Department of Pathology, University of Utah, Salt Lake City, Utah.
ARUP Laboratories, Salt Lake City, Utah.
Transfusion. 2020 May;60(5):986-996. doi: 10.1111/trf.15762. Epub 2020 Mar 17.
Platelets have the highest bacterial contamination risk of all blood components, and septic transfusion reactions remain a problem. A good estimate of contamination rates could provide information about residual risk and inform optimal testing strategies. We performed a systematic review and meta-analysis of platelet contamination rates by primary culture.
A literature search in December 2019 identified articles on platelet contamination rates using primary culture. We used meta-analysis to estimate the overall rate of contamination and meta-regression to identify heterogeneity. We studied the following sources of heterogeneity: collection method, sample volume, positivity criteria, and study date. Contamination rate estimates were obtained for apheresis (AP), platelet rich plasma (PRP), and buffy coat (BC) collection methods.
The search identified 6102 studies, and 22 were included for meta-analysis. Among these 22 studies, there were 21 AP cohorts (4,072,022 components), 4 PRP cohorts (138,869 components), and 15 BC cohorts (1,474,679 components). The overall mean contamination rate per 1000 components was 0.51 (95% CI: 0.38-0.67) including AP (0.23, 95% CI: 0.18-0.28), PRP, (0.38, 95% CI: 0.15-0.70), and BC (1.12, 95% CI: 0.51-1.96). There was considerable variability within each collection method. Sample volume, positivity criteria, and publication year were significant sources of heterogeneity.
The bacterial contamination rate of platelets by primary culture is 1 in 1961. AP and PRP components showed a lower contamination rate than BC components. There is clinically significant between-study variability for each method. Larger sample volumes increased sensitivity, and bacterial contamination rates have decreased over time.
血小板是所有血液成分中细菌污染风险最高的，并且脓毒性输血反应仍然是一个问题。对污染率的准确估计可以提供有关剩余风险的信息，并为最佳检测策略提供信息。我们对通过原代培养评估血小板污染率进行了系统回顾和荟萃分析。
2019 年 12 月进行文献检索，以确定使用原代培养评估血小板污染率的文章。我们使用荟萃分析来估计总体污染率，并进行荟萃回归以确定异质性。我们研究了以下异质性来源：采集方法、样本量、阳性标准和研究日期。获得了机采血小板（AP）、富含血小板血浆（PRP）和浓缩血小板（BC）采集方法的污染率估计值。
检索到 6102 项研究，其中 22 项研究进行了荟萃分析。在这 22 项研究中，有 21 项 AP 队列（4072022 份成分）、4 项 PRP 队列（138869 份成分）和 15 项 BC 队列（1474679 份成分）。每 1000 份成分的总体平均污染率为 0.51（95%CI：0.38-0.67），包括 AP（0.23，95%CI：0.18-0.28）、PRP（0.38，95%CI：0.15-0.70）和 BC（1.12，95%CI：0.51-1.96）。每种采集方法的内部差异都很大。样本量、阳性标准和发表年份是异质性的重要来源。
通过原代培养评估血小板的细菌污染率为 1/1961。AP 和 PRP 成分的污染率低于 BC 成分。每种方法的研究之间存在明显的临床差异。较大的样本量提高了敏感性，并且细菌污染率随时间推移而降低。
