Evolution of surveillance methods for detection of bacterial contamination of platelets in a university hospital, 1991 through 2004
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Published on: August 24, 2015
Roslyn A Yomtovian1, Elizabeth L Palavecino, Alden H Dysktra
1Department of Pathology and the Comprehensive Cancer Center, Case Western Reserve University, University Hospitals of Cleveland, Cleveland, Ohio 44106, USA.
Insights
Platelet bacterial contamination (PBC) is a common transfusion risk. Active surveillance identified numerous PBC cases, highlighting the need for improved detection methods to enhance platelet transfusion safety.
Area of Science:
- Hematology
- Transfusion Medicine
- Infectious Disease
Background:
- Platelet (PLT) bacterial contamination (PBC) represents the most frequent infection transmitted via transfusion.
- Understanding the efficacy of interventions is crucial for mitigating transfusion-associated infections.
Purpose of the Study:
- To evaluate the effectiveness of prospective (active) and passive surveillance methods in detecting platelet bacterial contamination.
- To assess the impact of contamination on transfusion recipients.
Main Methods:
- Prospective (active) surveillance over 10 years, including bacterial culture, Gram stain, and pH measurements of platelets.
- Passive surveillance triggered by transfusion reactions.
- Early (24-hour) culture of single-donor plateletpheresis (SDP) units.
Main Results:
- Active surveillance detected 38 instances of PBC, primarily in random-donor platelet units.
- Coagulase-negative staphylococci were the most common contaminants.
- Transfusion reactions occurred in 41% of recipients, with 9% mortality.
- pH testing and 24-hour SDP culture showed limitations in detection.
Conclusions:
- Current active surveillance methods for PBC require improvement to enhance the safety of platelet transfusions.
- There is a critical need for more sensitive and effective strategies to detect bacterial contamination in platelets before transfusion.
Background:
Platelet (PLT) bacterial contamination (PBC) is the most common transfusion-associated infection. It is important to understand the impact of interventions addressing this problem.
Study Design And Methods:
PBC was studied by prospective (active) and transfusion-reaction triggered (passive) surveillance from July 1991 to December 2004. Active surveillance, utilized for 10 years, included bacterial culture of all or 4- and 5-day-old PLTs at issue and intermittent use of Gram stain, pH measurements, and early (24-hr) culture of single-donor plateletpheresis (SDP) units.
Results:
Active surveillance detected 38 instances of PBC, 7 in SDP units (1:2213) and 31 in random-donor PLT units (1:2090 units, p = 0.89; or 1:418 pools of 5 units, p < 0.001). Contaminants were coagulase-negative staphylococci (CONS; n = 27), Staphylococcus aureus (4), Bacillus cereus (1), Serratia marcescens (2), streptococci (2 S. bovis, 1 S. uberis), and CONS with viridans group streptococcus (1). Only one instance of contamination, caused by Pseudomonas aeruginosa, was detected by passive surveillance, with fatal outcome. Colony counts of contaminants ranged from 0.5 x 10(2) to 4 x 10(11) colony-forming units per mL at time of issue. PBC was interdicted before transfusion in 6 cases through Gram stain screening. Transfusion reactions occurred in 13 of 32 recipients (41%), with 9 severe reactions (28%) and 3 deaths (9%). pH testing failed to detect 5 contaminated units and resulted in discard of nearly 2 percent of units, whereas culture of SDP units at 24 hours failed to identify a contaminated unit.
Conclusion:
Improved active surveillance methods for detecting PBC are needed to improve the safety of PLT transfusions.
