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Ramirez-Arcos S, Kumaran D, Cap A, Cardenas KM, Cloutier M, Ferdin J, Gravemann U, Ketter P, Landry P, Lu T, Niekerk T, Parker J, Renke C, Seltsam A, Stafford B, Süssner S, Vollmer T, Zilkenat S, McDonald C. Proliferation of psychrotrophic bacteria in cold-stored platelet concentrates. Vox Sang 2024. [PMID: 38631895 DOI: 10.1111/vox.13640] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Revised: 04/03/2024] [Accepted: 04/04/2024] [Indexed: 04/19/2024]
Abstract
BACKGROUND AND OBJECTIVES Platelet concentrates (PC) are stored at 20-24°C to maintain platelet functionality, which may promote growth of contaminant bacteria. Alternatively, cold storage of PC limits bacterial growth; however, data related to proliferation of psychotrophic species in cold-stored PC (CSP) are scarce, which is addressed in this study. MATERIALS AND METHODS Eight laboratories participated in this study with a pool/split approach. Two split PC units were spiked with ~25 colony forming units (CFU)/PC of Staphylococcus aureus, Klebsiella pneumoniae, Serratia liquefaciens, Pseudomonas fluorescens and Listeria monocytogenes. One unit was stored under agitation at 20-24°C/7 days while the second was stored at 1-6°C/no agitation for 21 days. PC were sampled periodically to determine bacterial loads. Five laboratories repeated the study with PC inoculated with lyophilized inocula (~30 CFU/mL) of S. aureus and K. pneumoniae. RESULTS All species proliferated in PC stored at 20-24°C, reaching concentrations of ≤109 CFU/mL by day 7. Psychrotrophic P. fluorescens and S. liquefaciens proliferated in CSP to ~106 CFU/mL and ~105 CFU/mL on days 10 and 17 of storage, respectively, followed by L. monocytogenes, which reached ~102 CFU/mL on day 21. S. aureus and K. pneumoniae did not grow in CSP. CONCLUSION Psychrotrophic bacteria, which are relatively rare contaminants in PC, proliferated in CSP, with P. fluorescens reaching clinically significant levels (≥105 CFU/mL) before day 14 of storage. Cold storage reduces bacterial risk of PC to levels comparable with RBC units. Safety of CSP could be further improved by implementing bacterial detection systems or pathogen reduction technologies if storage is beyond 10 days.
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Affiliation(s)
- Sandra Ramirez-Arcos
- Medical Affairs and Innovation, Canadian Blood Services, Ottawa, Ontario, Canada
- Department of Biochemistry, Microbiology and Immunology, University of Ottawa, Ottawa, Ontario, Canada
| | - Dilini Kumaran
- Medical Affairs and Innovation, Canadian Blood Services, Ottawa, Ontario, Canada
- Department of Biochemistry, Microbiology and Immunology, University of Ottawa, Ottawa, Ontario, Canada
| | - Andrew Cap
- Coagulation and Blood Research Task Area US Army Institute of Surgical Research, Fort Sam Houston, Texas, USA
| | - Kristin Michelle Cardenas
- Coagulation and Blood Research Task Area US Army Institute of Surgical Research, Fort Sam Houston, Texas, USA
| | | | - Justin Ferdin
- Coagulation and Blood Research Task Area US Army Institute of Surgical Research, Fort Sam Houston, Texas, USA
| | - Ute Gravemann
- German Red Cross Blood Service NSTOB, Springe, Germany
| | - Patrick Ketter
- Coagulation and Blood Research Task Area US Army Institute of Surgical Research, Fort Sam Houston, Texas, USA
| | | | - Thea Lu
- Cerus Corporation, Concord, California, USA
| | - Truscha Niekerk
- South African National Blood Service, Roodepoort, South Africa
| | - Joel Parker
- Coagulation and Blood Research Task Area US Army Institute of Surgical Research, Fort Sam Houston, Texas, USA
| | - Claudia Renke
- Austrian Red Cross, Blood Centre Linz, Linz, Austria
| | - Axel Seltsam
- Bavarian Red Cross Blood Service, Nuremberg, Germany
| | | | | | - Tanja Vollmer
- Institut für Laboratoriums- und Transfusionsmedizin, Herz- und Diabeteszentrum NRW, Universitätsklinikum der Ruhr-Universität Bochum, Bad Oeynhausen, Germany
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Carius BM, Bebarta GE, April MD, Fisher AD, Rizzo J, Ketter P, Wenke JC, Salinas J, Bebarta VS, Schauer SG. A Retrospective Analysis of Combat Injury Patterns and Prehospital Interventions Associated with the Development of Sepsis. PREHOSP EMERG CARE 2023; 27:18-23. [PMID: 34731068 DOI: 10.1080/10903127.2021.2001612] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND Combat injury related wound infections are common. Untreated, these wound infections may progress to sepsis and septic shock leading to increased morbidity and mortality rates. Understanding infectious complications, patterns, progression, and correlated prehospital interventions are vital to understand the development of sepsis. We aim to analyze demographics, injury patterns, and interventions associated with sepsis in battlefield