Klein Mark A, Kadidlo Diane, McCullough Jeffrey, McKenna David H, Burns Linda J
Division of Hematology, Oncology and Transplantation, Department of Medicine, University of Minnesota, Minneapolis, Minnesota, USA.
Biol Blood Marrow Transplant. 2006 Nov;12(11):1142-9. doi: 10.1016/j.bbmt.2006.06.011.
Microbial contamination of hematopoietic stem cell products is a rare but potentially fatal complication of hematopoietic stem cell transplantation. We report the incidence of contaminated products and describe the clinical outcomes for 35 patients at the University of Minnesota who received contaminated products from January 1990 to December 2004. In total, 2935 products were infused for 2863 transplants during this time, 36 of which 36 (1.2%) were contaminated. Coagulase negative Staphylococcus was the predominant species isolated on culture of the hematopoietic stem cell products. Patients received prophylactic antibiotics before infusion of the contaminated product based on the organism identified from culture and antibiotic sensitivities, if known. After transplantation, blood cultures from 2 patients grew the same pathogen as in the infused contaminated product, including 1 patient who had blood cultures positive for Pseudomonas cepacia. All patients who received contaminated products had benign post-transplantation courses except for the patient with Pseudomonas bacteremia, who ultimately died from complications. These results suggest that, although rare, microbial contamination of stem cell products does occur and there must be ongoing efforts by physicians and laboratory personnel to minimize the risk for introduction of contaminants. Prophylactic antibiotics are useful for certain contaminants; however, caution must be exercised when gram-negative contaminated products are administered.
造血干细胞产品的微生物污染是造血干细胞移植中一种罕见但可能致命的并发症。我们报告了污染产品的发生率，并描述了明尼苏达大学35例在1990年1月至2004年12月期间接受污染产品的患者的临床结局。在此期间，总共为2863例移植输注了2935份产品，其中36份（1.2%）被污染。凝固酶阴性葡萄球菌是在造血干细胞产品培养中分离出的主要菌种。如果已知，患者在输注污染产品前会根据培养鉴定出的微生物和抗生素敏感性接受预防性抗生素治疗。移植后，2例患者的血培养生长出与输注的污染产品中相同的病原体，其中1例洋葱伯克霍尔德菌血培养呈阳性。除了最终死于并发症的洋葱伯克霍尔德菌血症患者外，所有接受污染产品的患者移植后病程均为良性。这些结果表明，尽管罕见，但干细胞产品的微生物污染确实会发生，医生和实验室人员必须持续努力将引入污染物的风险降至最低。预防性抗生素对某些污染物有用；然而，在使用革兰氏阴性污染产品时必须谨慎。
