Brecher M E, Holland P V, Pineda A A, Tegtmeier G E, Yomtovian R
University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27514, USA.
Transfusion. 2000 Nov;40(11):1308-12. doi: 10.1046/j.1537-2995.2000.40111308.x.
Recent reports from Europe have advocated the use of bacterial culturing of platelets on Day 2 or 3 of storage to extend the shelf life of platelets to 7 days, thereby reducing the outdating of platelets and preserving a limited medical resource. To assess the optimal timing, the necessary sensitivity, and the possible efficacy of bacterial detection, the bacterial growth characteristics were reviewed in 165 platelet units, each inoculated on the day of collection with one of the following organisms: Bacillus cereus, Pseudomonas aeruginosa, Klebsiella pneumoniae, Serratia marcescens, Staphylococcus aureus, and Staphylococcus epidermidis from four previously published studies.
Quantitative culture data from inoculated platelet concentrates from five sites and four studies were combined into one database and analyzed for bacterial concentration thresholds (> or =10(1), > or =10(2), > or =10(3), > or =10(4), > or =10(5) CFU/mL) by day of storage.
All examples of B. cereus, P. aeruginosa, K. pneumoniae, S. marcescens, and S. aureus had concentrations > or =10(2) CFU per mL by Day 3 after inoculation. By Day 4, all units with these organisms contained > or =10(5) CFU per mL. Units contaminated with S. epidermidis showed slower and more varied growth. By Day 3 after inoculation, 81.3 percent had 10(2) CFU per mL. By Day 4 after inoculation, 46 (95.8%) of 48 units had concentrations > or =10(2) CFU per mL.
These experiments suggest that an assay capable of detecting 10(2) CFU per mL on Day 3 of storage would detect the vast majority of bacterially contaminated platelet units, prevent many cases of platelet-associated bacterial sepsis, and provide a scientific basis for the extension of the current platelet storage time. It would be expected that a rare, slow-growing organism could escape such a detection scheme.
欧洲最近的报告提倡在储存第2天或第3天对血小板进行细菌培养，以将血小板的保质期延长至7天，从而减少血小板过期并保存有限的医疗资源。为了评估最佳时间、必要的灵敏度以及细菌检测的可能效果，回顾了165个血小板单位的细菌生长特征，这些血小板单位在采集当天分别接种了以下一种微生物：蜡样芽孢杆菌、铜绿假单胞菌、肺炎克雷伯菌、粘质沙雷氏菌、金黄色葡萄球菌和表皮葡萄球菌，数据来自四项先前发表的研究。
来自五个地点和四项研究的接种血小板浓缩物的定量培养数据被合并到一个数据库中，并按储存天数分析细菌浓度阈值（≥10¹、≥10²、≥10³、≥10⁴、≥10⁵ CFU/mL）。
接种后第3天，所有蜡样芽孢杆菌、铜绿假单胞菌、肺炎克雷伯菌、粘质沙雷氏菌和金黄色葡萄球菌的样本浓度均≥10² CFU/mL。到第4天，所有感染这些微生物的单位每毫升含有≥10⁵ CFU。被表皮葡萄球菌污染的单位生长较慢且变化较大。接种后第3天，81.3%的单位每毫升有10² CFU。接种后第4天，48个单位中的46个（95.8%）浓度≥10² CFU/mL。
这些实验表明，一种能够在储存第3天检测到每毫升10² CFU的检测方法将检测到绝大多数被细菌污染的血小板单位，预防许多与血小板相关的细菌败血症病例，并为延长当前血小板储存时间提供科学依据。预计一种罕见的、生长缓慢的微生物可能会逃过这样的检测方案。
