Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
Vancouver Coastal Health Authority, Vancouver, British Columbia, Canada.
Transfusion. 2019 Jul;59(7):2292-2300. doi: 10.1111/trf.15317. Epub 2019 Apr 23.
Culturing residual blood components after suspected septic transfusion reactions guides management of patients and cocomponents. Current practice, accuracy of provider vital sign assessment, and performance of the AABB culture criteria are unknown. A multicenter international study was undertaken to investigate these issues and develop improved culture criteria.
Retrospective data for all transfusion reactions resulting in residual blood component culture in 2016 were collected from participating hospitals. The performance of the AABB culture criteria were assessed for detection of positive culture results. Modifications to the AABB criteria including 1) recommending culturing in the setting of isolated high fevers, 2) defining hypotension and tachycardia using objective parameters, and 3) incorporating antipyretic use were tested to determine if modifications improved performance. Modifications associated with improvement were incorporate into the BEST criteria. The AABB and the BEST criteria were then tested against a data set enriched for positive culture results to determine which criteria were superior.
Data were collected from 20 centers encompassing 779,143 transfusions, 3,187 reported transfusion reactions, and 1,104 cultured components. There was marked variation in reaction reporting and culturing rates (0.0%-100.0%). Of 35 total positive component cultures, only one of 35 (2.9%) had concordant patient cultures; 12 of 34 (35.3%) did not have patient cultures performed. The BEST criteria had better sensitivity for detection of a positive culture result compared to the AABB criteria (74% vs. 41%), although specificity decreased (45% vs. 65%).
Compared to the AABB criteria, the BEST criteria have improved sensitivity for positive culture detection.
培养疑似脓毒性输血反应后的残余血液成分可指导患者和共成分的管理。目前的做法、提供者生命体征评估的准确性以及 AABB 培养标准的执行情况尚不清楚。进行了一项多中心国际研究，以调查这些问题并制定改进的培养标准。
从参与医院收集了 2016 年所有导致残余血液成分培养的输血反应的回顾性数据。评估 AABB 培养标准对阳性培养结果的检测性能。对 AABB 标准进行了修改，包括 1）建议在孤立性高热的情况下进行培养，2）使用客观参数定义低血压和心动过速，以及 3）纳入退热药物的使用，以确定修改是否可以提高性能。与改进相关的修改被纳入到 BEST 标准中。然后，将 AABB 和 BEST 标准应用于阳性培养结果丰富的数据集，以确定哪种标准更优越。
从 20 个中心收集了数据，涵盖了 779,143 次输血、3,187 次报告的输血反应和 1,104 次培养的成分。反应报告和培养率存在明显差异（0.0%-100.0%）。在 35 个总阳性成分培养物中，只有 1 个（2.9%）与患者培养物一致；34 个（35.3%）中没有进行患者培养。与 AABB 标准相比，BEST 标准对阳性培养结果的检测具有更高的敏感性（74%对 41%），尽管特异性降低（45%对 65%）。
与 AABB 标准相比，BEST 标准在检测阳性培养物方面具有更高的敏感性。
