A prospective microbiologic surveillance program to detect and prevent the transfusion of bacterially contaminated platelets

Yomtovían, Roslyn; Lazarus, Hillard M.; Goodnough, Lawrence T.; Hirschler, Nora V.; Morrissey, Anne M.; Jacobs, Michael

doi:10.1046/j.1537-2995.1993.331194082380.x

Cited by 210 publications

(139 citation statements)

References 34 publications

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“…One in 2000 units of blood is contaminated from skin or blood at the time that it is drawn [23,24]. Despite leucoreduction and cold storage, about 1 in 30 000 stored red blood cell units can be demonstrated at some point to be bacterially contaminated.…”

Section: Are Stored Red Blood Cells Safe?mentioning

confidence: 99%

Current issues relating to the transfusion of stored red blood cells

Zimrin¹,

2009

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The development of blood storage systems allowed donation and transfusion to be separated in time and space. This separation has permitted the regionalization of donor services with subsequent economies of scale and improvements in the quality and availability of blood products. However, the availability of storage raises the question of how long blood products can and should be stored and how long they are safe and effective. The efficacy of red blood cells was originally measured as the increment in haematocrit and safety began with typing and the effort to reduce the risk of bacterial contamination. Appreciation of a growing list of storage lesions of red blood cells has developed with our increasing understanding of red blood cell physiology and our experience with red blood cell transfusion. However, other than frank haemolysis, rare episodes of bacterial contamination and overgrowth, the reduction of oxygen-carrying capacity associated with the failure of some transfused cells to circulate, and the toxicity of lysophospholipids released from membrane breakdown, storage-induced lesions have not had obvious correlations with safety or efficacy. The safety of red blood cell storage has also been approached in retrospective epidemiologic studies of transfused patients, but the results are frequently biased by the fact that sicker patients are transfused more often and blood banks do not issue blood products in a random order. Several large prospective studies of the safety of stored red blood cells are planned.

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Section: Are Stored Red Blood Cells Safe?mentioning

confidence: 99%

Current issues relating to the transfusion of stored red blood cells

Zimrin¹,

2009

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“…Currently, risk of infection associated with PRBC transfusion is 1:2,000 for bacterial infection; 1:58,000-149,000 for hepatitis B; and 1:872,000-1,700,000 for hepatitis C [23].…”

Section: Discussionmentioning

confidence: 99%

“…Rev Bras Cir Cardiovasc | Braz J Cardiovasc Surg Bras Cir Cardiovasc 2013;28(2):200-7 Gib MC, et al -Mediastinitis: mortality rate comparing single-stage surgical approach and preconditioning of wound for hepatitis B; and 1:872,000-1,700,000 for hepatitis C [23]. Analyzing these data, we may consider Group 2 as possibly more severe than Group 1.…”

mentioning

confidence: 99%

Mediastinitis: mortality rate comparing single-stage surgical approach and preconditioning of wound

Gib¹,

Alvarez²,

Wender³

2013

Revista Brasileira De Cirurgia Cardiovascular

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200Rev Bras Cir Cardiovasc | Braz J Cardiovasc SurgRev Bras Cir Cardiovasc 2013;28(2):200- INTRODUCTIONMedian sternotomy is the technical approach most used in the surgical treatment of cardiopathies. Mediastinitis is a severe complication leading to an increase in hospital costs, morbidity and mortality [1,2]. The treatment, however, has progressed with new antibiotics, along with technical and surgical care.Postoperative incidence of mediastinitis ranges from 0.5% to 5% [3][4][5]. However, mortality associated with such surgical complications, even after appropriate treatment, is extremely high, ranging between 14% and 47% [1,6,7]. Several studies have identified risk factors such as obesity, diabetes, reoperation, smoking, prolonged operative time, bilateral use of the internal thoracic artery, and postoperative bleeding [4,5,8,9].Surgical management of postoperative mediastinitis counts on several techniques described in the literature [5,[10][11][12][13][14][15][16][17]. Treatment may include single-or multiple-stage procedures, with or without the use of muscle or omental flap [11,12,18]. Therapeutic modalities encompass two options: preconditioning of the wound, leaving the wound open for a better cleaning and mediastinal drainage with dressings, or using one of the several closure techniques available. Singlestage closure shows a recurrence rate between 5%-50% in comparison to two-stage closure whose rate ranges from 2%-30% [19,20], however the long term exposure of the mediastinum enhances the morbidity.The present study aims to compare inpatient mortality rate from surgical debridement followed by primary wound closure with that from surgical debridement with closure after preconditioning of the wound. METHODSFrom January 2000 to December 2008, at Hospital de Clínicas de Porto Alegre (HCPA), southern Brazil, 3,166 cardiac surgeries were performed in adults using median sternotomy and extracorporeal circulation (ECC). A historical cohort of patients who had postoperative mediastinitis was followed up during hospital stay after the first surgery and reintervention(s). From 2007, we implemented the protocol of preconditioning of the wound for all patients. Data were abstracted from the patient's medical records. The entire patient sample that showed mediastinitis during this period was identified through the Cardiovascular Surgery Division records in combination with those from the Commission on Hospital Infection Control (CCIH) of HCPA. Mediastinitis was defined as deep surgical wound infection with clinical and microbiologic evidence of compromised retrosternal space. During this period, 49 patients developed mediastinitis, an incidence of 1.55%. Of these, 43 patients met the classification criteria (El Oakley) [3] as type III or IV and were included in the study.The diagnosis of mediastinitis was based on physical examination and laboratory tests. Three diagnostic criteria were elected during initial evaluation: sternal instability; leukocytosis of more than 15,000; and wound secretion. All patients w...

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“…There are several factors that playa role in the incidence and detection of Tx sepsis, such as the storage temperature ( below O°C, 4°C or 22°C), the volume of blood cultured, the temperature and the culture media used for the detection, and the sensitivity of the method. Nevertheless, the incidence of contaminated products ranges from 1: 13,100 to I :330 for red blood cells, from 1:20,000 to 1:3,600 for single donor apheresis platelets, and from 1: 10,000 to 1:250 for pooled random platelet concentrates (6,7,8,9,10).…”

Section: Bacterial Contaminationmentioning

confidence: 99%

“…However, false positive and false negative results are encountered. The method is laborious, expensive and its efficiency is still debatable (9), though a prospective study showed evidence that it might be suitable for routine screening (10). Bacterial cultures: different results have been reported since there is no standardization as to the volume to be inoculated, the culture medium, temperature, atmosphere, time of incubation and microorganism quantification.…”

Section: Bacterial Contaminationmentioning

confidence: 99%

Current concepts on the transmission of bacteria and parasites by blood components

Neto

1995

Sao Paulo Med. J.

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Several bacterial and parasite transfusion-transmitted diseases have been described in the medical literature. This review deals with the main bacterial (Syphilis, Lyme disease, Gram positive and Gram negative agents), parasite (Chagas disease, malaria, leishmaniasis, toxoplasmosis and babesiosis) and rickettsial diseases that are carried by blood products. Preventional aspects (e.g. storage, screening tests, use of leukocyte-depleted components), diagnosis, geographical distribution and the incidence of these transfusional hazards are also discussed.

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A prospective microbiologic surveillance program to detect and prevent the transfusion of bacterially contaminated platelets

Cited by 210 publications

References 34 publications

Current issues relating to the transfusion of stored red blood cells

Current issues relating to the transfusion of stored red blood cells

Mediastinitis: mortality rate comparing single-stage surgical approach and preconditioning of wound

Current concepts on the transmission of bacteria and parasites by blood components

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