Transfusion-associated Bacterial Sepsis Research Articles

Is your blood bag safe for transfusion? Bacterial screening of donor blood and its components: An essential infection control tool for safe transfusion practice

Introduction: Transfusion-associated bacterial sepsis is still a major public health concern that has received little attention. Data on bacterial contamination of blood are scarce, despite rising demand for blood transfusions. Blood bags intended for transfusion should be free of microorganisms. Aim: The aim of the study was to assess the prevalence, identify the microorganisms involved in bacterial contamination of donor blood and blood components and determine blood products most likely to be contaminated, received in microbiology laboratory for sterility testing. Settings and Design: The study was carried out in the department of microbiology in association with the transfusion medicine department of tertiary care hospital in Western Uttar Pradesh from January 2023 to June 2023. Methodology: A total of 87 cellular blood components were tested aerobically for bacterial contamination using the BD BACTEC™ FX 40 automated culture system. For incubation, culture vials that showed positive signals were subcultured onto a set of solid media followed by bacterial identification and antimicrobial susceptibility testing. Results: The overall prevalence rate was 14.9% (whole blood 18.75%, platelets 14.2%, packed cells 13.3% and fresh frozen plasma 10.5%). The contaminants were Aeromonas hydrophila, Sphingomonas paucimobilis, Escherichia coli, Coagulase-negative Staphylococcus spp., Pseudomonas aeruginosa, Delftia acidovorans, and Candida albicans. Discussion: The bacterial contamination in blood products suggests the patient who receives blood products is at risk of developing infection. Implementing proper blood transfusion policies, donor screening and technical staff training will all help to reduce the contamination rate of blood and blood components. Conclusion: Bacterial contamination of blood bags indicates a potential risk of healthcare-associated infection. Microbiological Sterility testing for donor blood bags in blood banks should be used as mandatory infection control Tool for Quality assurance.

Hemovigilance data: An effective approach for evaluating bacterial protection systems for platelet transfusions.

Septic transfusion reactions due to bacterial contamination in platelet concentrates (PCs) are continually reported to hemovigilance (HV) programs. Worldwide, blood centers use different systems to avoid transfusion-associated bacterial sepsis in PCs. Herein, national HV data were gathered to compare bacterial protection systems and to assess the risk of bacterial contamination. HV data with definite transfusion-associated bacterial sepsis in PCs were obtained from Australia, Canada, the United Kingdom (U. K.), and Switzerland between 2006 and 2016. These data were reviewed to evaluate bacterial protection systems including early small-volume (ESV), early large-volume (ELV), and delayed large-volume (DLV) bacterial culture screening and pathogen inactivation (PI) treatment. Implementation of DLV bacterial culture screening in the U. K. and PI treatment in Switzerland resulted in significant reductions (P < 0.05) in transfusion-associated bacterial sepsis for the period of 2011-2016 compared to the prior 4 years (2006-2010). Approximately 1.86 million DLV bacterial culture-screened PCs and 0.21 million PI-treated PCs were issued with no reported septic fatalities nor cases of life-threatening sepsis. In Australia, two life-threatening septic transfusion reactions (1.923 per million) were reported out of almost 1.04 million ELV bacterial culture-screened PCs, and no septic fatalities were reported. Meanwhile, in Canada, four life-threatening septic transfusion reactions (3.6/million) and one fatality (0.9/million) were observed in about 1.11 million ESV bacterial culture-screened PCs. DLV bacterial culture and PI treatment significantly reduced the incidence of septic reactions. The advantages and disadvantages of both systems merit further investigation before implementation.

