Royal Hospital, Muscat, Oman.
New York Blood Center, New York, New York, USA.
Transfusion. 2023 Sep;63(9):1728-1737. doi: 10.1111/trf.17486. Epub 2023 Jul 15.
The updated guidance for improving bacterial detection (BD) of platelets has included the implementation of large-volume delayed sampling (LVDS) with the addition of anaerobic culture bottles (BPNs) and sampling of each platelet split product.
The frequency of BD was reviewed during this LVDS time period in comparison with pre-LVDS and the Post-Approval Surveillance Study of Platelet Outcomes, Release Tested (PASSPORT) study (when BPNs were last used).
There was more than a twofold increase in bottles inoculated per collection during LVDS, with an almost fivefold increase in sample volume collected. During LVDS, the concordance of split products within an initial reactive collection was only 8.7%. There was no difference in LVDS aerobic culture bottle (BPA) true positives (TPs), but there was a significant increase in LVDS false positives (FPs), p < .0001, compared to both PASSPORT and pre-LVDS, respectively. There was an increase in BPN TPs during LVDS (p < .05 compared to PASSPORT), with predominance of Cutibacter acnes (C. acnes), noted exclusively in BPN, and accounting for more than two-fifths of all organisms detected. Time to alarm during LVDS for TPs had two peaks with one due to C. acnes at 96 h compared to 17 h for non-C. acnes.
The high FP frequency, along with low clinical significance of TPs found in BPNs, has led to the needless discard of inventory, as the utility of BPNs in BD for platelets is yet to be established and may require much larger studies.
为提高血小板细菌检测（BD）的准确性，更新的指南包括实施大容量延迟采样（LVDS），同时添加厌氧培养瓶（BPN）并对每个血小板分离产品进行采样。
在 LVDS 期间，我们对 BD 的频率进行了回顾，与 LVDS 之前以及最后一次使用 BPN 时的血小板结果放行测试（PASSPORT）研究后监测（Post-Approval Surveillance Study of Platelet Outcomes，Release Tested，PASSPORT）进行了比较。
在 LVDS 期间，每个采集的接种瓶数增加了两倍以上，采集的样本量几乎增加了五倍。在 LVDS 期间，初始反应性采集内的分离产品一致性仅为 8.7%。LVDS 有氧培养瓶（BPA）的真阳性（TP）没有差异，但与 PASSPORT 和 LVDS 之前相比，LVDS 的假阳性（FP）显著增加，p<0.0001。在 LVDS 期间，BPN 的 TP 增加（与 PASSPORT 相比，p<0.05），其中以痤疮丙酸杆菌（C. acnes）为主，仅在 BPN 中发现，占所有检测到的生物的五分之二以上。LVDS 期间 TP 报警时间有两个高峰，一个是由于 C. acnes 导致的 96 小时，另一个是由于非 C. acnes 导致的 17 小时。
FP 频率高，BPN 中发现的 TP 临床意义低，导致库存浪费，因为 BPN 在血小板 BD 中的实用性尚未确定，可能需要更大规模的研究。
