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Bacterial detection in apheresis platelets: blood systems experience with a two‐bottle and one‐bottle culture system

Identifieur interne : 001481 ( Istex/Checkpoint ); précédent : 001480; suivant : 001482

Bacterial detection in apheresis platelets: blood systems experience with a two‐bottle and one‐bottle culture system

Auteurs : RBID : ISTEX:18B480F614845A92A8D5F1A4F7BA944B9F573889

Abstract

BACKGROUND: United Blood Services (UBS) began bacterial testing of platelets (PLTs) using one‐bottle cultures in September 2003. Collection of 7‐day PLTs using two‐bottle cultures began in April 2006. This study compares our experience using both systems. STUDY DESIGN AND METHODS: PLTs from 13 UBS regional centers cultured from September 1, 2003, to September 1, 2007, were included in the analysis. Positive‐signal bottles from a commercially available microbial detection system (BacT/ALERT, bioMérieux) were sent, with corresponding PLTs if available, for confirmatory testing using plate culture media. AABB definitions were used with modifications. RESULTS: A total of 51,265 7‐day PLT collections and 191,521 5‐day PLT collections were tested with bacterial cultures. The overall true‐positive (TP) rate for the two‐bottle system (1:8544) was comparable to the TP rate with the previous one‐bottle system (1:6344). In three of six yield cases, only the anaerobic bottle was positive (two cases of Group D Streptococci, one case of Corynebacterium spp.). The false‐positive (FP) and indeterminate (IND) rates in the anaerobic bottle (1:1767 and 1:1830, respectively) were significantly higher than those in the aerobic bottle (1:6408 and 1:17,088, respectively; p < 0.001). One confirmed transfusion‐related septic reaction, classified as a late TP after investigation, was reported out of 242,786 tested PLT donations. CONCLUSION: The rate of TP cases by the two‐bottle system was not increased over the one‐bottle system, although anaerobic‐bottle‐only positive cases were detected. FP and IND rates were increased in the two‐bottle system, attributable to the anaerobic bottle. Observation of only one documented transfusion‐related septic reaction in 4 years of bacterial screening at UBS is reassuring, although limitations in passive surveillance and higher rates of reactions reported by others indicate the need for continued vigilance.

