Reich-Slotky Ronit, Wu Fann, Della-Latta Phyllis, Savage David G, Schwartz Joseph
Division of Transfusion Medicine, Department of Pathology, New York Presbyterian Hospital, Columbia University Medical Center, New York, New York 10032, USA.
Transfusion. 2008 Nov;48(11):2409-13. doi: 10.1111/j.1537-2995.2008.01851.x. Epub 2008 Jul 22.
Positive microbial cultures of peripheral blood progenitor cell (PBPC) products, although estimated to be low, are serious events in the manufacture of hematopoietic progenitor cell (HPC) products that warrant a thorough investigation to determine the contamination source.
Two patients underwent autologous PBPC collection. The first patient was admitted before the collection and was febrile intermittently throughout hospitalization. The second patient spiked a low-grade fever by the end of the procedure. The HPC products from each patient were cultured during processing and before infusion. Blood cultures were drawn during febrile episodes and before transplant. Bacterial identification and antimicrobial susceptibilities were performed on all positive cultures. All strains were typed using pulsed-field gel electrophoresis (PFGE) to determine their relatedness.
The blood cultures from both patients and their corresponding HPC products grew Staphylococcus epidermidis. The PFGE pattern of the S. epidermidis recovered from each patient blood was indistinguishable from the one recovered from the corresponding HPC product. The gel pattern of the strains recovered from the first patient differed by four bands from the one recovered from the second. For each patient, the antibiotic susceptibility patterns of the blood cultures and the HPC products were identical. Infusion of the contaminated HPC had no adverse event, and the patients engrafted successfully.
By use of PFGE technology, the contamination source of PBPC products was identified. It is concluded that the contamination resulted from intermittent bacteremia in the donors and was not introduced during laboratory manufacturing.
外周血祖细胞（PBPC）产品的微生物培养呈阳性，尽管估计发生率较低，但在造血祖细胞（HPC）产品制造过程中是严重事件，需要进行全面调查以确定污染源。
两名患者接受了自体PBPC采集。第一名患者在采集前入院，住院期间间歇性发热。第二名患者在手术结束时出现低热。对每名患者的HPC产品在处理过程中和输注前进行培养。在发热期和移植前采集血培养。对所有阳性培养物进行细菌鉴定和药敏试验。使用脉冲场凝胶电泳（PFGE）对所有菌株进行分型以确定它们的相关性。
两名患者的血培养及其相应的HPC产品均培养出表皮葡萄球菌。从每名患者血液中分离出的表皮葡萄球菌的PFGE图谱与从相应HPC产品中分离出的图谱无法区分。从第一名患者分离出的菌株的凝胶图谱与从第二名患者分离出的菌株相差四条带。对于每名患者，血培养和HPC产品的药敏模式相同。输注受污染的HPC没有发生不良事件，患者成功植入。
通过使用PFGE技术，确定了PBPC产品的污染源。得出的结论是，污染是由供体的间歇性菌血症引起的，而不是在实验室制造过程中引入的。
