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A prospective microbiologic surveillance program to detect and prevent the transfusion of bacterially contaminated
R Yomtovian1, H M Lazarus, L T Goodnough
1Department of Pathology, Case Western Reserve University, Cleveland, Ohio.
Abstract:
After two patients received bacterially contaminated platelet transfusions, a prospective surveillance program was instituted to perform Gram staining and microbiologic culturing of platelets at the time of transfusion. In 12 months, 3141 random-donor platelet pools (prepared from 14,481 units) and 2476 single-donor apheresis units were cultured. All single-donor apheresis units were sterile, but 6 (0.19%) of the random-donor pools were found to be bacterially contaminated, with 1 unit of 5 in the pool being the source in each case. Contaminants were Staphylococcus epidermidis (4 cases), Bacillus cereus (1), and Staphylococcus aureus (1) at counts of 0.5 x 10(2) to 10(11) colony-forming units per mL in platelet pools and 10(3) to 10(13) colony-forming units per mL in source units. The contamination rate for units transfused at < or = 4 days (1.8/10,000) was significantly lower than that at 5 days (11.9/10,000; p < 0.05), as was the magnitude of contamination (p < 0.05). Use of the pretransfusion Gram stain on 4- and 5-day-old platelet pools was 100 percent sensitive (4/4 true positives) and 99.93 percent specific (1 false positive) in detecting contaminated pools. These data define the extent and magnitude of platelet bacterial contamination and demonstrate the efficacy of the pretransfusion Gram stain on platelet units stored for 4 and 5 days in preventing the transfusion of heavily contaminated units. It is concluded that the risk of platelet contamination is related to the duration of component storage.(ABSTRACT TRUNCATED AT 250 WORDS)
Insights
Bacterial contamination in platelet transfusions was assessed. Pretransfusion Gram staining effectively detected contaminated platelet pools, especially those stored longer, reducing transfusion risks.
Area of Science:
- Transfusion Medicine
- Microbiology
- Infectious Disease
Background:
- Bacterial contamination of platelet transfusions poses a significant risk to patient safety.
- Previous incidents highlighted the need for improved surveillance of platelet products.
Purpose of the Study:
- To prospectively evaluate the incidence and magnitude of bacterial contamination in platelet components.
- To assess the efficacy of pretransfusion Gram staining in detecting contaminated platelet units.
Main Methods:
- Prospective surveillance involving Gram staining and microbiologic culturing of platelet pools and single-donor apheresis units.
- Analysis of contamination rates based on storage duration (≤4 days vs. 5 days).
- Evaluation of the sensitivity and specificity of Gram staining for detecting bacterial contamination.
Main Results:
- Six of 3141 random-donor platelet pools (0.19%) were bacterially contaminated, primarily by Staphylococcus epidermidis.
- Single-donor apheresis units were consistently sterile.
- Contamination rates and magnitude were significantly higher in platelet pools stored for 5 days compared to those stored for ≤4 days.
- Pretransfusion Gram staining demonstrated 100% sensitivity and 99.93% specificity in detecting contaminated pools.
Conclusions:
- The risk of bacterial contamination in platelet components is associated with the duration of storage.
- Pretransfusion Gram staining is a highly effective method for preventing the transfusion of bacterially contaminated platelet units, particularly those stored for extended periods.