Bacterial Contamination of Stored Blood Ready for Transfusion at a Referral Hospital in Ethiopia

Background: After the discovery of Human Immuno -deficiency virus, screening of blood donors practically reduced viral pathogens. However, transfusion associated bacterial sepsis, which causes high mortality and morbidity remain an important public health concern, has been received very little attention in the African set up including Ethiopia. Objective: The aim of this study was to determine the prevalence of bacterial contamination of blood and their antibiotic susceptibility pattern at Debre Markos referal hospital, North West Ethiopia. Methods: A facility based cross-sectional study was conducted using randomly sampled 120 whole blood units. The blood samples were obtained from screened, stored whole blood. All laboratory activities were carried out as Clinical and Laboratory Standards Institute (CLSI) protocol. Data were entered and analyzed using SPSS version 16 software. P<0.005 is statistically significant. Results: The prevalence of bacterial contamination among stored blood was 12.5%. Gram positive bacteria (S. pneumonia, S. auraus, coagulase-negative Staphylococcus, viridian streptococcus) and gram negative (S. typhi, E. coli and K. pneumonia) were the common isolates identified. The isolated bacterial organisms showed varying susceptibility to the antibiotics tested. All isolated gram positive organisms were resistance to Tetracycline and susceptible to Ceftriaxone. Similarly, all the gram negative organisms isolated were resistance to Cotrimoxazole and susceptible to Ciprofloxacin and Cefoxicitin Conclusion: In our study, we conclude the existence of this serious clinical issue (contamination of blood, development of drug resistance) and need for further surveillance and/or study.

Bacterial Contamination of Blood and Blood Products at Mbarara Regional Blood Bank in Rural South Western Uganda

Background: Screening blood donors has practically eliminated viral and bacterial pathogens in blood used for transfusion. However, transfusion-associated bacterial sepsis remains an important health-care concern and the commonest cause of transfusion-related fatality in resource limited settings. Data on bacterial contamination of blood are scarce while the demand of blood transfusion is continuously growing. Therefore we conducted a study to determine the prevalence and type of bacterial contamination in donor blood and blood products, at the Mbarara Regional Blood Bank. Methodology: A total of 510 units of screened blood and blood products consisting of refrigerated whole blood and packed cells were randomly sampled following aseptic procedures from Mbarara Regional Blood Bank. Two samples from each unit were collected in universal containers containing Brain Heart Infusion Broth and incubated at 37℃ for up to 7 days. Subcultures were carried out on Blood agar, Chocolate agar and MacConkey agar. Isolates were identified by standard microbiologic techniques and drug susceptibility testing was performed by Kirby Bauer disc diffusion method. Results: Of the 510 samples collected between June and October 2012, 18 (3.5%) samples showed growth. The contaminants were Staphylococcus aureus 17/18 (94.4%) and Streptococcus viridans 1/18 (5.6%). Isolates were sensitive to erythomycin, ampicillin, chloramphenicol and ciprofloxacin and resistant to penicillin and cloxacillin. Conclusion: Blood and blood products from Mbarara Regional Blood have unacceptable levels of bacterial contamination that can affect patient safety especially in an area with high malaria endemicity. Therefore it is critical to improve hygiene precautions in order to minimize bacterial contamination and ensure patient safety.

Distribution, origin and contamination risk of coagulase-negative staphylococci from platelet concentrates

Transfusion-associated bacterial sepsis is the most common microbiological risk of transfusion and is caused mostly by platelet concentrates (PCs). The most frequently identified bacterial contaminants of PCs are coagulase-negative staphylococci (CNS). In order to learn more about the distribution, source and risk of the CNS that are involved in bacterial contamination of PCs, CNS strains isolated during platelet screening were collected and characterized to the species level with three different methods: 16S rRNA and sodA gene sequencing, matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS) and amplified fragment length polymorphism (AFLP) analysis. AFLP analysis was also used for the typing of the CNS strains. A total of 83 CNS strains were analysed by sequencing and 8 different CNS species were identified, with Staphylococcus epidermidis being the predominant species. MALDI-TOF MS and AFLP analysis confirmed these results to a large extent. However, MALDI_TOF MS could not identify all strains to the species level and AFLP analysis revealed an additional, likely novel, CNS species. The species identified are mainly recognized as being part of the normal skin flora. Typing of the CNS strains by AFLP analysis showed that there was not a unique strain which is significantly more often present during bacterial contamination of PCs.

