Bacteremia in the red blood cells obtained from the cell saver in patients submitted to heart surgery

Abstract

Objective: to determine the microbiological characteristics of the red blood cells obtained with the cell saver in heart surgery patients on an extra-body circuit. Method: a cross-sectional and descriptive study conducted with 358 patients scheduled for heart surgery where the saver was used. Sociodemographic variables were collected, as well as from the saver and of the microbial identification in the re-infusion bag proceeding from the cell saver. Informed consent performed. Results: of the 170 GRAM+ bacteria isolations, the most frequent species were Staphylococcus epidermidis in 69% (n=138) of the cases and Streptococcus sanguinis with a report of 10% (n=20). Significant differences were found in the Staphylococcus epidermidis strain in patients with a Body Mass Index ≥25 (p=0.002) submitted to valve surgery (p=0.001). Vancomycin was the antimicrobial which resisted the Staphylococcus epidermidis strain with a minimum inhibitory concentration of >16 µg/ml. Conclusion: the microbiological characteristics of the red blood cells obtained after processing autologic blood recovered with the cell saver during heart surgery are of GRAM+ bacterial origin, the most isolated species being Staphylococcus epidermidis. Consequently, in order to reduce the presence of these GRAM+ cocci, an antibiotic should be added to the cell saver reservoir, according to a previously established protocol.

Risk factors associated with positive bacterial culture in salvaged red blood cells during cardiac surgery and postoperative infection incidence: A prospective cohort study

“…S. epidermidis was previously reported to be associated with 69% of culture (+) in sRBCs following the CS-mediated washing of salvaged blood for patients undergoing cardiac surgery. But it did not demonstrate the effect on patients after surgery (5). In contrast, the present results offer insight into postoperative infection incidence in patients that were transfused with bacterially positive sRBCs.…”

“…Previous reports have explored risk factors associated with culture (+) in sRBCs, yielding varying outcomes that may be attributable to differences in patients, exposure time, intraoperative procedures, and the surgical environment (including operating room cleanliness). One study of cardiac surgery patients found that those with a BMI ≥25 who underwent valvular surgery tended to be more susceptible to S. epidermidis cultures (+) in sRBCs ( 5 ). Another controlled study compared new and old operating rooms and detected fivefold lower bacterial counts in sRBCs samples prepared in the new operating room relative to the old room, indicating that operating room cleanliness is likely to impact bacterial deposition ( 23 ).…”

“…The cut-off value for operative duration and CS usage time were selected using a receiving operating curve based on the value that achieved the maximal sum of sensitivity and specificity (277.5 and 272.5 min in this study population). BMI classification was performed based on standard guidelines ( 5 ). SPSS 26.0 (IBM, NY, USA) was used for all statistical analyses, with P < 0.05 as the significance threshold.…”

“…However, the benefits of a given clinical strategy must be carefully weighed against the potential adverse outcomes of such treatment. Manuel detected Gram-positive bacteria, primarily Staphylococcus epidermidis , in sRBCs samples collected from shed blood following washing with Cell Saver (CS) machines in patients undergoing cardiac surgery ( 5 ). They further observed higher rates of postoperative infections in patients that underwent cardiac surgery with ICS as compared to cardiac surgery patients for whom salvage was not performed ( 6 ).…”

Cell Saver Blood Reinfusion Up to 24 Hours Post Collection in Pediatric Cardiac Surgical Patients Does Not Increase Incidence of Hospital-Acquired Infections or Mortality

“…Concern regarding findings of bacteremia in the red blood cells (RBCs) of cell saver blood in adults undergoing cardiac surgery has raised concerns regarding safety of its infusion (19). Bacterial culture growth demonstrated in 60-85% of salvaged blood, attributed to airborne bacteria in the environment, has not been directly correlated with postoperative infections (20).…”