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Bacterial contamination in postmortem bone donors
Stephan Vehmeyer1, Julius Wolkenfelt, Ruud Deijkers
1Netherlands Bone Bank Foundation, Leiden. info@vehmeijer.nl
Abstract:
We analyzed factors influencing the contamination rate of allografts and blood samples obtained from postmortem bone donors. 5,710 allografts were harvested, from 550 donors of which 3,164 (55%) were swab culture negative. Blood cultures were positive in 140 donors (26%). The risk of graft contamination increased with each extra team member (Odds Ratio 1.9). It was also higher with organisms of greater virulence in donors with a positive blood culture (OR 3.5). The risk of blood contamination increased per hour postmortem (OR 1.1) and the same increase was seen with organisms of high virulence. In donors with multiple trauma, the risk of blood contamination with organisms of high virulence was greater (OR 8.2), but smaller in donors with preceding organ procurement (OR 0.1). To minimize the bacterial load, donors should be obtained in operating rooms, using aseptic techniques with only a few personnel for procurement. The postmortem time should be kept to a minimum. The procurement cultures from donors with multiple trauma should be carefully interpreted. Blood cultures should be taken into account, since these can help to find contamination not detected by swab cultures.
Insights
Minimizing personnel and postmortem time during bone allograft procurement reduces contamination. Aseptic techniques and careful interpretation of cultures are crucial for safe allograft and blood sample handling.
Area of Science:
- Orthopedic surgery
- Microbiology
- Transplantation science
Background:
- Allograft contamination poses a risk to recipients.
- Understanding factors influencing contamination is vital for improving allograft safety.
- Postmortem bone donors are a critical source for allografts.
Purpose of the Study:
- To identify key factors affecting contamination rates in postmortem bone allografts and associated blood samples.
- To provide evidence-based recommendations for reducing bacterial load during procurement.
Main Methods:
- Analysis of 5,710 allografts from 550 postmortem bone donors.
- Swab and blood cultures were used to assess contamination.
- Statistical analysis, including odds ratios, was employed to determine risk factors.
Main Results:
- 55% of allografts were culture-negative; 26% of blood cultures were positive.
- Increased team size (OR 1.9) and donor postmortem time (OR 1.1) correlated with higher contamination risks.
- High-virulence organisms increased contamination risk in donors with positive blood cultures (OR 3.5) and multiple trauma (OR 8.2).
Conclusions:
- Procurement in operating rooms with aseptic techniques and minimal personnel is recommended.
- Minimizing postmortem interval and carefully interpreting cultures from trauma donors are essential.
- Integrating blood culture results aids in detecting undetected contamination.
