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Published on: August 24, 2015
Relationship between bacterial load, species virulence, and transfusion reaction with transfusion of bacterially
Michael R Jacobs1, Caryn E Good, Hillard M Lazarus
1Department of Pathology, Case Western Reserve University School of Medicine and University Hospitals Case Medical Center, Cleveland, Ohio, USA. mrj6@cwru.edu
Background:
Bacterial contamination is currently the major infectious hazard of platelet transfusion, but associations between bacterial species and quantity and transfusion reactions have not been characterized.
Methods:
Patients receiving platelets from July 1991 through December 2006 were observed using active surveillance by quantitative culture of platelets at the time of issue or passive surveillance by investigation of clinical reactions in patients and culture of implicated units. Patient reactions were classified by type and severity and were correlated with bacterial species and number. Endotoxin content of gram-negative contaminants was determined by limulus lysate assay.
Results:
Fifty-two bacterially contaminated platelet units were detected (50 by active and 2 by passive surveillance). Rates of bacterial contamination and septic transfusion reactions were 32.0-fold and 10.6-fold higher, respectively, as determined by active versus passive surveillance (P < .001). Including 2 index cases, bacterial contaminants included gram-negative bacilli in 4 units (3 of which were associated with fatal reactions), staphylococci in 44 units, streptococci in 4 units, and Bacillus cereus in 2 units. Endotoxin content of the 4 units that were contaminated with gram-negative bacilli ranged from 11,373 to 173,130 endotoxin units. Reaction severity was greater for units with bacterial counts of > or =10(5) colony-forming units/mL and higher bacterial virulence. A detection method with a 10(3) colony-forming units/mL threshold would detect >90% of contaminants.
Conclusions:
Active surveillance detected 32-fold more bacterially contaminated platelet units and 10.6-fold more septic reactions than did passive surveillance, and virulent species and bacterial counts of > or =10(5) colony-forming units/mL were associated with more-severe transfusion reactions. Improved detection methods or use of pathogen inactivation technology are needed to eliminate this problem.
Insights
Active surveillance significantly increases detection of bacterial contamination in platelet transfusions, revealing higher rates of septic reactions. Higher bacterial counts and virulent species correlate with more severe transfusion reactions.
Area of Science:
- Transfusion Medicine
- Infectious Diseases
- Microbiology
Background:
- Bacterial contamination poses a significant infectious risk in platelet transfusions.
- Previous studies lacked detailed characterization of bacterial species and quantity in relation to transfusion reactions.
Purpose of the Study:
- To characterize bacterial species and quantify bacterial loads in platelet units.
- To determine the association between bacterial contamination and the incidence and severity of transfusion reactions.
Main Methods:
- Utilized active surveillance (quantitative culture of platelets) and passive surveillance (investigation of clinical reactions).
- Classified patient reactions by type and severity, correlating them with bacterial species and counts.
- Assessed endotoxin content of gram-negative contaminants using limulus lysate assay.
Main Results:
- Active surveillance identified 32.0-fold more contaminated units and 10.6-fold more septic reactions than passive surveillance.
- Gram-negative bacilli, staphylococci, streptococci, and Bacillus cereus were identified contaminants.
- Higher bacterial counts (> or =10(5) CFU/mL) and virulent species were linked to more severe reactions, including fatal outcomes with gram-negative bacilli.
Conclusions:
- Active surveillance is superior for detecting bacterial contamination and septic reactions in platelet transfusions.
- Bacterial load and species virulence are critical factors influencing transfusion reaction severity.
- Enhanced detection methods or pathogen inactivation technologies are crucial for mitigating transfusion-transmitted bacterial infections.
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