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Microbial contamination of hematopoietic progenitor cell grafts—incidence, clinical outcome, and cost‐effectiveness: an analysis of 735 grafts
Author(s) -
Kamble Rammurti,
Pant Shubham,
Selby George B.,
KharfanDabaja Mohamed A.,
Sethi Sanjay,
Kratochvil Kristen,
Kohrt Nancy,
Ozer Howard
Publication year - 2005
Publication title -
transfusion
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.045
H-Index - 132
eISSN - 1537-2995
pISSN - 0041-1132
DOI - 10.1111/j.1537-2995.2005.04178.x
Subject(s) - medicine , enterobacter cloacae , antibiotics , cord blood , surgery , progenitor cell , incidence (geometry) , vancomycin , hematopoietic stem cell transplantation , bone marrow , staphylococcus aureus , transplantation , stem cell , microbiology and biotechnology , bacteria , biology , klebsiella pneumoniae , biochemistry , genetics , physics , optics , escherichia coli , gene
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.