Bacterial Contamination of Blood Components

DOI: 10.1128/CMR.18.1.195-204.2005

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FIG. 1.
Risk of infectious disease transmission per unit transfused by year, 1983 to 2001. Reprinted from reference 27 with permission of the publisher.
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FIG. 2.
Growth curves of four units of AS-3 red blood cells inoculated with S. liqueifaciens (two units inoculated to 4.2 CFU/ml) and Y. enterocolitica (two units inoculated to 11.6 CFU/ml) (5a). Bacteria were not detectable by culture until days 3 to 6. Isolates were from strains actually implicated in post-red-blood-cell-transfusion sepsis (the isolates were kindly provided by M. Arduino, Centers for Disease Control and Prevention, Atlanta, Ga.).
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FIG. 3.
Growth curves of six bacteria species (S. marcescens, n = 7; K. pneumoniae, n = 21; S. epidermidis, n = 21; Pseudomonas sp., n = 15; B. cereus, n = 9; S. aureus, n = 22) in 95 platelet units. All bacteria were inoculated on day zero at 10-50 CFU/ml (10).

TABLE 1.

Organisms isolated from red cells implicated in transfusion-associated infections^a

Organism	No. of contaminated units in:			Total no.
Organism	United States	United Kingdom	France (29 isolates, 25 implicated units)	Total no.
Gram positive
Coagulase-negative staphylococci	2 (1)	2	3	7 (1)
Streptococcus spp.			4^d	4
Staphylococcus aureus			2^b	2
Enteroccocus faecalis			1^c	1
Bacillus cereus			2	2
Propionibacterium acnes			1	1
Subtotal	2 (1 or 50%)	2 (0 or 0%)	13 (0 or 0%)	17 (1 or 6%)
Gram negative
Serratia liquifaciens	2 (2)	1	2 (1)	5 (3)
Serratia marcescens	1			1
Yersinia enterocolitica		1 (1)	1	2 (1)
Enterobacter spp.			1 (1)	1 (1)
Acinetobacter spp.			5 (1)^b	5 (1)
Pseudomonas spp.			2 (1)	2 (1)
Escherichia coli			3^c	3
Klebsiella pneumoniae			1	1
Proteus mirabilis			1	1
Subtotal	3 (2 or 67%)	2 (1 or 50%)	16 (4 or 25%)	21 (7 or 33%)
Total	5 (3 or 60%)	4 (1 or 25%)	29 (4 or 14%)	38 (8 or 21%)

↵ a Summary of organisms identified in the BACON, SHOT, and BACTHEM studies (35, 51, 57). Numbers and percentages of fatalities are given in parentheses.
↵ b In one case, S. aureus and A. baumannii were both isolated from the implicated bag.
↵ c In one case, E. faecalis and E. coli were both isolated from the implicated bag.
↵ d In two cases, two isolates of Streptococcus were isolated from the implicated bag. Of the eight reported fatalities, seven (87.5%) were due to gram-negative organisms.

TABLE 2.

Organisms implicated in infections associated with platelet transfusions^a

Organism	No. of contaminated units in:			Total no.
Organism	United States	United Kingdom	France	Total no.
Gram positive
Bacillus cereus	1	4 (1)	2	7 (1)
Coagulase-negative staphylococci	9	6 (1)	5	20 (1)
Streptococcus spp.	3 (1)	2		5 (1)
Staphylococcus aureus	4	2 (1)		6 (1)
Propionibacterium acnes			3	3
Subtotal	17 (1 or 6%)	14 (3 or 21%)	10 (0 or 0%)	41 (4 or 10%)
Gram negative
Klebsiella spp.			2 (1)	2 (1)
Serratia spp.	2 (2)		1 (1)	3 (3)
Escherichia coli	5 (1)	2 (1)	1	8 (2)
Acinetobacter spp.			1	1
Enterobacter spp.	2 (1)	1 (1)	1	4 (2)
Providencia rettgeri	1 (1)			1 (1)
Yersinia enterocolitica	1			1
Subtotal	11 (5 or 45%)	3 (2 or 67%)	6 (2 or 33%)	20 (9 or 45%)
Total	28 (6 or 21%)	17 (5 or 29%)	16 (2 or 13%)	58 (11 or 19%)

↵ a Summary of organisms identified in the BACON, SHOT, and BACTHEM studies (35, 51, 57). Numbers and percentages of fatalities are given in parentheses.

TABLE 3.

Percentage and mean count of donors with bacteria after skin disinfection^a

No. of CFU/plate	% of contaminated donors after disinfection with:
No. of CFU/plate	Povidone iodine × 2	IPA^b and iodine	IPA × 2 (sponge)	IPA × 2 (swab)
0	39	79	0	29
≤10	57	93	69	50
≤100	75	100	86	68
≤1,000	96	100	97	89
Mean count	175	3	161	237

TABLE 4.

Summary of recent experiences with culturing of apheresis-derived platelets at three large blood centers^a

↵ a http://www.hhs.gov/bloodsafety/pastmeetings.html#n .
↵ b True positive = positive bottles in which an organism was identified and a repeat sample from the bag or a retention sample also contained the same organism. False positive = positive bottles that contained no organism (machine false positive) or from which the organism could not be reisolated from the original bag or a retained sample.