary bacterial culture (SBC) have been proposed as alternative risk control strategies, but a comprehensive financial comparison has not been conducted. STUDY DESIGN AND METHODS A Markov-based decision tree was constructed to model the financial and clinical impact of PR, PORt, and SBC, as well as a baseline strategy involving routine testing only. Hospitals were assumed to acquire leukoreduced apheresis platelets on Day 3 after collection, and, in the base case analysis, expiration would occur at the end of Day 5 (PR and SBC) or 7 (PORt). Monte Carlo simulations assessed the direct medical costs for platelet acquisition, testing, transfusion, and possible complications. Input parameters, including test sensitivity and specificity, were drawn from existing literature, and costs (2018 US dollars) were based on a hospital perspective. RESULTS The total costs per unit acquired by the hospital under the baseline strategy, PR, PORt, and SBC were $651.45, $827.82, $686.33, and $668.50, respectively. All risk-reduction strategies decreased septic transfusion reactions and associated expenses, with the greatest reductions from PR. PR would add $191.09 in per-unit acquisition costs, whereas PORt and SBC would increase per-unit testing costs by $31.79 and $17.26, respectively. Financial outcomes were sensitive to platelet dating; allowing 7-day storage with SBC would lead to a cost savings of $12.41 per transfused unit. Results remained robust in probabilistic sensitivity analyses. CONCLUSIONS All three strategies are viable approaches to reducing bacterially contaminated platelet transfusions, although SBC is likely to be the cheapest overall.
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Affiliation(s)
- Seema Kacker
- Division of Transfusion Medicine, Department of Pathology, Johns Hopkins University, Baltimore, Maryland
| | - Evan M Bloch
- Division of Transfusion Medicine, Department of Pathology, Johns Hopkins University, Baltimore, Maryland
| | - Paul M Ness
- Division of Transfusion Medicine, Department of Pathology, Johns Hopkins University, Baltimore, Maryland
| | - Eric A Gehrie
- Division of Transfusion Medicine, Department of Pathology, Johns Hopkins University, Baltimore, Maryland
| | - Christi E Marshall
- Division of Transfusion Medicine, Department of Pathology, Johns Hopkins University, Baltimore, Maryland
| | - Parvez M Lokhandwala
- Division of Transfusion Medicine, Department of Pathology, Johns Hopkins University, Baltimore, Maryland
| | - Aaron A R Tobian
- Division of Transfusion Medicine, Department of Pathology, Johns Hopkins University, Baltimore, Maryland
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24
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Siddon AJ, Tormey CA, Snyder EL. Platelet Transfusion Medicine. Platelets 2019. [DOI: 10.1016/b978-0-12-813456-6.00064-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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25
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Gravemann U, Handke W, Müller TH, Seltsam A. Bacterial inactivation of platelet concentrates with the THERAFLEX UV-Platelets pathogen inactivation system. Transfusion 2018; 59:1324-1332. [PMID: 30588633 DOI: 10.1111/trf.15119] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Revised: 11/27/2018] [Accepted: 12/03/2018] [Indexed: 12/13/2022]
Abstract
BACKGROUND The THERAFLEX UV-Platelets system (Maco Pharma) uses ultraviolet C (UVC) light for pathogen inactivation (PI) of platelet concentrates (PCs) without any additional photoactive compound. The aim of the study was to systematically investigate bacterial inactivation with this system under conditions of intended use. STUDY DESIGN AND METHODS The robustness of the system was evaluated by assessing its capacity to inactivate high concentrations of different bacterial species in accordance with World Health Organization guidelines. The optimal use of the PI system was explored in time-to-treatment experiments by testing its ability to sterilize PCs contaminated with low levels of bacteria on the day of manufacture (target concentration, 100 colony-forming units/unit). The bacteria panel used for spiking experiments in this study included the World Health Organization International Repository Platelet Transfusion Relevant Reference Strains (n = 14), commercially available strains (n = 13), and in-house clinical isolates (n = 2). RESULTS Mean log reduction factors after UVC treatment ranged from 3.1 to 7.5 and varied between different strains of the same species. All PCs (n = 12/species) spiked with up to 200 colony-forming units/bag remained sterile until the end of storage when UVC treated 6 hours after spiking. UVC treatment 8 hours after spiking resulted in single breakthrough contaminations with the fast-growing species Escherichia coli and Streptococcus pyogenes. CONCLUSION The UVC-based THERAFLEX UV-Platelets system efficiently inactivates transfusion-relevant bacterial species in PCs. The comprehensive data from this study may provide a valuable basis for the optimal use of this UVC-based PI system.
