Posttransfusion Sepsis Attributable to Bacterial Contamination in Platelet Collection Set Manufacturing Facility, United States

Abstract

During May 2018‒December 2022, we reviewed transfusion-transmitted sepsis cases in the United States attributable to polymicrobial contaminated apheresis platelet components, including Acinetobacter calcoaceticus‒baumannii complex or Staphylococcus saprophyticus isolated from patients and components. Transfused platelet components underwent bacterial risk control strategies (primary culture, pathogen reduction or primary culture, and secondary rapid test) before transfusion. Environmental samples were collected from a platelet collection set manufacturing facility. Seven sepsis cases from 6 platelet donations from 6 different donors were identified in patients from 6 states; 3 patients died. Cultures identified Acinetobacter calcoaceticus‒baumannii complex in 6 patients and 6 transfused platelets, S. saprophyticus in 4 patients and 4 transfused platelets. Whole-genome sequencing showed environmental isolates from the manufacturer were closely related genetically to patient and platelet isolates, indicating the manufacturer was the most probable source of recurrent polymicrobial contamination. Clinicians should maintain awareness of possible transfusion-transmitted sepsis even when using bacterial risk control strategies.

Keywords: Acinetobacter calcoaceticus‒baumannii complex; Staphylococcus saprophyticus; United States; bacteria; bacterial contamination; blood safety; blood transfusions; manufacturing facility; platelet collection set; platelets; posttransfusion sepsis.

Figure 1

Investigation timeline of transfusion-transmitted sepsis cases and key events for bacterial contamination in platelet collection set manufacturing facilities, United States, 2018–2022. CDC, Centers for Disease Control and Prevention; EIN, Emerging Infections Network; Epi-X, Epidemic Information Exchange; FDA, Food and Drug Administration; MMWR, report published in Morbidity and Mortality Weekly Report (9).

Figure 2

Platelet components contaminated with Acinetobacter spp. or Staphylococcus saprophyticus identified from cases of transfusion-transmitted bacterial sepsis or routine bacterial testing before transfusion, United States, 2018–2022.

Figure 3

Whole-genome sequencing of Staphylococcus saprophyticus (A) and ACBC (B) isolates implicated in the bacterial contamination of platelet blood products, United States, 2018–2022. Maximum-likelihood phylogenies based on core genes were generated by using Roary (https://github.com/sanger-pathogens/Roary) and RaxML (https://cme.h-its.org); phylogenetic trees were midpoint rooted. Clusters were identified based on SNVPhyl (https://snvphyl.readthedocs.io) and highlighted if they included isolates linked to a sepsis transfusion case. Acinetobacter spp. isolates not falling in the ACBC were also included. Black circles on branches indicate 100% support for the branch of 100 bootstraps. US states are identified by 2-letter postal codes. Scale bars indicate nucleotide substitutions per site. ACBC, Acinetobacter calcoaceticus–baumannii complex; DR, Dominican Republic; PAS, platelet additive solution; PR, Puerto Rico.

Figure 4

Public ACBC shown with study isolates from investigation of bacterial contamination of platelet blood products, United States, 2018–2022. Shown is a RaxML (https://cme.h-its.org)‒generated phylogeny based on core genes of genomes from ACBC isolates from this study compared with all A. calcoaceticus, A. lactucae, and A. seifertii and a subsampled set of A. baumannii, A. nosocomialis, and A. pittii genomes from the National Center for Biotechnology Information RefSeq (https://www.ncbi.nlm.nih.gov/refseq) database, along with all Staphylococcus saprophyticus from the RefSeq database. Isolate location, isolate source, and species from National Center for Biotechnology Information database along with all S. saprophyticus isolates or by average nucleotide identity were layered onto the phylogeny. Pink and green indicate the 2 clusters from Figure 3, panel B. Black circles on branches indicate 100% support for the branch of 100 bootstraps. US states are identified by 2-letter postal codes. Scale bar indicates nucleotide substitutions per site. ACBC, Acinetobacter calcoaceticus-baumannii; DR, Dominican Republic.

Figure 5

Public Staphylococcus saprophyticus genomes and study isolates from investigation of bacterial contamination of platelet blood products, United States, 2018–2022. Shown is a RaxML (https://cme.h-its.org)‒generated phylogeny based on 1,808 core genes of all S. saprophyticus isolates from this study and all S.saprophyticus genomes from the National Center for Biotechnology Information RefSeq (https://www.ncbi.nlm.nih.gov/refseq) database. Isolate location, isolate source, and species from National Center for Biotechnology Information or by average nucleotide identity were layered onto the phylogeny. Light orange, blue, and purple indicate the 3 clusters from Figure 3, panel A. Black circles on branches indicate 100% support for the branch of 100 bootstraps. US states are identified by 2-letter postal codes. Scale bar indicates nucleotide substitutions per site. DR, Dominican Republic; PR, Puerto Rico.