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- Title
Sepsis from an apheresis platelet contaminated with Acinetobacter calcoaceticus/baumannii complex bacteria and Staphylococcus saprophyticus after pathogen reduction.
- Authors
Fridey, Joy L.; Stramer, Susan L.; Nambiar, Ashok; Moayeri, Morvarid; Bakkour, Sonia; Langelier, Charles; Crawford, Emily; Lu, Thea; Lanteri, Marion C.; Kamm, Jack; Miller, Steve; Wagner, Stephen J.; Benjamin, Richard J.; Busch, Michael P.
- Abstract
<bold>Background: </bold>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.<bold>Case Report: </bold>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.<bold>Methods: </bold>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.<bold>Results: </bold>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.<bold>Conclusion: </bold>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.
- Subjects
ACINETOBACTER baumannii; PERIPHERALLY inserted central catheters; ACINETOBACTER; STAPHYLOCOCCUS; SEPSIS; BACTERIAL contamination; BLOOD transfusion reaction; GRAM-negative aerobic bacteria; BLOOD platelet transfusion; BACTERIAL diseases; PLATELETPHERESIS
- Publication
Transfusion, 2020, Vol 60, Issue 9, p1960
- ISSN
0041-1132
- Publication type
journal article
- DOI
10.1111/trf.15951