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Affiliation(s)
- Ute Gravemann
- German Red Cross Blood Service NSTOB, Institute Springe, Springe, Germany
| | - Wiebke Handke
- German Red Cross Blood Service NSTOB, Institute Springe, Springe, Germany
| | - Thomas H Müller
- German Red Cross Blood Service NSTOB, Institute Springe, Springe, Germany
| | - Axel Seltsam
- German Red Cross Blood Service NSTOB, Institute Springe, Springe, Germany
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26
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Prioli KM, Karp JK, Lyons NM, Chrebtow V, Herman JH, Pizzi LT. Economic Implications of Pathogen Reduced and Bacterially Tested Platelet Components: A US Hospital Budget Impact Model. Appl Health Econ Health Policy 2018; 16:889-899. [PMID: 30062464 PMCID: PMC6244623 DOI: 10.1007/s40258-018-0409-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
BACKGROUND US FDA draft guidance includes pathogen reduction (PR) or secondary rapid bacterial testing (RT) in its recommendations for mitigating risk of platelet component (PC) bacterial contamination. An interactive budget impact model was created for hospitals to use when considering these technologies. METHODS A Microsoft Excel model was built and populated with base-case costs and probabilities identified through literature search and a survey of US hospital transfusion service directors. Annual costs of PC acquisition, testing, wastage, dispensing/transfusion, sepsis, shelf life, and reimbursement for a mid-sized hospital that purchases all of its PCs were compared for four scenarios: 100% conventional PCs (C-PC), 100% RT-PC, 100% PR-PC, and 50% RT-PC/50% PR-PC. RESULTS Annual total costs were US$3.64, US$3.67, and US$3.96 million when all platelets were C-PC, RT-PC, or PR-PC, respectively, or US$3.81 million in the 50% RT-PC/50% PR-PC scenario. The annual net cost of PR-PC, obtained by subtracting annual reimbursements from annual total costs, is 6.18% above that of RT-PC. Maximum usable shelf lives for C-PC, RT-PC, and PR-PC are 3.0, 5.0, and 3.6 days, respectively; hospitals obtain PR-PC components earliest at 1.37 days. CONCLUSION The model predicts minimal cost increase for PR-PC versus RT-PC, including cost offsets such as elimination of bacterial detection and irradiation, and reimbursement. Additional safety provided by PR, including risk mitigation of transfusion-transmission of a broad spectrum of viruses, parasites, and emerging pathogens, may justify this increase. Effective PC shelf life may increase with RT, but platelets can be available sooner with PR due to elimination of bacterial detection, depending on blood center logistics.
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Affiliation(s)
- Katherine M. Prioli
- Center for Health Outcomes, Policy, and Economics, Rutgers University, 160 Frelinghuysen Road, Suite 417, Piscataway, NJ 08854 USA
| | - Julie Katz Karp
- Department of Pathology, Anatomy, and Cell Biology, Thomas Jefferson University Hospital, 111 South 11th Street, Philadelphia, PA 19107 USA
| | - Nina M. Lyons
- Thomas Jefferson University, 901 Walnut Street, Suite 901, Philadelphia, PA 19107 USA
| | - Vera Chrebtow
- Global Marketing and Communications, Cerus Corporation, 2550 Stanwell Drive, Concord, CA 94520 USA
| | - Jay H. Herman
- Department of Pathology, Anatomy, and Cell Biology, Thomas Jefferson University Hospital, 111 South 11th Street, Philadelphia, PA 19107 USA
| | - Laura T. Pizzi
- Center for Health Outcomes, Policy, and Economics, Rutgers University, 160 Frelinghuysen Road, Suite 417, Piscataway, NJ 08854 USA
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Levy JH, Neal MD, Herman JH. Bacterial contamination of platelets for transfusion: strategies for prevention. Crit Care 2018; 22:271. [PMID: 30367640 PMCID: PMC6204059 DOI: 10.1186/s13054-018-2212-9] [Citation(s) in RCA: 69] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Accepted: 09/25/2018] [Indexed: 01/07/2023]
Abstract
Platelet transfusions carry greater risks of infection, sepsis, and death than any other blood product, owing primarily to bacterial contamination. Many patients may be at particular risk, including critically ill patients in the intensive care unit. This narrative review provides an overview of the problem and an update on strategies for the prevention, detection, and reduction/inactivation of bacterial contaminants in platelets. Bacterial contamination and septic transfusion reactions are major sources of morbidity and mortality. Between 1:1000 and 1:2500 platelet units are bacterially contaminated. The skin bacterial microflora is a primary source of contamination, and enteric contaminants are rare but may be clinically devastating, while platelet storage conditions can support bacterial growth. Donor selection, blood diversion, and hemovigilance are effective but have limitations. Biofilm-producing species can adhere to biological and non-biological surfaces and evade detection. Primary bacterial culture testing of apheresis platelets is in routine use in the US. Pathogen reduction/inactivation technologies compatible with platelets use ultraviolet light-based mechanisms to target nucleic acids of contaminating bacteria and other pathogens. These methods have demonstrated safety and efficacy and represent a proactive approach for inactivating contaminants before transfusion to prevent transfusion-transmitted infections. One system, which combines ultraviolet A and amotosalen for broad-spectrum pathogen inactivation, is approved in both the US and Europe. Current US Food and Drug Administration recommendations advocate enhanced bacterial testing or pathogen reduction/inactivation strategies (or both) to further improve platelet safety. Risks of bacterial contamination of platelets and transfusion-transmitted infections have been significantly mitigated, but not eliminated, by improvements in prevention and detection strategies. Regulatory-approved technologies for pathogen reduction/inactivation have further enhanced the safety of platelet transfusions. Ongoing development of these technologies holds great promise.
