血小板成分制品在实施原代培养前后的细菌污染和脓毒输血反应率：美国学术医疗中心 1991 年至 2017 年的经验。

Bacterial contamination and septic transfusion reaction rates associated with platelet components before and after introduction of primary culture: experience at a US Academic Medical Center 1991 through 2017.

机构信息

Department of Pathology and Medicine, University Hospitals Cleveland Medical Center and Case Western Reserve University School of Medicine, Cleveland, Ohio, USA.

Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA.

出版信息

Transfusion. 2020 May;60(5):974-985. doi: 10.1111/trf.15780. Epub 2020 May 1.

DOI:10.1111/trf.15780

PMID:32357261

Abstract

BACKGROUND

The high incidence of septic transfusion reactions (STRs) led to testing being mandated by AABB from 2004. This was implemented by primary culture of single-donor apheresis platelets (APs) from 2004 and prestorage pooled platelets (PSPPs) from 2007.

STUDY DESIGN/METHODS: Platelet (PLT) aliquots were cultured at issue and transfusion reactions evaluated at our hospital. Bacterial contamination and STR rates (shown as rates per million transfusions in Results) were evaluated before and after introduction of primary culture by blood centers that used a microbial detection system (BacT/ALERT, bioMerieux) or enhanced bacterial detection system (eBDS, Haemonetics).

RESULTS

A total of 28,457 PLTs were cultured during pre-primary culture periods (44.7% APs; 55.3% at-issue pooled PLTs [AIPPs]) and 97,595 during post-primary culture periods (79.3% APs; 20.7% PSPPs). Forty-three contaminated units were identified in preculture and 34 in postculture periods (rates, 1511 vs. 348; p < 0.0001). Contamination rates of APs were significantly lower than AIPPs in the preculture (393 vs. 2415; p < 0.0001) but not postculture period compared to PSPPs (387 vs. 198; p = 0.9). STR rates (79 vs. 90; p = 0.98) were unchanged with APs but decreased considerably with pooled PLTs (826 vs. 50; p = 0.0006). Contamination (299 vs. 324; p = 0.84) and STR rates (25 vs. 116; p = 0.22) were similar for PLTs tested by BacT/ALERT and eBDS primary culture methods. A change in donor skin preparation method in 2012 was associated with decreased contamination and STR rates.

CONCLUSION

Primary culture significantly reduced bacterial contamination and STR associated with pooled but not AP PLTs. Measures such as secondary testing near time of use or pathogen reduction are needed to further reduce STRs.

摘要

背景

由于败血症输血反应（STR）的高发生率，AABB 于 2004 年开始要求进行检测。这是通过从 2004 年开始对单个供体的单采血小板（AP）进行原代培养，以及从 2007 年开始对储存前的血小板混合液（PSPP）进行原代培养来实现的。

研究设计/方法：在我们的医院，对血小板（PLT）等分试样进行培养，并在输血反应时进行评估。在采用微生物检测系统（BacT/ALERT，bioMerieux）或增强型细菌检测系统（eBDS，Haemonetics）的血库引入原代培养之前和之后，评估细菌污染和 STR 率（结果中以每百万次输血的发生率表示）。

结果

在原代培养前的时期共培养了 28457 个 PLT（44.7%的 AP；55.3%的即时混合血小板[AIPP]），在原代培养后共培养了 97595 个 PLT（79.3%的 AP；20.7%的 PSPP）。在原代培养前和原代培养后分别发现了 43 个污染单位（发生率分别为 1511 比 348；p<0.0001）。AP 的污染率在原代培养前明显低于 AIPP（393 比 2415；p<0.0001），但在原代培养后与 PSPP 相比并无差异（387 比 198；p=0.9）。AP 的 STR 率（79 比 90；p=0.98）没有变化，但混合 PLT 的 STR 率明显降低（826 比 50；p=0.0006）。用 BacT/ALERT 和 eBDS 原代培养方法检测的 PLT 的污染率（299 比 324；p=0.84）和 STR 率（25 比 116；p=0.22）相似。2012 年供体皮肤准备方法的改变与污染和 STR 率的降低有关。