Bacterial contamination of blood and blood components in a tertiary hospital setting in Nigeria

Active screening of blood donors has practically eliminated viral pathogens during provision of transfusion services; however, transfusion-associated bacterial sepsis remains an important health-care concern. Currently, it is the most frequently reported cause of infectious transfusion-related fatalities. The aim of this study was to determine the prevalence of bacterial contamination in donor blood and/or blood products, and also to identify the isolated microorganism in a semi-urban university teaching hospital setting in Nigeria. The study was carried out at the Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria over a five-month period (May to September 2009). A total of 162 units of screened blood and blood products consisting of 160 (98.7%) refrigerated packed cells/whole blood and two (1.3%) platelet concentrate were randomly sampled following aseptic procedure. Samples were incubated at 370C for up to 7-days in Brain Heart Infusion growth medium. The identities of the isolated organisms were determined following standard microbiologic techniques. The resistance pattern of isolates to selected antimicrobial agents was also determined by the disc diffusion method. Overall prevalence of bacterial contamination in donated blood bank refrigerated blood is 8.8%. The organisms isolated were Gram-positive, namely, Staphylococcus aureus,coagulase negative staphylococcus, Bacillus sp,and Listeria sp. Resistance of the organisms to the antibiotics ranged from 29% to 100%. Bacterial contamination of blood and blood components for transfusion is common in Nigeria and it is a potential risk for hospital acquired infection. Key Words: bacterial contaminants, hospital-acquired infection, blood/blood components.

A noninvasive near infrared system for detection of platelet components contaminated with bacteria

Platelet (PLT) transfusion-associated bacterial sepsis has remained a substantial patient risk, primarily due to lacking effective and point-of-issue measures to detect bacterial contamination. This study describes near infrared (NIR) spectroscopy to examine inoculated PLTs without sampling within a few seconds. This study evaluated apheresis PLTs inoculated with low concentrations of Bacillus cereus and Staphylococcus epidermidis, comparing with sterile bags. Short-wavelength NIR spectra over the range from 700 to 1100 nm in the transmittance mode were obtained using research (NIRS6500, Foss NIRSystems) and portable (NIRGun, Shizuoka Shibuya Seiki) instruments at 6-hour intervals from 0 to 72 hours after inoculation (HAI). The sensitivity of the NIRS6500 was 100% (43/43) and 98% (50/51) after incubating PLTs inoculated with B. cereus for 42 HAI or more and with S. epidermidis for 54 HAI or more, respectively. Difference spectra calculated by subtracting the NIR spectra of stored PLTs with that of the same PLTs measured at 0 HAI improved the discrimination results compared with conventional second derivative spectra. The NIRS6500 system can provide a PLT monitoring system based on difference spectra. The chemical components of PLTs that were influenced by bacterial metabolism seemed to play an important role in the calibration structure. Further studies should examine samples spiked with various species of prevalent bacteria.

Incidence of bacterial transmission and transfusion reactions by blood components

Successful reduction of the risk of viral transmission via blood components has focused attention on the risk of transfusion-associated bacterial sepsis. The incidence of transfusion reactions due to bacteria is currently estimated at between 1 per 100,000 and 1 per 1,000,000 units in the case of packed red blood cells and between 1 per 900 and 1 per 100,000 units in the case of platelet concentrates. For autologous transfusion, only isolated case reports are available which do not permit a quantitative risk assessment. No reliable data on the risk of morbidity and mortality due to transfusion-associated bacterial infection are available for Germany at present. As platelet concentrates provide more favourable conditions for bacterial growth by virtue of being stored at room temperature, these blood components are thought to bear a considerably greater risk of bacterial contamination than red blood cells. The rate of contamination of platelet concentrates is cited at between 0.02% and 1.2%, depending on the production and bacterial culture techniques used, whereas the rate for packed red blood cells is between 0.1% and 0.2%. Risk reduction strategies include careful selection of blood donors, optimisation of donation and production techniques, and detection of bacteria in samples of blood components prior to transfusion. Also of importance for patient safety are quality assurance measures in the preparation for transfusion, in measures of patient monitoring, and investigation of transfusion reactions.

