Microbial contamination of hematopoietic progenitor cell grafts-incidence, clinical outcome, and cost-effectiveness: an analysis of 735 grafts

TitleMicrobial contamination of hematopoietic progenitor cell grafts-incidence, clinical outcome, and cost-effectiveness: an analysis of 735 grafts
Publication TypeJournal Article
Year of Publication2005
AuthorsKamble R, Pant S, Selby GB, Kharfan-Dabaja MA, Sethi S, Kratochvil K, Kohrt N, Ozer H
JournalTransfusion
Volume45
Issue6
Pagination874 - 8
Date PublishedJun
ISSN0041-1132 (Print) 0041-1132 (Linking)
Accession Number15934984
Keywords*Hematopoietic Stem Cell Transplantation, *Incidence, Anti-Infective Agents / therapeutic use, Antibiotic Prophylaxis, Bacterial Infections / drug, Bone Marrow Cells / microbiology, Ciprofloxacin / therapeutic use, control / transmission, Cost-Benefit Analysis, Fetal Blood / microbiology, Hematopoietic Stem Cells / *microbiology, Humans, Retrospective Studies, Specimen Handling, therapy / *economics / *epidemiology / microbiology / prevention &, Treatment Outcome
Abstract

BACKGROUND: Screening of progenitor cell grafts (marrow, peripheral blood, and cord blood) for microbial contamination is required by the standards of AABB. Clinical sequelae from infusion of these contaminated grafts, however, is uncommon. STUDY DESIGN AND METHODS: A retrospective analysis of 735 consecutive marrow and peripheral blood progenitor cell harvests between 1998 and 2003 was performed. Analysis included incidence, clinical outcome, and cost outcomes of positive blood cultures and antibiotic therapy. RESULTS: Thirty-three of 735 (4.5%) harvests were contaminated. The incidence of microbial contamination varied with the source of the graft (4 of 26 [15%] were cord blood, 8 of 177 [4.5%] were marrow, and 21 of 532 [3.9%] were peripheral blood). Coagulase-negative Staphylococcus (n=22) and Propionibacterium acnes (n=8) were most frequently isolated. Potentially pathogenic organisms were isolated in 6 of 735 (0.81%) grafts (methicillin-sensitive Staphylococcus aureus, 4; methicillin-resistant S. aureus, 1; and Enterobacter cloacae, 1). The estimated total cost of surveillance was approximately $81,585. The cost of vancomycin therapy in 4 patients who received prophylactic antibiotic therapy was approximately $10,000. No adverse sequelae followed infusion of contaminated grafts. CONCLUSION: Clinical sequelae following infusion of microbially contaminated progenitor cells is extremely rare. Prophylactic empiric antibiotics may be unnecessary. Routine microbial surveillance of progenitor cell grafts is a low-yield procedure.

DOI10.1111/j.1537-2995.2005.04178.x
Alternate JournalTransfusion
Notify Library Reference ID752

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