Fatal false-negative transfusion infection involving a buffy coat platelet pool contaminated with biofilm-positive Staphylococcus epidermidis: a case report.
Transfusion
; 55(10): 2384-9, 2015 Oct.
Article
em En
| MEDLINE
| ID: mdl-25988568
ABSTRACT
BACKGROUND:
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. CASE REPORT 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.DISCUSSION:
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.CONCLUSION:
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.
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Infecções Estafilocócicas
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Staphylococcus epidermidis
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Leucemia Mielogênica Crônica BCR-ABL Positiva
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Transfusão de Plaquetas
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Biofilmes
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Buffy Coat
Tipo de estudo:
Prognostic_studies
Limite:
Aged80
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Humans
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Male
Idioma:
En
Ano de publicação:
2015
Tipo de documento:
Article