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- Title
Fatal false-negative transfusion infection involving a buffy coat platelet pool contaminated with biofilm-positive Staphylococcus epidermidis: a case report.
- Authors
Kou, Yuntong; Pagotto, Franco; Hannach, Barbara; Ramirez ‐ Arcos, Sandra
- Abstract
<bold>Background: </bold>Bacterial 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.<bold>Case Report: </bold>In 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.<bold>Discussion: </bold>At Canadian Blood Services, PCs are screened for bacterial contamination with the BacT/ALERT system (bioMérieux) 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.<bold>Conclusion: </bold>Despite 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.
- Subjects
BUFFY coat; BLOOD transfusion reaction; BIOFILMS; BACTERIAL contamination; BLOOD platelets; STAPHYLOCOCCUS epidermidis; STAPHYLOCOCCUS; STAPHYLOCOCCAL diseases; TREATMENT of chronic myeloid leukemia; BLOOD cells; BLOOD platelet transfusion; DISEASE complications; TREATMENT effectiveness; PHYSIOLOGY; INFECTIOUS disease transmission
- Publication
Transfusion, 2015, Vol 55, Issue 10, p2384
- ISSN
0041-1132
- Publication type
journal article
- DOI
10.1111/trf.13154