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Affiliation(s)
- Jerrold H Levy
- Duke University Hospital, 2301 Erwin Road, Durham, NC, 27710, USA.
| | - Matthew D Neal
- University of Pittsburgh Medical Center, 200 Lothrop Street, Pittsburgh, PA, 15213, USA
| | - Jay H Herman
- Thomas Jefferson University Hospital, 111 S. 11th Street, Philadelphia, PA, 19107, USA
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Chetouane Y, Gallian P, Chetouane K, Dubourg G, Chiaroni J, Raoult D, Camoin-Jau L. Comparing two blood culture systems for the detection of bacterial contamination in platelet concentrates. Transfusion 2018; 58:2604-2610. [PMID: 30293236 DOI: 10.1111/trf.14911] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Revised: 04/27/2018] [Accepted: 05/18/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND The transfusion of platelet concentrates (PCs) contaminated with bacteria may cause serious, and even fatal, septic reactions in patients. The aim of this study was to compare the VersaTREK with the BACTEC FX automated culture systems for screening bacterial contamination, directly after the delay of 24 hours of preparation to obtain the final pooled buffy coat PCs, to prevent transfusion-transmitted bacterial infections. STUDY DESIGN AND METHODS Seven bacterial strains were each inoculated into five replicate pooled buffy coat PCs at approximately 100 colony-forming units/unit, and 5- or 10-mL samples were inoculated into duplicate aerobic culture bottles. The time and detection rates were compared between BACTEC FX, as a reference method, and VersaTREK. RESULTS Time to detection was significantly shorter using VersaTREK for most species detected by both systems for the volumes tested. Of 70 VersaTREK cultures, 69 (98.57% detection rate) were positive after 24 hours of incubation with the 5-mL sample. In contrast, the BACTEC FX system detected all positive samples in PCs for the volume of 10 mL, although seven samples were false negatives for the 5-mL volume. CONCLUSION The VersaTREK system compared favorably to the BACTEC FX system for 5-mL volumes (p < 0.05) and could be considered a potential method for detecting bacterial contamination in PC samples directly after 24 hours of preparation of the final pooled buffy coat PCs.
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Affiliation(s)
- Yasmine Chetouane
- Aix-Marseille Université, Microbes, Evolution, Phylogeny and Infection (MEPHI) MEPHI, Institut de Recherche pour le Développement (IRD) IRD 198, Marseille, France.,Institut Hospitalo-Universitaire Méditerranée-Infection, Pôle des Maladies Infectieuses, Assistance Publique-Hôpitaux de Marseille
| | - Pierre Gallian
- Institut Hospitalo-Universitaire Méditerranée-Infection, Pôle des Maladies Infectieuses, Assistance Publique-Hôpitaux de Marseille.,Etablissement Français du Sang (EFS) Alpes Méditerranée, Marseille, France
| | - Kahina Chetouane
- Université Paris-Sud, Châtenay-Malabry, Assistance Publique des Hôpitaux de Paris, Paris, France
| | - Gregory Dubourg
- Aix-Marseille Université, Microbes, Evolution, Phylogeny and Infection (MEPHI) MEPHI, Institut de Recherche pour le Développement (IRD) IRD 198, Marseille, France.,Institut Hospitalo-Universitaire Méditerranée-Infection, Pôle des Maladies Infectieuses, Assistance Publique-Hôpitaux de Marseille
| | - Jacques Chiaroni
- Etablissement Français du Sang (EFS) Alpes Méditerranée, Marseille, France.,Aix-Marseille Université, Centre national de la recherche scientifique (CNRS) CNRS, EFS, Anthropologie Bio-culturelle, Droit, Ethique et Santé ADES Unité mixte de recherche (UMR) UMR 7268, Marseille, France
| | - Didier Raoult
- Aix-Marseille Université, Microbes, Evolution, Phylogeny and Infection (MEPHI) MEPHI, Institut de Recherche pour le Développement (IRD) IRD 198, Marseille, France.,Institut Hospitalo-Universitaire Méditerranée-Infection, Pôle des Maladies Infectieuses, Assistance Publique-Hôpitaux de Marseille
| | - Laurence Camoin-Jau
- Aix-Marseille Université, Microbes, Evolution, Phylogeny and Infection (MEPHI) MEPHI, Institut de Recherche pour le Développement (IRD) IRD 198, Marseille, France.,Institut Hospitalo-Universitaire Méditerranée-Infection, Pôle des Maladies Infectieuses, Assistance Publique-Hôpitaux de Marseille.,Laboratoire d'Hématologie, Centre hospitalo-universitaire CHU Timone, Assistance Publique Hôpitaux de Marseille, Marseille, France
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29
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Bah A, Cardoso M, Seghatchian J, Goodrich RP. Reflections on the dynamics of bacterial and viral contamination of blood components and the levels of efficacy for pathogen inactivation processes. Transfus Apher Sci 2018; 57:683-8. [DOI: 10.1016/j.transci.2018.09.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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30
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Erony SM, Marshall CE, Gehrie EA, Boyd JS, Ness PM, Tobian AA, Carroll KC, Blagg L, Shifflett L, Bloch EM. The epidemiology of bacterial culture-positive and septic transfusion reactions at a large tertiary academic center: 2009 to 2016. Transfusion 2018; 58:1933-1939. [DOI: 10.1111/trf.14789] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Revised: 04/08/2018] [Accepted: 04/08/2018] [Indexed: 01/21/2023]
Affiliation(s)
- Sean M. Erony
- Johns Hopkins Hospital and Medical Institutions; Baltimore Maryland
| | | | - Eric A. Gehrie
- Johns Hopkins Hospital and Medical Institutions; Baltimore Maryland
| | - Joan S. Boyd
- Johns Hopkins Hospital and Medical Institutions; Baltimore Maryland
| | - Paul M. Ness
- Johns Hopkins Hospital and Medical Institutions; Baltimore Maryland
| | | | - Karen C. Carroll
- Johns Hopkins Hospital and Medical Institutions; Baltimore Maryland
| | - Lorraine Blagg
- Johns Hopkins Hospital and Medical Institutions; Baltimore Maryland
| | - Lisa Shifflett
- Johns Hopkins Hospital and Medical Institutions; Baltimore Maryland
| | - Evan M. Bloch
- Johns Hopkins Hospital and Medical Institutions; Baltimore Maryland
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31
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Kamel H, Goldman M. More than one way to enhance bacterial detection in platelet components. Transfusion 2018; 58:1574-1577. [DOI: 10.1111/trf.14774] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Accepted: 04/24/2018] [Indexed: 12/25/2022]