Bacterial contamination of random‐donor platelets in a university hospital in the midwestern region of Brazil

Bacterial blood contamination was probably the first recognized transfusion-transmitted disease. Although the transfusion-associated bacterial sepsis has been known for a long time, it remains an important health problem. At present it is the most frequently reported cause of infectious transfusion-related fatalities. The aims of the study were to determine the prevalence of microbiologic contamination in random-donor platelets (RDPs) and to identify the isolated microorganism obtained from a Brazilian university hemotherapy service. A total of 2000 RDPs were analyzed from November 2004 to June 2005. The time of storage of the platelet (PLT) concentrates studied ranged from the day of donation (Day 0) to the fifth day of storage (Day 5). The RDP cultures were initially performed in pools with bottles containing brain heart infusion (BHI) growth medium, and cultures were incubated aerobically at 37 degrees C for up to 7 days and subcultured onto chocolate agar at 37 degrees C for 48 hours under conditions of microaerophilia. In the cases of positivity of one pool, the culture was individually performed for all the samples of that pool. Eight units (0.4%; 95% confidence interval, 0.31-0.49) were found to be contaminated. Isolated microorganisms were three Acinetobacter lwoffii, one Enterobacter intermedium, one Serratia phymuthica, one Staphylococcus haemolyticus, one Staphylococcus hominis, and one Bacillus sp. PLT concentrates were contaminated with bacteria in 0.4 percent of tested units, which represents a potential risk to patients and a public health problem. Regarding the contaminant microorganisms, a predominance of Gram-negative agents was observed (62.5%).

Bacterial contamination of blood components – incidence and significance for homologous and autologous transfusion Bakterielle Kontamination von Blutkomponenten – Inzidenz und Signifikanz für die allogene und autologe Transfusion

Abstract Successful reduction of the risk of viral transmission via blood components has emphasized the risk of transfusion-associated bacterial sepsis. The incidence of transfusion reactions due to bacteria is currently estimated to be between 1:100,000 and 1:1,000,000 units in the case of packed red blood cells and between 1:900 and 1:100,000 units in the case of platelet concentrates. For autologous transfusion, only isolated case reports are available which do not permit a quantitative risk assessment. At present, no reliable data on the risk of morbidity and mortality due to transfusion-associated bacterial infection are available for Germany. Since platelet concentrates, stored at room temperature, provide more favorable conditions for bacterial growth, these blood components are thought to bear a considerably greater risk of bacterial contamination than red blood cells. The rate of contamination of platelet concentrates is cited to be between 0.02 and 1.2%, depending on the production and bacterial culture techniques used, whereas the rate for packed red blood cells is between 0.1 and 0.2%. Risk reduction strategies include careful selection of blood donors, optimization of donation and production techniques, and detection of bacteria in samples of blood components prior to transfusion. Also important for patient safety are quality assurance measures in the preparation for transfusion, patient monitoring, and investigation of transfusion reactions.

Transfusion‐transmitted bacterial infection: risks, sources and interventions

Records of the transmission of bacterial infections by transfusion date back to the beginning of organized blood banking. Despite tremendous strides in preventing viral infection through careful donor screening and viral testing, there has been little improvement in reducing the risk of bacterial sepsis since the introduction of closed collection systems. Based on the French Haemovigilance study, the British Serious Hazards of Transmission (SHOT) study and fatality reports to the United States Food and Drug Administration, the risk of clinically apparent sepsis exceeds the risk of HIV, HBV, and HCV transmission. Sources of contamination include the skin, blood, disposables, and the environment. Potential interventions to reduce transfusion-associated bacterial sepsis include improvements to donor arm preparation, diversion of the first aliquot of whole blood, introduction of bacterial testing and/or implementation of pathogen reduction methods.

