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Sepsis from an apheresis platelet contaminated with Acinetobacter calcoaceticus/baumannii complex bacteria and
Joy L Fridey1, Susan L Stramer2, Ashok Nambiar3
1Southern California Region, American Red Cross, Pomona, California, USA.
Background:
Strategies to reduce platelet (PLT) bacterial contamination include donor screening, skin disinfection, sample diversion, bacterial culture, pathogen reduction (PR), and day-of-transfusion tests. We report bacterial sepsis following a pathogen-reduced PLT transfusion.
Case Report:
An adult male with relapsed acute lymphoblastic leukemia was successfully treated for central catheter-associated Staphylococcus aureus bacteremia. A peripherally inserted central catheter (PICC) was placed. Chills, rigors, and flushing developed immediately after PICC-infused pathogen-reduced PLTs, progressing to septic shock requiring intensive care management.
Methods:
PICC and peripheral blood (PB), transfused bag saline flushes (TBFs), environmental samples, and the pathogen-reduced untransfused co-component (CC) were cultured. Plasma metagenomic and bacterial isolate whole-genome sequencing; PLT mitochondrial DNA (mtDNA) testing of untransfused CC and TBF; CC testing for amotosalen (S-59)/S-59 photoproducts; isolate PR studies (INTERCEPT); and TBF polymerase chain reaction for recipient Y-chromosome DNA were performed.
Results:
PB and PICC cultures grew Acinetobacter calcoaceticus/baumannii complex (ACBC). TBF was gram-positive; mass spectrometry identified ACBC and Staphylococcus saprophyticus (SS). CC Gram stain and cultures were negative. Environmental cultures, some done after decontamination, were ACBC/SS negative. Posttransfusion patient plasma and TBF ACBC sequences were genetically identical. No Y-chromosome signal was detected in TBF. S-59 photoproducts and evidence of mtDNA amplification inhibition were found in the CC. Spiking PR studies showed >5.9-log inactivation for both isolates. Donor skin cultures for Acinetobacter were negative.
Conclusion:
CC sterility, PR studies, residual S-59 photoproducts, and mtDNA amplification inhibition suggest successful PR. Unidentified environmental sources and inherent or acquired bag defects may have contributed to postmanufacturing pathogen-reduced PLT contamination.
Insights
Pathogen-reduced platelet (PLT) transfusions can still cause bacterial sepsis. This case highlights potential contamination from bag defects or environmental sources, despite successful pathogen reduction procedures.
Area of Science:
- Hematology
- Infectious Diseases
- Transfusion Medicine
Background:
- Bacterial contamination of platelet (PLT) transfusions is a significant risk.
- Existing strategies to mitigate contamination include donor screening, skin disinfection, sample diversion, bacterial culture, pathogen reduction (PR), and day-of-transfusion tests.
Observation:
- A patient with relapsed acute lymphoblastic leukemia developed septic shock following a transfusion of pathogen-reduced PLTs.
- Cultures identified Acinetobacter calcoaceticus/baumannii complex (ACBC) and Staphylococcus saprophyticus (SS) in transfused bag saline flushes (TBFs).
- Genetic sequencing confirmed the ACBC in TBFs was identical to that found in the patient's post-transfusion plasma.
Findings:
- Pathogen reduction (PR) studies indicated successful inactivation of bacterial isolates.
- Residual amotosalen (S-59) photoproducts and mitochondrial DNA (mtDNA) amplification inhibition were detected in the co-component.
- Despite negative donor skin cultures and environmental sampling post-decontamination, contamination was suspected.
Implications:
- This case suggests that even with effective pathogen reduction, contamination of PLTs can occur.
- Potential sources include inherent or acquired defects in PLT bags or unidentified environmental factors.
- Further investigation into postmanufacturing contamination pathways is warranted to enhance transfusion safety.
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