Affiliation(s)
- Hany Kamel
- Department of Medical AffairsBlood SystemsScottsdale AZ
| | - Mindy Goldman
- Medical, Scientific and Research Affairs, Canadian Blood ServicesOttawa Ontario Canada
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32
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Kim G, Karbaschi M, Cooke M, Gaitas A. Light-based methods for whole blood bacterial inactivation enabled by a recirculating flow system. Photochem Photobiol 2018; 94:744-751. [PMID: 29418006 PMCID: PMC6136252 DOI: 10.1111/php.12899] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Accepted: 01/03/2018] [Indexed: 12/25/2022]
Abstract
Light of certain wavelengths can be used to inactivate pathogens. Whole blood is opaque; thus, the penetration of light is reduced. Here, we overcame this limitation using a thin transparent tube that is illuminated from all angles. Three light-based techniques were evaluated: photodynamic therapy (PDT) using a 660-nm light and antibody-photosensitizer conjugates, ultraviolet, and violet light. We observed a reduction of 55-71% of Staphylococcus aureus after 5 h of exposure (starting concentration 107 CFU mL-1 ) and an 88-97% reduction in methicillin-resistant Staphylococcus aureus (MRSA) (starting 104 CFU mL-1 ). An 83-92% decrease for S. aureus and 98-99.9% decrease for MRSA were observed when combined with an immunocapture approach. Complete blood count with differential analysis did not reveal any significant changes in the blood cell numbers. Genotoxicity studies showed that violet and ultraviolet did not induce any significant level of single strand breaks and alkali labile sites in the peripheral blood mononuclear cells (PBMC). In contrast, ultraviolet did induce a very low level of cyclobutane pyrimidine dimers, a UV damage indicator. PDT generated a significant level of single strand breaks and 8-oxoGua in these cells. The approaches showed promise for whole blood pathogen inactivation with minimal collateral damage to PBMC.
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Affiliation(s)
- Gwangseong Kim
- Kytaro, Inc., Miami, FL 33199
- Department of Electrical Engineering, Florida International University, Miami, FL 33199
| | - Mahsa Karbaschi
- Oxidative Stress Group, Department of Environmental Health Sciences, Florida International University, Miami, FL 33199
| | - Marcus Cooke
- Oxidative Stress Group, Department of Environmental Health Sciences, Florida International University, Miami, FL 33199
| | - Angelo Gaitas
- Kytaro, Inc., Miami, FL 33199
- Department of Electrical Engineering, Florida International University, Miami, FL 33199
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33
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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34
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Bloch EM, Marshall CE, Boyd JS, Shifflett L, Tobian AA, Gehrie EA, Ness PM. Implementation of secondary bacterial culture testing of platelets to mitigate residual risk of septic transfusion reactions. Transfusion 2018; 58:1647-1653. [DOI: 10.1111/trf.14618] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Revised: 02/07/2018] [Accepted: 02/26/2018] [Indexed: 11/28/2022]
Affiliation(s)
- Evan M. Bloch
- Department of Pathology, Transfusion Medicine DivisionJohns Hopkins UniversityBaltimore Maryland
| | - Christi E. Marshall
- Department of Pathology, Transfusion Medicine DivisionJohns Hopkins UniversityBaltimore Maryland
| | - Joan S. Boyd
- Department of Pathology, Transfusion Medicine DivisionJohns Hopkins UniversityBaltimore Maryland
| | - Lisa Shifflett
- Department of Pathology, Transfusion Medicine DivisionJohns Hopkins UniversityBaltimore Maryland
| | - Aaron A.R. Tobian
- Department of Pathology, Transfusion Medicine DivisionJohns Hopkins UniversityBaltimore Maryland
| | - Eric A. Gehrie
- Department of Pathology, Transfusion Medicine DivisionJohns Hopkins UniversityBaltimore Maryland
| | - Paul M. Ness
- Department of Pathology, Transfusion Medicine DivisionJohns Hopkins UniversityBaltimore Maryland
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35
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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] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Accepted: 02/28/2017] [Indexed: 11/30/2022]
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36
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Hadjesfandiari N, Weinhart M, Kizhakkedathu JN, Haag R, Brooks DE. Development of Antifouling and Bactericidal Coatings for Platelet Storage Bags Using Dopamine Chemistry. Adv Healthc Mater 2018; 7. [PMID: 28961393 DOI: 10.1002/adhm.201700839] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Indexed: 11/10/2022]
Abstract
Platelets have a limited shelf life, due to the risk of bacterial contamination and platelet quality loss. Most platelet storage bags are made of a mixture of polyvinyl chloride with a plasticizer, denoted as pPVC. To improve biocompatibility of pPVC with platelets and to inhibit bacterial biofilm formation, an antifouling polymer coating is developed using mussel-inspired chemistry. A copolymer of N,N-dimethylacrylamide and N-(3-aminopropyl)methacrylamide hydrochloride is synthesized and coupled with catechol groups, named DA51-cat. Under mild aqueous conditions, pPVC is first equilibrated with an anchoring polydopamine layer, followed by a DA51-cat layer. Measurements show this coating decreases fibrinogen adsorption to 5% of the control surfaces. One-step coating with DA51-cat does not coat pPVC efficiently although it is sufficient for coating silicon wafers and gold substrates. The dual layer coating on platelet bags resists bacterial biofilm formation and considerably decreases platelet adhesion. A cationic antimicrobial peptide, E6, is conjugated to DA51-cat then coated on silicon wafers and introduces bactericidal activity to these surfaces. Time-of-flight second ion-mass spectroscopy is successfully applied to characterize these surfaces. pPVC is widely used in medical devices; this method provides an approach to controlling biofouling and bacterial growth on it without elaborate surface modification procedures.
