期刊
TRANSFUSION
卷 55, 期 10, 页码 2384-2389出版社
WILEY
DOI: 10.1111/trf.13154
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资金
- Canadian Blood Services
- Health Canada
BACKGROUNDBacterial contamination of platelet concentrates (PCs) poses the major posttransfusion infectious risk in developed countries. The aerobic microorganism most frequently isolated from PCs is coagulase-negative Staphylococcus epidermidis, a normal inhabitant of the human skin, which has been involved in fatal transfusion reactions worldwide. CASE REPORTIn September 2014, a splenectomized elderly male patient, suffering from leukemia, was transfused with two 5-day-old buffy coat platelet (PLT) pools. The patient returned to emergency on the same day with a low-grade fever. He was bacteremic and died on the next day. Microbiology and molecular testing of a blood sample from the patient and one of the PCs yielded the same S. epidermidis strain. Further analysis demonstrated that this S. epidermidis isolate displays a biofilm-positive phenotype in PCs. DISCUSSIONAt Canadian Blood Services, PCs are screened for bacterial contamination with the BacT/ALERT system (bioMerieux) at approximately 24 hours postcollection. The implicated PC had been tested and yielded a false-negative culture result. A titration experiment indicated that, at the time of screening, the contaminated PC had a titer of less than 0.74 colony-forming units (CFU)/mL (<227 CFUs/unit) of S. epidermidis. Mathematical models have predicted that up to 70% of PCs contaminated with coagulase-negative staphylococci at concentrations of 0.02 CFU/mL can be missed by BacT/ALERT screening. CONCLUSIONDespite several mitigation strategies, false-negative cultures with current PLT screening practices still occur. This report creates awareness of the pathogenicity of opportunistic S. epidermidis, a low-virulence organism, in susceptible patients who may not develop a typical transfusion reaction.
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