Department of Pathology and Laboratory Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA.
Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, Minnesota, USA.
Transfusion. 2021 Aug;61(8):2414-2420. doi: 10.1111/trf.16545. Epub 2021 Jun 28.
In the setting of suspected septic transfusion reactions, bacterial culture of both the transfused patient and the residual blood component is recommended. Primary bacterial contamination can occur at the time of component collection. Clinically insignificant "secondary contamination" can occur during post-transfusion component discard, retrieval for culture, or manipulation of the bag at the time of culture sampling.
This retrospective, multi-center study analyzes positive residual component culture results and companion patient blood cultures from 15 hospitals, 1 blood center, and all cultured transfusion reactions within the province of Quebec, Canada, over a 5-year period. Imputability was assigned as "definite" (concordant growth), "possible" (discordant growth or lack of growth in patient culture), or "unable to assess" (patient not cultured).
There were 373 positive component cultures from 360 unique transfusion reactions, with 276 (76.7%) companion patient blood cultures performed, of which 10 (2.8%) yielded the pathogen detected in the positive component. Of these 10 definite pathogens, 7 (2 Staphylococcus aureus, 3 other staphylococci, and 1 Streptococcus pyogenes and 1 Bacillus sp.) were associated with platelet and 3 (Aeromonas veronii, Staphylococcus epidermidis, and Enterococcus faecalis) with RBC transfusions. RBC and plasma components comprised 70% of positive component cultures.
The process of performing residual component culture is vulnerable to secondary contamination. The significance of microorganisms recovered from component culture cannot be interpreted in isolation. In the context of low prevalence of primary contamination of blood components, the positive predictive value of a positive component culture result is very low.
在疑似脓毒性输血反应的情况下，建议对接受输血的患者和剩余血液成分进行细菌培养。在采集成分时可能会发生原发性细菌污染。在输血后丢弃成分、为培养而检索成分或在培养取样时处理袋子的过程中，可能会发生无临床意义的“二次污染”。
这项回顾性多中心研究分析了来自加拿大魁北克省的 15 家医院、1 家血库的 15 个阳性剩余成分培养结果和伴发的患者血液培养结果，以及在 5 年内该省所有培养的输血反应。归因于“明确”（一致生长）、“可能”（患者培养物中存在生长差异或无生长）或“无法评估”（未培养患者）。
共有 360 次输血反应中有 373 次阳性成分培养，其中 276 次（76.7%）进行了伴发患者血液培养，其中 10 次（2.8%）培养出阳性成分中检测到的病原体。在这 10 个明确的病原体中，7 个（2 个金黄色葡萄球菌、3 个其他葡萄球菌和 1 个化脓链球菌和 1 个芽孢杆菌）与血小板相关，3 个（阿氏假单胞菌、表皮葡萄球菌和粪肠球菌）与 RBC 输血相关。RBC 和血浆成分占阳性成分培养的 70%。
进行剩余成分培养的过程容易受到二次污染的影响。不能孤立地解释从成分培养中回收的微生物的意义。在血液成分原发性污染率较低的情况下，阳性成分培养结果的阳性预测值非常低。