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Affiliation(s)
- Narges Hadjesfandiari
- Center for Blood Research; University of British Columbia; 2350 Health Sciences Mall Vancouver V6T 1Z3 Canada
- Department of Chemistry; University of British Columbia; Vancouver V6T 1Z1 Canada
| | - Marie Weinhart
- Institute of Chemistry and Biochemistry; Freie Universität Berlin; Takustrasse 3 14195 Berlin Germany
| | - Jayachandran N. Kizhakkedathu
- Center for Blood Research; University of British Columbia; 2350 Health Sciences Mall Vancouver V6T 1Z3 Canada
- Department of Chemistry; University of British Columbia; Vancouver V6T 1Z1 Canada
- Department of Pathology and Laboratory Medicine; University of British Columbia; Vancouver V6T 2B5 Canada
| | - Rainer Haag
- Institute of Chemistry and Biochemistry; Freie Universität Berlin; Takustrasse 3 14195 Berlin Germany
| | - Donald E. Brooks
- Center for Blood Research; University of British Columbia; 2350 Health Sciences Mall Vancouver V6T 1Z3 Canada
- Department of Chemistry; University of British Columbia; Vancouver V6T 1Z1 Canada
- Department of Pathology and Laboratory Medicine; University of British Columbia; Vancouver V6T 2B5 Canada
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37
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Petersson F, Kilsgård O, Shannon O, Lood R. Platelet activation and aggregation by the opportunistic pathogen Cutibacterium (Propionibacterium) acnes. PLoS One 2018; 13:e0192051. [PMID: 29385206 PMCID: PMC5792000 DOI: 10.1371/journal.pone.0192051] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Accepted: 01/16/2018] [Indexed: 11/19/2022] Open
Abstract
Cutibacterium (Propionibacterium) acnes, considered a part of the skin microbiota, is one of the most commonly isolated anaerobic bacteria from medical implants in contact with plasma. However, the precise interaction of C. acnes with blood cells and plasma proteins has not been fully elucidated. Herein, we have investigated the molecular interaction of C. acnes with platelets and plasma proteins. We report that the ability of C. acnes to aggregate platelets is dependent on phylotype, with a significantly lower ability amongst type IB isolates, and the interaction of specific donor-dependent plasma proteins (or concentrations thereof) with C. acnes. Pretreatment of C. acnes with plasma reduces the lag time before aggregation demonstrating that pre-deposition of plasma proteins on C. acnes is an important step in platelet aggregation. Using mass spectrometry we identified several plasma proteins deposited on C. acnes, including IgG, fibrinogen and complement factors. Inhibition of IgG, fibrinogen or complement decreased C. acnes-mediated platelet aggregation, demonstrating the importance of these plasma proteins for aggregation. The interaction of C. acnes and platelets was visualized using fluorescence microscopy, verifying the presence of IgG and fibrinogen as components of the aggregates, and co-localization of C. acnes and platelets in the aggregates. Here, we have demonstrated the ability of C. acnes to activate and aggregate platelets in a bacterium and donor-specific fashion, as well as added mechanistic insights into this interaction.
