Fatal group C streptococcal infection due to transfusion of a bacterially contaminated pooled platelet unit despite routine bacterial culture screening

Authors

  • Fernanda Lessa,

    1. From the Epidemic Intelligence Service, Office of Workforce and Career Development, the Division of Healthcare Quality Promotion, and the Division of Bacterial Diseases, Coordinating Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; the Florida Department of Health, Tallahassee, Florida; the H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida; and Florida Blood Services, St Petersburg, Florida.
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  • German F. Leparc,

    1. From the Epidemic Intelligence Service, Office of Workforce and Career Development, the Division of Healthcare Quality Promotion, and the Division of Bacterial Diseases, Coordinating Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; the Florida Department of Health, Tallahassee, Florida; the H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida; and Florida Blood Services, St Petersburg, Florida.
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  • Kaaron Benson,

    1. From the Epidemic Intelligence Service, Office of Workforce and Career Development, the Division of Healthcare Quality Promotion, and the Division of Bacterial Diseases, Coordinating Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; the Florida Department of Health, Tallahassee, Florida; the H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida; and Florida Blood Services, St Petersburg, Florida.
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  • Roger Sanderson,

    1. From the Epidemic Intelligence Service, Office of Workforce and Career Development, the Division of Healthcare Quality Promotion, and the Division of Bacterial Diseases, Coordinating Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; the Florida Department of Health, Tallahassee, Florida; the H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida; and Florida Blood Services, St Petersburg, Florida.
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  • Chris A. Van Beneden,

    1. From the Epidemic Intelligence Service, Office of Workforce and Career Development, the Division of Healthcare Quality Promotion, and the Division of Bacterial Diseases, Coordinating Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; the Florida Department of Health, Tallahassee, Florida; the H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida; and Florida Blood Services, St Petersburg, Florida.
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  • Patricia L. Shewmaker,

    1. From the Epidemic Intelligence Service, Office of Workforce and Career Development, the Division of Healthcare Quality Promotion, and the Division of Bacterial Diseases, Coordinating Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; the Florida Department of Health, Tallahassee, Florida; the H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida; and Florida Blood Services, St Petersburg, Florida.
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  • Bette Jensen,

    1. From the Epidemic Intelligence Service, Office of Workforce and Career Development, the Division of Healthcare Quality Promotion, and the Division of Bacterial Diseases, Coordinating Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; the Florida Department of Health, Tallahassee, Florida; the H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida; and Florida Blood Services, St Petersburg, Florida.
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  • Matthew J. Arduino,

    1. From the Epidemic Intelligence Service, Office of Workforce and Career Development, the Division of Healthcare Quality Promotion, and the Division of Bacterial Diseases, Coordinating Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; the Florida Department of Health, Tallahassee, Florida; the H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida; and Florida Blood Services, St Petersburg, Florida.
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  • Matthew J. Kuehnert

    1. From the Epidemic Intelligence Service, Office of Workforce and Career Development, the Division of Healthcare Quality Promotion, and the Division of Bacterial Diseases, Coordinating Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; the Florida Department of Health, Tallahassee, Florida; the H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida; and Florida Blood Services, St Petersburg, Florida.
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  • This investigation was supported by the Office of Workforce and Career Development, Centers for Disease Control and Prevention.

  • Disclaimer: The findings and conclusions in this report are those of the authors and do not necessarily represent the views of the Department of Health and Human Services.

Fernanda Lessa, MD, MPH, 1600 Clifton Road NE, MS A-24, Atlanta, GA 30333, e-mail: flessa@cdc.gov.

Abstract

BACKGROUND: An elderly man with chronic myelomonocytic leukemia developed respiratory distress and died less than 48 hours after transfusion of a pool of eight whole blood–derived platelets (PLTs). Blood cultures from the recipient and cultures of remnants from the pooled PLT bag grew group C streptococci (GCS). An investigation was conducted to identify both the infection's source and the reasons for the false-negative screening result.

STUDY DESIGN AND METHODS: Red blood cell (RBC) units (cocomponent from the eight donations) were traced, quarantined, and cultured. Specimens from the implicated donor were obtained. Isolates were identified and typed by 16S rRNA and pulsed-field gel electrophoresis (PFGE). The blood center screening method was reviewed.

RESULTS: β-Hemolytic GCS, cultured from 1 of 8 RBC units, linked the fatal case to a single donor. The donor's throat swab collected 20 days after donation was positive for the presence of GCS, identified as Streptococcus dysgalactiae subsp. equisimilis. Isolates from the recipient, RBC unit, residual PLTs, and donor's throat swab were indistinguishable by PFGE. The donor denied any symptoms of infection before or after donation. PLT bacterial screening at the blood center was performed using a commercially available bacterial detection system (BacT/ALERT, bioMérieux) with a threshold of 15 colony-forming units per bag.

CONCLUSION: An asymptomatic donor was implicated as the source of GCS-contaminated PLTs. Current screening methods for PLTs are not sufficient to detect all bacterial contamination. Pooled PLTs are a particular challenge because the small volume of individual units places limits on culturing strategies. Improved detection of bacterial contamination of PLTs is needed.

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