Transfusion-transmitted bacterial infection: risks, sources and interventions.

Records of the transmission of bacterial infections by transfusion date back to the beginning of organized blood banking. Despite tremendous strides in preventing viral infection through careful donor screening and viral testing, there has been little improvement in reducing the risk of bacterial sepsis since the introduction of closed collection systems. Based on the French Haemovigilance study, the British Serious Hazards of Transmission (SHOT) study and fatality reports to the United States Food and Drug Administration, the risk of clinically apparent sepsis exceeds the risk of HIV, HBV, and HCV transmission. Sources of contamination include the skin, blood, disposables, and the environment. Potential interventions to reduce transfusion-associated bacterial sepsis include improvements to donor arm preparation, diversion of the first aliquot of whole blood, introduction of bacterial testing and/or implementation of pathogen reduction methods.

Transfusion-related bacterial sepsis.

Transfusion-associated bacterial sepsis is a persistent problem in transfusion medicine, posing a greater threat than the combined risks of receiving a blood product contaminated with HIV-1 or 2, hepatitis C virus (HCV), hepatitis B virus (HBV), and human T-cell lymphtrophic virus (HTVL) -I or -II. This article provides a brief overview of the current incidence, clinical presentation, associated blood products and organisms, and the most feasible and effective methods available to reduce the potential risk of transfusion-associated sepsis. Because bacterial contamination of blood products is the most frequent cause of transfusion-transmitted infectious disease, and as no single existing strategy can completely eliminate its risk, it is important that clinical suspicion be high, and any partial solutions additively be implemented.

Difficultés diagnostiques des incidents transfusionnels par contamination bactérienne à propos de deux observations

The French hemovigilance system has recently underlined the relative frequency of transfusion-associated bacterial sepsis and the necessity to remain constantly aware of this eventuality. We describe the experience of a hematology unit over a 18-month period: 189 acute transfusion reactions were registered and bacterial cultures of the implicated cellular blood products realized in 82 of them. A positive result was obtained in two cases. For both cases, clinical symptoms of transfusion reaction were limited to a lasting fever, and a skin rash occurred in aplastic patients with preexisting signs of sepsis. The causal relationship between this contamination and the transfusion reaction is difficult to establish. Clinical manifestations justifying a bacterial inquiry must therefore be more precisely defined, particularly in multitransfused patients.

Transfusion-associated bacterial sepsis: a concise review

Transfusion-associated bacterial sepsis: a concise review

A retrospective analysis of microbial contaminants in outdated random-donor platelets from multiple sites.

Platelet components contaminated with bacteria are an important source of transfusion-associated bacterial sepsis. Estimates of contamination rates vary widely (0-10%) and are highly controversial. The present study, designed with stringent testing regimens, retrospectively determined the prevalence of microbial contaminants in platelets from four collection regions. During a 9-month period, outdated platelet units were assayed by spreading aliquots from the unit, and from thioglycollate broth medium inoculated with part of the unit, onto 5-percent sheep blood agar media. Cultures were examined after 72-hour incubation at 37 degrees C, and, if bacterial growth was present, the assay processes were repeated with fresh inocula. Units were considered contaminated only if repeatedly positive. Four (0.08%) of 4995 units sampled were contaminated, two with Corynebacterium sp. and one each with Propionibacterium acnes and Aspergillus terreus. Contaminants were present at low, subclinical levels and were detected only after amplification in thioglycollate. The contaminated units were cultured 1, 2, 3, and 7 days after expiration. Contamination rates were low and did not vary by region. The identification of A. terreus suggests the role that transfusion may play in transmitting fungal infections should be reassessed. The persistent detection of contaminated platelet units supports the need for a test to detect clinically relevant levels of microbial contaminants in blood components.