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Affiliation(s)
- Frida Petersson
- Division of Infection Medicine, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Ola Kilsgård
- Division of Infection Medicine, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
- Department of Immunotechnology, Faculty of Engineering Lund, Lund University, Lund, Sweden
| | - Oonagh Shannon
- Division of Infection Medicine, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Rolf Lood
- Division of Infection Medicine, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
- * E-mail:
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38
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Harm SK, Szczepiorkowski ZM, Dunbar NM. Routine use of Day 6 and Day 7 platelets with rapid testing: two hospitals assess impact 1 year after implementation. Transfusion 2018; 58:938-942. [DOI: 10.1111/trf.14473] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Revised: 12/01/2017] [Accepted: 12/01/2017] [Indexed: 11/29/2022]
Affiliation(s)
- Sarah K. Harm
- Department of Pathology and Laboratory Medicine; University of Vermont Medical Center; Burlington Vermont
| | - Zbigniew M. Szczepiorkowski
- Department of Pathology and Laboratory Medicine; Dartmouth-Hitchcock Medical Center; Lebanon New Hampshire
- Institute of Hematology and Transfusion Medicine; Warsaw Poland
| | - Nancy M. Dunbar
- Department of Pathology and Laboratory Medicine; Dartmouth-Hitchcock Medical Center; Lebanon New Hampshire
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39
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Brecher ME. Do older platelets increase the risk of transfusion-associated sepsis? Transfusion 2018; 58:1-2. [PMID: 29314102 DOI: 10.1111/trf.14433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Accepted: 11/02/2017] [Indexed: 11/26/2022]
Affiliation(s)
- Mark E Brecher
- Laboratory Corporation of America Diagnostics, Burlington, NC.,Department of Pathology and Laboratory Medicine, University of North Carolina, Durham, NC
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40
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Makroo RN, Sardana R, Mediratta L, Butta H, Thakur UK, Agrawal S, Chowdhry M, Kumar S, Chokroborty S. Evaluation of bacterial inactivation in random donor platelets and single-donor apheresis platelets by the INTERCEPT blood system. Asian J Transfus Sci 2018; 12:146-153. [PMID: 30692800 PMCID: PMC6327773 DOI: 10.4103/ajts.ajts_87_17] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND: Blood transfusion of contaminated components is a potential source of sepsis by a wide range of known and unknown pathogens. Collection mechanism and storage conditions of platelets make them vulnerable for bacterial contamination. Several interventions aim to reduce the transfusion of contaminated platelet units; however, data suggest that contaminated platelet transfusion remains very common. AIM: A pathogen inactivation system, “INTERCEPT”, to inactivate bacteria in deliberately contaminated platelet units was implemented and evaluated. MATERIALS AND METHODS: Five single-donor platelets (SDP) and five random donor platelets (RDP) were prepared after prior consent of donors. Both SDP and RDP units were deliberately contaminated by stable stock ATCC Staphylococcus aureus and Escherichia coli, respectively, with a known concentration of stock culture. Control samples were taken from the infected units and bacterial concentrations were quantified. The units were treated for pathogen inactivation with the INTERCEPT (Cerus Corporation, Concord, CA) Blood system for platelets (Amotosalen/UVA), as per the manufacturer's instructions for use. Post illumination, test samples were analyzed for any bacterial growth. RESULTS: Post-illumination test samples did not result in any bacterial growth. A complete reduction of >6 log10S. aureus in SDP units and >6 log10Escherichia coli in RDP units was achieved. CONCLUSION: The INTERCEPT system has been shown to be very effective in our study for bacterial inactivation. Implementation of INTERCEPT may be used as a mitigation against any potential bacterial contamination in platelet components.
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Affiliation(s)
- Raj Nath Makroo
- Department of Transfusion Medicine, Indraprastha Apollo Hospitals, New Delhi, India
| | - Raman Sardana
- Department of Microbiology, Indraprastha Apollo Hospitals, New Delhi, India
| | - Leena Mediratta
- Department of Microbiology, Indraprastha Apollo Hospitals, New Delhi, India
| | - Hena Butta
- Department of Microbiology, Indraprastha Apollo Hospitals, New Delhi, India
| | - Uday Kumar Thakur
- Department of Transfusion Medicine, Indraprastha Apollo Hospitals, New Delhi, India
| | - Soma Agrawal
- Department of Transfusion Medicine, Indraprastha Apollo Hospitals, New Delhi, India
| | - Mohit Chowdhry
- Department of Transfusion Medicine, Indraprastha Apollo Hospitals, New Delhi, India
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41
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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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: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [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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Affiliation(s)
- Evan M. Bloch
- Department of PathologyJohns Hopkins University, School of MedicineBaltimore MD
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Benjamin RJ, Braschler T, Weingand T, Corash LM. Hemovigilance monitoring of platelet septic reactions with effective bacterial protection systems. Transfusion 2017; 57:2946-2957. [PMID: 28840603 DOI: 10.1111/trf.14284] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Revised: 07/01/2017] [Accepted: 07/02/2017] [Indexed: 02/05/2023]
Abstract
BACKGROUND Delayed, large-volume bacterial culture and amotosalen/ultraviolet-A light pathogen reduction are effective at reducing the risk of bacterial proliferation in platelet concentrates (PCs). Hemovigilance programs continue to receive reports of suspected septic transfusion reactions, most with low imputability. Here, we compile national hemovigilance data to determine the relative efficacy of these interventions. STUDY DESIGN AND METHODS Annual reports from the United Kingdom, France, Switzerland, and Belgium were reviewed between 2005 and 2016 to assess the risk of bacterial contamination and septic reactions. RESULTS Approximately 1.65 million delayed, large-volume bacterial culture-screened PCs in the United Kingdom and 2.3 million amotosalen/ultraviolet-A-treated PCs worldwide were issued with no reported septic fatalities. One definite, one possible, and 12 undetermined/indeterminate septic reactions and eight contaminated "near misses" were reported with delayed, large-volume bacterial cultures between 2011 and 2016, for a lower false-negative culture rate than that in the previous 5 years (5.4 vs. 16.3 per million: odds ratio, 3.0; 95% confidence interval, 1.4-6.5). Together, the Belgian, Swiss, and French hemovigilance programs documented zero probable or definite/certain septic reactions with 609,290 amotosalen/ultraviolet-A-treated PCs (<1.6 per million). The rates were significantly lower than those reported with concurrently transfused, nonpathogen-reduced PCs in Belgium (<4.4 vs. 35.6 per million: odds ratio, 8.1; 95% confidence interval,1.1-353.3) and with historic septic reaction rates in Switzerland (<6.0 vs. 82.9 per million: odds ratio, 13.9; 95% confidence interval, 2.1-589.2), and the rates tended to be lower than those from concurrently transfused, nonpathogen-reduced PCs in France (<4.7 vs. 19.0 per million: odds ratio, 4.1; 95% confidence interval, 0.7-164.3). CONCLUSION Pathogen reduction and bacterial culture both reduced the incidence of septic reactions, although under-reporting and strict imputability criteria resulted in an underestimation of risk.
