Sr. Director, Transfusion Innovation & Product Development American Red Cross Holland Laboratory Rockville, Maryland, United States
Background/Case Studies: The US FDA communicated heightened awareness of Acinetobacter-related sepsis from platelet transfusions in 2019 and 2021, and in December 2022 further communicated concern for polymicrobial contamination. Since 2018, there have been several septic transfusion reactions (STRs) in platelet recipients involving Acinetobacter spp. (A sp.), Staphylococcus saprophyticus (SS), and/or Leclercia adecarboxylata (LA). The CDC conducted genetic testing of the isolates which suggest a potential common source of bacteria. To better understand upstream polymicrobial contamination in platelets, we reviewed the hemovigilance database of the largest US blood center since BacT testing began in 2004.
Study
Design/Methods: The hemovigilance database from the largest US blood center was reviewed for any polymicrobial contamination of platelets from 2017 – 2023, and all occurrences of relevant mono or polymicrobial positive BacT cultures including A sp., SS, and/or LA, since 2004 when BacT testing began.
Results/Findings: Since 2017, there have been 95 instances of BacT positives with polymicrobial contamination including 8 cases which involved A sp., SS, and/or LA spanning from 2017 – 2021 (Table 1), most of which occurred in 2019. Additionally, since 2004 there have been 18 BacT positives involving A sp. (Table 1), 11 of LA, and 39 of SS. 28 of the 39 cultures with SS occurred since 2019 after system-wide implementation of anaerobic testing. Conclusions: These data confirm identification of A sp. and SS in platelet units as early as 2006 and an increase of SS after the system-wide implementation of anaerobic testing in 2019. Of the 95 instances of BacT positive platelet units with polymicrobial contaminations, 8 of the cases involved A sp., SS, and/or LA spanning from 2017 - 2021. While bacterial mitigations for upstream bacterial contamination reduce the occurrence of STRs, more work is needed to better understand less common causes of contamination.
Importance of research: STRs from platelet bacterial contamination are a persistent cause of transfusion-associated mortality. Since 2018, 8 STRs have involved Acinetobacter sp., Staphylococcus saprophyticus, and/or Leclercia adecarboxylata. Whereas bacterial contamination of platelets from donor bacteremia or skin microbiota is a known risk with well-established mitigations, recent STRs occurred despite bacterial risk mitigations and may point to additional routes of contamination.
