Emerg Infect Dis. 2019 Aug;25(8):1445-1451. doi: 10.3201/eid2508.181936.
In the United States, fatal transfusion-transmitted infections from red blood cell units are rare. Although this pattern mostly reflects how inhospitable refrigerated red blood cell units are to contaminant growth, fatalities caused by microorganisms that can grow at storage temperature (4°C), but not in standard clinical blood cultures at 37°C, are probably underestimated. We analyzed a fatal red blood cell transfusion in Peoria, Illinois, USA, that occurred in 2017. Samples from the patient's whole blood and the red blood cell unit remained culture-negative during the investigation, despite direct visualization of gram-negative bacilli within the unit immediately after transfusion. We identified the bacteria as Pseudomonas poae, a nonpathogenic pseudomonad carrying multiple cold-shock domain protein genes, and confirmed its cold tolerance and inability to grow at 37°C. Our work indicates transfusion reaction workups need to include testing for psychrophilic organisms, which could explain the cause of other apparently culture-negative transfusion reactions.
在美国，致命的经输血传播的感染来自红细胞单位是罕见的。虽然这种模式主要反映了冷藏的红细胞单位对污染物生长的不利影响，但在储存温度（4°C）下可以生长而在 37°C 的标准临床血液培养中不能生长的微生物引起的死亡可能被低估了。我们分析了 2017 年在美国伊利诺伊州皮奥里亚发生的一起致命的红细胞输血事件。尽管在输血后立即直接观察到单位内有革兰氏阴性杆菌，但在调查过程中，患者的全血和红细胞单位的样本仍保持培养阴性。我们将细菌鉴定为恶臭假单胞菌（Pseudomonas poae），一种携带多个冷休克结构域蛋白基因的非致病性假单胞菌，并证实了其耐寒性和不能在 37°C 下生长的特性。我们的工作表明，输血反应的检查需要包括对嗜冷菌的检测，这可能解释了其他明显培养阴性的输血反应的原因。