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Affiliation(s)
| | | | - Tina Weingand
- Blutspendedienst Zentralschweiz SRK, Luzern, Switzerland
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Ramirez-Arcos S, DiFranco C, McIntyre T, Goldman M. Residual risk of bacterial contamination of platelets: six years of experience with sterility testing. Transfusion 2017; 57:2174-2181. [DOI: 10.1111/trf.14202] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2017] [Revised: 04/04/2017] [Accepted: 04/30/2017] [Indexed: 01/29/2023]
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Abstract
BACKGROUND Reports of septic transfusion reactions (STRs) after transfusion of culture-negative platelets (PLTs) justify more effective prevention strategies. Pathogen reduction technologies or performance of additional point-of-issue testing are proposed strategies to enhance safety through Day 5 of storage. STUDY DESIGN AND METHODS Trima leukoreduced apheresis PLTs (APs) were collected during two study periods (45 and 31 months) using standard procedures, with target settings adjusted during the second period to maintain split rate after increased culture volume. Primary testing for bacterial contamination was performed using BacT/ALERT 3D with sampling from the mother bag 24 to 36 hours after collection. Two culture approaches were compared: in Period A, an 8-mL sample in one aerobic culture bottle (CB), and in Period B a minimal proportional sample volume (PSV) of at least 3.8% of mother bag volume into one to three aerobic CBs (7-10 mL per bottle). RESULTS In Periods A and B, 188,389 and 159,098 AP collections were tested, respectively. The true-positive (TP) rate in Period A was 0.90 per 10,000 collections and in Period B was 1.83 per 10,000 (p < 0.05). In Period B, 12 of 29 (41%) TP results had discrepant CB results (DCBRs; at least one of multiple bottles without growth). The false-positive rate in Period B, 15.05 per 10,000 collections, was significantly higher than that of Period A, 3.66 per 10,000. One contaminated collection resulting in STR(s) was reported in each study period. Implementation of PSV was operationally successful and did not impact the AP split rate. CONCLUSION Proportional sample volume improved the sensitivity of primary testing and identified collections that could have escaped detection had only a single bottle with 8- to 10-mL volume been used. PSV may represent another approach to enhanced PLT safety for 5-day storage without a requirement for secondary testing.
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McDonald C, Allen J, Brailsford S, Roy A, Ball J, Moule R, Vasconcelos M, Morrison R, Pitt T. Bacterial screening of platelet components by National Health Service Blood and Transplant, an effective risk reduction measure. Transfusion 2017; 57:1122-1131. [PMID: 28425610 DOI: 10.1111/trf.14085] [Citation(s) in RCA: 68] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Revised: 01/19/2017] [Accepted: 01/19/2017] [Indexed: 11/28/2022]
Abstract
BACKGROUND Bacterial contamination of blood components remains a major cause of sepsis in transfusion medicine. Between 2006 and 2010 in the 5 years before the introduction of bacterial screening of platelet (PLT) components by National Health Service Blood and Transplant (NHSBT), seven cases of PLT component-associated transmission of bacterial infection were recorded for 10 patients, three of which were fatal. STUDY DESIGN AND METHODS Sampling of individual PLT components was undertaken at 36 to 48 hours after donation and tested in the BacT/ALERT system with 8 mL inoculated into each of aerobic and anaerobic culture bottles. Bottles were incubated until the end of the 7-day shelf life and initial reactive bottles were examined for contamination. Bacterial screened time-expired PLTs were tested as in the screen method. RESULTS From February 2011 to September 2015, a total of 1,239,029 PLT components were screened. Initial-reactive, confirmed-positive, and false-positive rates were 0.37, 0.03, and 0.19%, respectively. False-negative cultures, all with Staphylococcus aureus, occurred on four occasions; three were visually detected before transfusion and one confirmed transmission resulted in patient morbidity. The NHSBT screening protocol effectively reduced the number of clinically adverse transfusion transmissions by 90% in this reporting period, compared to a similar time period before implementation. Delayed testing of 4515 time-expired PLT units after screening revealed no positives. CONCLUSION The implementation of bacterial screening of PLT components with the NHSBT BacT/ALERT protocol was an effective risk reduction measure and increased the safety of the blood supply.