Url:
DOI: 10.1111/j.1537-2995.2008.01763.x

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<div type="abstract" xml:lang="eng">BACKGROUND: United Blood Services (UBS) began bacterial testing of platelets (PLTs) using one‐bottle cultures in September 2003. Collection of 7‐day PLTs using two‐bottle cultures began in April 2006. This study compares our experience using both systems. STUDY DESIGN AND METHODS: PLTs from 13 UBS regional centers cultured from September 1, 2003, to September 1, 2007, were included in the analysis. Positive‐signal bottles from a commercially available microbial detection system (BacT/ALERT, bioMérieux) were sent, with corresponding PLTs if available, for confirmatory testing using plate culture media. AABB definitions were used with modifications. RESULTS: A total of 51,265 7‐day PLT collections and 191,521 5‐day PLT collections were tested with bacterial cultures. The overall true‐positive (TP) rate for the two‐bottle system (1:8544) was comparable to the TP rate with the previous one‐bottle system (1:6344). In three of six yield cases, only the anaerobic bottle was positive (two cases of Group D Streptococci, one case of Corynebacterium spp.). The false‐positive (FP) and indeterminate (IND) rates in the anaerobic bottle (1:1767 and 1:1830, respectively) were significantly higher than those in the aerobic bottle (1:6408 and 1:17,088, respectively; p < 0.001). One confirmed transfusion‐related septic reaction, classified as a late TP after investigation, was reported out of 242,786 tested PLT donations. CONCLUSION: The rate of TP cases by the two‐bottle system was not increased over the one‐bottle system, although anaerobic‐bottle‐only positive cases were detected. FP and IND rates were increased in the two‐bottle system, attributable to the anaerobic bottle. Observation of only one documented transfusion‐related septic reaction in 4 years of bacterial screening at UBS is reassuring, although limitations in passive surveillance and higher rates of reactions reported by others indicate the need for continued vigilance.</div>
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<abstract>BACKGROUND: United Blood Services (UBS) began bacterial testing of platelets (PLTs) using one‐bottle cultures in September 2003. Collection of 7‐day PLTs using two‐bottle cultures began in April 2006. This study compares our experience using both systems. STUDY DESIGN AND METHODS: PLTs from 13 UBS regional centers cultured from September 1, 2003, to September 1, 2007, were included in the analysis. Positive‐signal bottles from a commercially available microbial detection system (BacT/ALERT, bioMérieux) were sent, with corresponding PLTs if available, for confirmatory testing using plate culture media. AABB definitions were used with modifications. RESULTS: A total of 51,265 7‐day PLT collections and 191,521 5‐day PLT collections were tested with bacterial cultures. The overall true‐positive (TP) rate for the two‐bottle system (1:8544) was comparable to the TP rate with the previous one‐bottle system (1:6344). In three of six yield cases, only the anaerobic bottle was positive (two cases of Group D Streptococci, one case of Corynebacterium spp.). The false‐positive (FP) and indeterminate (IND) rates in the anaerobic bottle (1:1767 and 1:1830, respectively) were significantly higher than those in the aerobic bottle (1:6408 and 1:17,088, respectively; p > 0.001). One confirmed transfusion‐related septic reaction, classified as a late TP after investigation, was reported out of 242,786 tested PLT donations. CONCLUSION: The rate of TP cases by the two‐bottle system was not increased over the one‐bottle system, although anaerobic‐bottle‐only positive cases were detected. FP and IND rates were increased in the two‐bottle system, attributable to the anaerobic bottle. Observation of only one documented transfusion‐related septic reaction in 4 years of bacterial screening at UBS is reassuring, although limitations in passive surveillance and higher rates of reactions reported by others indicate the need for continued vigilance.</abstract>
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<correspondenceTo>Leon Su, 6210 E. Oak Street, Scottsdale, AZ 85257; e‐mail:
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<unparsedEditorialHistory>Received for publication December 23, 2007; revision received February 27, 2008, and accepted March 3, 2008.</unparsedEditorialHistory>
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<title type="main">Bacterial detection in apheresis platelets: blood systems experience with a two‐bottle and one‐bottle culture system</title>
<title type="shortAuthors">SU ET AL.</title>
<title type="short">BACTERIAL DETECTION IN APHERESIS PLTs</title>
</titleGroup>
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<creator creatorRole="author" xml:id="cr1" affiliationRef="#aff-1-1">
<personName>
<givenNames>Leon L.</givenNames>
<familyName>Su</familyName>
</personName>
</creator>
<creator creatorRole="author" xml:id="cr2" affiliationRef="#aff-1-1">
<personName>
<givenNames>Hany</givenNames>
<familyName>Kamel</familyName>
</personName>
</creator>
<creator creatorRole="author" xml:id="cr3" affiliationRef="#aff-1-1">
<personName>
<givenNames>Brian</givenNames>
<familyName>Custer</familyName>
</personName>
</creator>
<creator creatorRole="author" xml:id="cr4" affiliationRef="#aff-1-1">
<personName>
<givenNames>Sandi</givenNames>
<familyName>Vanderpool</familyName>
</personName>
</creator>
<creator creatorRole="author" xml:id="cr5" affiliationRef="#aff-1-1">
<personName>
<givenNames>Dennis</givenNames>
<familyName>Harpool</familyName>
</personName>
</creator>
<creator creatorRole="author" xml:id="cr6" affiliationRef="#aff-1-1">
<personName>
<givenNames>Michael</givenNames>
<familyName>Busch</familyName>
</personName>
</creator>
<creator creatorRole="author" xml:id="cr7" affiliationRef="#aff-1-1">
<personName>
<givenNames>Peter</givenNames>
<familyName>Tomasulo</familyName>
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<unparsedAffiliation>From the United Blood Services and Blood Systems, Scottsdale, Arizona; and Blood Systems Research Institute, San Francisco, California.</unparsedAffiliation>
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<p>