settings. MATERIALS AND METHODS This is a secondary analysis of previously published data from the Department of Defense Trauma Registry (DoDTR) from 2007 to 2020. We searched for casualties diagnosed with sepsis (excluding line-sepsis) throughout their initial hospitalization. Regression models were used to seek associations. RESULTS Our initial request yielded 28,950 encounters, of which 25,654 (88.6%) were adults that met inclusion, including 243 patients (0.9%) diagnosed with sepsis. Patients included US military (34%), non-North Atlantic Treaty Organization (NATO) military (33%) and humanitarian (30%) groups. Patients diagnosed with sepsis had a significantly lower survival rate than non-septic patients (78.1% vs. 95.7%, p < 0.001). There was no significant difference in administration of prehospital antibiotics between septic and the general populations (10.6% vs. 12.3%, p = 0.395). Prehospital intraosseous access (OR 1.56, 95% CI 1.27-1.91, p = 0.207) and packed red cell administration (1.63, 1.24-2.15, 0.029) were the interventions most associated with sepsis. CONCLUSIONS Sepsis occurred infrequently in the DoDTR when evacuation from battlefield is not delayed, but despite increased intervention frequency, developing sepsis demonstrates a significant drop in survival rates. Future research would benefit from the development of risk mitigation measures.
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Affiliation(s)
| | | | - Michael D April
- Department of Military and Emergency Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA.,40th Forward Resuscitation and Surgical Detachment, Fort Carson, Colorado, USA
| | - Andrew D Fisher
- Department of Surgery, University of New Mexico School of Medicine, Albuquerque, New Mexico, USA.,Medical Command, Texas Army National Guard, Austin, Texas, USA
| | - Julie Rizzo
- Madigan Army Medical Center, Joint Base Lewis McChord, Washington, USA.,US Army Institute of Surgical Research, JBSA Fort Sam Houston, Texas, USA
| | - Patrick Ketter
- US Army Institute of Surgical Research, JBSA Fort Sam Houston, Texas, USA
| | - Joseph C Wenke
- US Army Institute of Surgical Research, JBSA Fort Sam Houston, Texas, USA
| | - Jose Salinas
- US Army Institute of Surgical Research, JBSA Fort Sam Houston, Texas, USA
| | - Vikhyat S Bebarta
- Center for COMBAT Research, Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | - Steven G Schauer
- Department of Military and Emergency Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA.,US Army Institute of Surgical Research, JBSA Fort Sam Houston, Texas, USA.,Brooke Army Medical Center, JBSA Fort Sam Houston, Texas, USA
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Ketter P, Yu JJ, Cap AP, Forsthuber T, Arulanandam B. Pentraxin 3: an immune modulator of infection and useful marker for disease severity assessment in sepsis. Expert Rev Clin Immunol 2016; 12:501-7. [PMID: 26982005 DOI: 10.1586/1744666x.2016.1166957] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
The acute phase protein pentraxin 3 (PTX3) is a pattern recognition receptor involved in regulation of the host immune response. This relatively newly discovered member of the pentraxin superfamily elicits both immunostimulatory and immunoregulatory functions preventing autoimmune pathology and orchestrated clearance of pathogens through opsonization of damage- and pathogen-associated molecular patterns (DAMP/PAMP). Thus, PTX3 has been described as a possible evolutionary precursor to immunoglobulins. While shown to provide protection against specific bacterial and fungal pathogens, persistent elevation of PTX3 levels following initial onset of infection appear to predict poor patient outcome and may contribute to disease sequelae such as tissue damage and coagulopathy. Measurement of PTX3 following onset of sepsis may improve patient risk assessment and thus be useful in guiding subsequent therapeutic interventions including steroidal anti-inflammatory and altered antibiotic therapies. In this review, we summarize the role of PTX3 in inflammatory syndromes and its utility as a marker of sepsis disease severity.
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Affiliation(s)
- Patrick Ketter
- a Blood and Coagulation Program , United States Army Institute of Surgical Research , JBSA-Fort Sam Houston , TX , USA
| | - Jieh-Juen Yu
- b Department of Biology , University of Texas at San Antonio , San Antonio , TX , USA
| | - Andrew P Cap
- a Blood and Coagulation Program , United States Army Institute of Surgical Research , JBSA-Fort Sam Houston , TX , USA
| | - Thomas Forsthuber
- b Department of Biology , University of Texas at San Antonio , San Antonio , TX , USA
| | - Bernard Arulanandam
- b Department of Biology , University of Texas at San Antonio , San Antonio , TX , USA
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