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Taha M, Culibrk B, Kalab M, Schubert P, Yi QL, Goodrich R, Ramirez-Arcos S. Efficiency of riboflavin and ultraviolet light treatment against high levels of biofilm-derived Staphylococcus epidermidis in buffy coat platelet concentrates. Vox Sang 2017; 112:408-416. [PMID: 28378343 DOI: 10.1111/vox.12519] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Revised: 03/03/2017] [Accepted: 03/05/2017] [Indexed: 12/22/2022]
Abstract
BACKGROUND AND OBJECTIVES Staphylococcus epidermidis forms surface-attached aggregates (biofilms) in platelet concentrates (PCs), which are linked to missed detection during PC screening. This study was aimed at evaluating the efficacy of riboflavin-UV treatment to inactivate S. epidermidis biofilms in buffy coat (BC) PCs. MATERIALS AND METHODS Biofilm and non-biofilm cells from S. epidermidis ST-10002 and S. epidermidis AZ-66 were individually inoculated into whole blood (WB) units (~106 colony-forming units (CFU)/ml) (N = 4-5). One spiked and three unspiked WB units were processed to produce a BC-PC pool. Riboflavin was added to the pool which was then split into two bags: one for UV treatment and the second was untreated. Bacterial counts were determined before and after treatment. In vitro PC quality was assessed by flow cytometry and dynamic light scattering. RESULTS Bacterial counts were reduced during BC-PC production from ~106 CFU/ml in WB to 103 -104 CFU/ml in PCs (P < 0·0001). Riboflavin-UV treatment resulted in significantly higher reduction of S. epidermidis AZ-66 than strain ST-10002 (≥3·5 log reduction and 2·6-2·8 log reduction, respectively, P < 0·0001). Remaining bacteria post-treatment were able to proliferate in PCs. No differences in S. epidermidis inactivation were observed in PCs produced from WB inoculated with biofilm or non-biofilm cells (P > 0·05). Platelet activation was enhanced in PCs produced with WB inoculated with biofilms compared to non-biofilm cells (P < 0·05). CONCLUSION Riboflavin-UV treatment was similarly efficacious in PCs produced from WB inoculated with S. epidermidis biofilm or non-biofilm cells. Levels of biofilm-derived S. epidermidis ≥103 CFU/ml were not completely inactivated; however, further testing is necessary with lower (real-life) bacterial levels.
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Affiliation(s)
- M Taha
- Canadian Blood Services, Ottawa, ON, Canada
| | - B Culibrk
- Canadian Blood Services, Ottawa, ON, Canada
| | - M Kalab
- Agriculture and Agri-Food Canada, Ottawa, ON, Canada
| | - P Schubert
- Canadian Blood Services, Ottawa, ON, Canada
| | - Q-L Yi
- Canadian Blood Services, Ottawa, ON, Canada
| | - R Goodrich
- Infectious Disease Research Center, Colorado State University, Fort Collins, CO, USA
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Mizutani M, Samejima H, Terunuma H, Kino-oka M. Experience of contamination during autologous cell manufacturing in cell processing facility under the Japanese Medical Practitioners Act and the Medical Care Act. Regen Ther 2016; 5:25-30. [PMID: 31245497 PMCID: PMC6581811 DOI: 10.1016/j.reth.2016.06.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Revised: 06/16/2016] [Accepted: 06/23/2016] [Indexed: 11/24/2022] Open
Abstract
Cell therapy and regenerative medicine technologies require strict cell manufacturing procedures to be defined and addressed. Maintenance of the aseptic environment is critical to preclude extrinsic contamination risks, similar to conventional pharmaceutical manufacturing. However, intrinsic contamination risks exist in all cell manufacturing processes owing to the use of cells as the raw materials that cannot be sterilized, thus giving rise to the primary and secondary risks of cell contamination and cross-contamination, respectively. Analysis of contamination risks was conducted on experienced batches (29,858 batches) for the production of immune cells derived from autologous blood mononuclear cells under the Medical Practitioners Act and the Medical Care Act in Japan. From these batches, 0.06% (18 cases) of contamination occurred, representing low probability of contamination incidence during cell processing. Almost all the causes of these contaminations were regarded to be from the collected blood (intrinsic contamination), and subsequent cross-contaminations were prevented, considering that the secondary contamination risk can be reduced by adequate managements of operational procedures for changeover in aseptic environment.
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Affiliation(s)
- Manabu Mizutani
- Division of Science and Biotechnology, Graduate School of Engineering, Osaka University, 2-1 Yamadaoka, Suita, Osaka, 565-0871, Japan
- Biotherapy Institute of Japan, 2-4-8 Edagawa, Koto-ku, Tokyo, 135-0051, Japan
| | - Hazuki Samejima
- Biotherapy Institute of Japan, 2-4-8 Edagawa, Koto-ku, Tokyo, 135-0051, Japan
| | - Hiroshi Terunuma
- Biotherapy Institute of Japan, 2-4-8 Edagawa, Koto-ku, Tokyo, 135-0051, Japan
| | - Masahiro Kino-oka
- Division of Science and Biotechnology, Graduate School of Engineering, Osaka University, 2-1 Yamadaoka, Suita, Osaka, 565-0871, Japan
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