<b>BACKGROUND:</b>
United Blood Services (UBS) began bacterial testing of platelets (PLTs) using one‐bottle cultures in September 2003. Collection of 7‐day PLTs using two‐bottle cultures began in April 2006. This study compares our experience using both systems.</p>
<p>
<b>STUDY DESIGN AND METHODS:</b>
PLTs from 13 UBS regional centers cultured from September 1, 2003, to September 1, 2007, were included in the analysis. Positive‐signal bottles from a commercially available microbial detection system (BacT/ALERT, bioMérieux) were sent, with corresponding PLTs if available, for confirmatory testing using plate culture media. AABB definitions were used with modifications.</p>
<p>
<b>RESULTS:</b>
A total of 51,265 7‐day PLT collections and 191,521 5‐day PLT collections were tested with bacterial cultures. The overall true‐positive (TP) rate for the two‐bottle system (1:8544) was comparable to the TP rate with the previous one‐bottle system (1:6344). In three of six yield cases, only the anaerobic bottle was positive (two cases of Group D
<i>Streptococci</i>
, one case of
<i>Corynebacterium</i>
spp.). The false‐positive (FP) and indeterminate (IND) rates in the anaerobic bottle (1:1767 and 1:1830, respectively) were significantly higher than those in the aerobic bottle (1:6408 and 1:17,088, respectively; p < 0.001). One confirmed transfusion‐related septic reaction, classified as a late TP after investigation, was reported out of 242,786 tested PLT donations.</p>
<p>
<b>CONCLUSION:</b>
The rate of TP cases by the two‐bottle system was not increased over the one‐bottle system, although anaerobic‐bottle‐only positive cases were detected. FP and IND rates were increased in the two‐bottle system, attributable to the anaerobic bottle. Observation of only one documented transfusion‐related septic reaction in 4 years of bacterial screening at UBS is reassuring, although limitations in passive surveillance and higher rates of reactions reported by others indicate the need for continued vigilance.</p>
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<title></title>
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<affiliation>From the United Blood Services and Blood Systems, Scottsdale, Arizona; and Blood Systems Research Institute, San Francisco, California.</affiliation>
<affiliation>Correspondence: Leon Su, 6210 E. Oak Street, Scottsdale, AZ 85257; e‐mail: lsu@bloodsystems.org.</affiliation>
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<affiliation>Correspondence: Leon Su, 6210 E. Oak Street, Scottsdale, AZ 85257; e‐mail: lsu@bloodsystems.org.</affiliation>
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<affiliation>Correspondence: Leon Su, 6210 E. Oak Street, Scottsdale, AZ 85257; e‐mail: lsu@bloodsystems.org.</affiliation>
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<affiliation>From the United Blood Services and Blood Systems, Scottsdale, Arizona; and Blood Systems Research Institute, San Francisco, California.</affiliation>
<affiliation>Correspondence: Leon Su, 6210 E. Oak Street, Scottsdale, AZ 85257; e‐mail: lsu@bloodsystems.org.</affiliation>
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<namePart type="given">Dennis</namePart>
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<affiliation>From the United Blood Services and Blood Systems, Scottsdale, Arizona; and Blood Systems Research Institute, San Francisco, California.</affiliation>
<affiliation>Correspondence: Leon Su, 6210 E. Oak Street, Scottsdale, AZ 85257; e‐mail: lsu@bloodsystems.org.</affiliation>
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<affiliation>Correspondence: Leon Su, 6210 E. Oak Street, Scottsdale, AZ 85257; e‐mail: lsu@bloodsystems.org.</affiliation>
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<affiliation>From the United Blood Services and Blood Systems, Scottsdale, Arizona; and Blood Systems Research Institute, San Francisco, California.</affiliation>
<affiliation>Correspondence: Leon Su, 6210 E. Oak Street, Scottsdale, AZ 85257; e‐mail: lsu@bloodsystems.org.</affiliation>
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<abstract lang="eng">BACKGROUND: United Blood Services (UBS) began bacterial testing of platelets (PLTs) using one‐bottle cultures in September 2003. Collection of 7‐day PLTs using two‐bottle cultures began in April 2006. This study compares our experience using both systems. STUDY DESIGN AND METHODS: PLTs from 13 UBS regional centers cultured from September 1, 2003, to September 1, 2007, were included in the analysis. Positive‐signal bottles from a commercially available microbial detection system (BacT/ALERT, bioMérieux) were sent, with corresponding PLTs if available, for confirmatory testing using plate culture media. AABB definitions were used with modifications. RESULTS: A total of 51,265 7‐day PLT collections and 191,521 5‐day PLT collections were tested with bacterial cultures. The overall true‐positive (TP) rate for the two‐bottle system (1:8544) was comparable to the TP rate with the previous one‐bottle system (1:6344). In three of six yield cases, only the anaerobic bottle was positive (two cases of Group D Streptococci, one case of Corynebacterium spp.). The false‐positive (FP) and indeterminate (IND) rates in the anaerobic bottle (1:1767 and 1:1830, respectively) were significantly higher than those in the aerobic bottle (1:6408 and 1:17,088, respectively; p < 0.001). One confirmed transfusion‐related septic reaction, classified as a late TP after investigation, was reported out of 242,786 tested PLT donations. CONCLUSION: The rate of TP cases by the two‐bottle system was not increased over the one‐bottle system, although anaerobic‐bottle‐only positive cases were detected. FP and IND rates were increased in the two‐bottle system, attributable to the anaerobic bottle. Observation of only one documented transfusion‐related septic reaction in 4 years of bacterial screening at UBS is reassuring, although limitations in passive surveillance and higher rates of reactions reported by others indicate the need for continued vigilance.</abstract>
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<identifier type="ISSN">0041-1132</identifier>
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