Implementation of secondary bacterial culture testing of platelets to mitigate residual risk of septic transfusion reactions

Bloch, Evan M.; Marshall, Christi E.; Boyd, Joan S.; Shifflett, Lisa; Tobian, Aaron A.R.; Gehrie, Eric A.; Ness, Paul M.

doi:10.1111/trf.14618

Cited by 36 publications

(52 citation statements)

References 28 publications

(47 reference statements)

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“…Another study in the United Kingdom, conducted by McDonald and coworkers, showed a contamination rate of 0.02% for apheresis PLTs that were sampled 36 to 48 hours after donation; a total of 16 mL was drawn from each transfusable product and inoculated into both aerobic and anaerobic media. We recently reported a contamination rate of 0.03% after implementation of secondary bacterial culture that was performed at time of receipt from the blood center, Day 3 after collection . This represents an incidence of bacterial contamination of one in 2881 apheresis PLTs.…”

Section: Discussionmentioning

confidence: 99%

The epidemiology of bacterial culture–positive and septic transfusion reactions at a large tertiary academic center: 2009 to 2016

et al. 2018

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Section: Discussionmentioning

confidence: 99%

The epidemiology of bacterial culture–positive and septic transfusion reactions at a large tertiary academic center: 2009 to 2016

et al. 2018

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“…The SBC strategy model was based on the BacT/ALERT (bioMerieux, Inc.) system and has been previously described . Units would be received on Day 3 and sampled, with 5 mL of each platelet product inoculated into a single aerobic culture bottle.…”

Section: Methodsmentioning

confidence: 99%

“…Parameters associated with SBC were obtained from a feasibility study conducted at a large academic medical center . While seven of eight contaminated units were detected by culture within 24 hours, only five of these eight units were successfully interdicted before transfusion.…”

Section: Methodsmentioning

confidence: 99%

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Financial impact of alternative approaches to reduce bacterial contamination of platelet transfusions

et al. 2019

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BACKGROUND Bacterial contamination of platelets remains the leading infectious risk from blood transfusion. Pathogen reduction (PR), point‐of‐release testing (PORt), and secondary bacterial culture (SBC) have been proposed as alternative risk control strategies, but a comprehensive financial comparison has not been conducted. STUDY DESIGN AND METHODS A Markov‐based decision tree was constructed to model the financial and clinical impact of PR, PORt, and SBC, as well as a baseline strategy involving routine testing only. Hospitals were assumed to acquire leukoreduced apheresis platelets on Day 3 after collection, and, in the base case analysis, expiration would occur at the end of Day 5 (PR and SBC) or 7 (PORt). Monte Carlo simulations assessed the direct medical costs for platelet acquisition, testing, transfusion, and possible complications. Input parameters, including test sensitivity and specificity, were drawn from existing literature, and costs (2018 US dollars) were based on a hospital perspective. RESULTS The total costs per unit acquired by the hospital under the baseline strategy, PR, PORt, and SBC were $651.45, $827.82, $686.33, and $668.50, respectively. All risk‐reduction strategies decreased septic transfusion reactions and associated expenses, with the greatest reductions from PR. PR would add $191.09 in per‐unit acquisition costs, whereas PORt and SBC would increase per‐unit testing costs by $31.79 and $17.26, respectively. Financial outcomes were sensitive to platelet dating; allowing 7‐day storage with SBC would lead to a cost savings of $12.41 per transfused unit. Results remained robust in probabilistic sensitivity analyses. CONCLUSIONS All three strategies are viable approaches to reducing bacterially contaminated platelet transfusions, although SBC is likely to be the cheapest overall.

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“…In this issue of TRANSFUSION, Bloch and colleagues demonstrate the feasibility and utility of implementing a secondary 5‐mL aerobic bacterial culture of apheresis PLTs on Day 3 after collection as an alternative to point‐of‐release testing. Cultures were performed by hospital blood bank staff using a sterile connection device and a sampling kit, and PLTs were stored for a maximum of 5 days.…”

Section: Methods Employed To Screen Apheresis Plts For Bacteriamentioning

confidence: 99%

More than one way to enhance bacterial detection in platelet components

Kamel

Goldman

2018

Transfusion

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Implementation of secondary bacterial culture testing of platelets to mitigate residual risk of septic transfusion reactions

Abstract: We demonstrate the feasibility of SBC of apheresis platelets to mitigate bacterial risk. SBC is lower cost than alternative measures (e.g., pathogen reduction and point-of-release testing) and can be integrated into workflow at hospital transfusion services.

Cited by 36 publications

References 28 publications

The epidemiology of bacterial culture–positive and septic transfusion reactions at a large tertiary academic center: 2009 to 2016

The epidemiology of bacterial culture–positive and septic transfusion reactions at a large tertiary academic center: 2009 to 2016

Financial impact of alternative approaches to reduce bacterial contamination of platelet transfusions

More than one way to enhance bacterial detection in platelet components

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