Blood proteins from transgenic animal bioreactors

T HE TRANSMISSION of viruses by blood transfusion and replacement therapy with human plasma proteins has caused serious concern in recent years, eliciting several changes in the preparation of blood products. The selection of donors, rigorous screening of collected blood, and virucidal procedures introduced in the purification of plasma proteins have nearly eliminated the problems of human immunodeficiency virus and hepatitis B virus transmission, and plasma-derived proteins are generally considered to be safe. ~ Past experiences of plasma fractionators with product safety have made them cautious, as shown by the voluntary withdrawal of intravenous immunoglobulin (IGIV) products in 1994 after reports of hepatitis C transmission in Europe, of albumin and factor VIII (FVIII) concentrates containing a unit of blood from a Creutzfeldt-Jakob disease (CJD)-affected donor, and several intramuscular ilnmunoglobulin products in early 1995. The discussion on the contamination of plasma products by infectious agents that could transmit neurodegenerative diseases like CJD or Gerstmann-Str~iussler-Scheinker disease, on transfusion-associated bacterial sepsis and parasitic Chagas disease is ongoing. The production of recombinant human plasma proteins is considered to be an alternative, which will increase the available amount and safety of product. More important, the lower cost of production will permit its use in prophylaxis or for oral administration. As a result, new treatment regimens, such as the topical application of a~ antitrypsin (a1AT) in psoriasis may become feasible. Indeed, the increasing acceptance of recombinant FVIII (rFVIII) by both clinicians and patients has provided added impetus to the search for new sources of plasma proteins. The widespread use of transgenic animals in basic research, 2 development of human disease models, 3 and genetic improvement of livestock 4 have led to considerable interest in employing genetically engineered animals for the production of therapeutic human proteins, 5,6 as an alternative or a complement to eukaryotic cell culture systems. Human plasma proteins being considered for expression are those commonly used in therapy, such as factor IX (FIX), 7,8 FVIII, 9 protein C (PC), 1~ antithrombin III (ATIII) (H. Meade, personal communication, February 1995), as well as serum albumin (HSA) ~2, ~I-AT, 13-14 hemoglobin (Hb),~s and fibrinogen (Velander et al: Unpublished observations, February 1994). In the transgenic approach, synthesis of a recombinant protein is targeted to a selected cell type or organ, enabling the product to be harvested from body fluids like milk, blood, saliva, or urine. Since 1987, numerous proteins with therapeutic potential have been successfully collected by noninvasive methods from transgenic mice or farm animals like rabbits, sheep, pigs, and goats, 16A7 leading to the commercial development of well-established technologies. Questions with respect to transgene inheritance and stability, appropriate posttranslational modifications on heterologous proteins, industrial production procedures, and regulatory affairs have now emerged, as there are limited data published on the long-term effects of foreign protein expression on transgenic animal bioreactor (TAB). In this review, the authors discuss the benefits and limitations of transgenic production of human blood proteins, and express their views on its possible impact on transfusion medicine.

Transfusion-associated bacterial sepsis

The incidence of sepsis caused by transfusion of bacterially contaminated blood components is similar to or less than that of transfusion-transmitted hepatitis C virus infection, yet significantly exceeds those currently estimated for transfusion-associated human immunodeficiency and hepatitis B viruses. Outcomes are serious and may be fatal. In addition, transfusion of sterile allogenic blood can have generalized immunosuppressive effects on recipients, resulting in increased susceptibility to postoperative infection. This review examines the frequency of occurrence of transfusion-associated sepsis, the organisms implicated, and potential sources of bacteria. Approaches to minimize the frequency of sepsis are discussed, including the benefits and disadvantages of altering the storage conditions for blood. In addition, the impact of high levels of bacteria on the gross characteristics of erythrocyte and platelet concentrates is described. The potentials and limitations of current tests for detecting bacteria in blood are also discussed.