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


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.


CONCLUSIONS
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.
Kamble
Rammurti
R
Section of Hematology-Oncology and Bone Marrow Transplantation, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma 73104, USA. Rammurti-kamble@ouhsc.edu
Pant
Shubham
S
Selby
George B
GB
Kharfan-Dabaja
Mohamed A
MA
Sethi
Sanjay
S
Kratochvil
Kristen
K
Kohrt
Nancy
N
Ozer
Howard
H
D000890:Anti-Infective Agents / Q000627:therapeutic use; D019072:Antibiotic Prophylaxis; D001424:Bacterial Infections / Q000188:drug therapy / Q000191:economics* / Q000453:epidemiology* / Q000382:microbiology / Q000517:prevention & control / Q000635:transmission; D001854:Bone Marrow Cells / Q000382:microbiology; D002939:Ciprofloxacin / Q000627:therapeutic use; D003362:Cost-Benefit Analysis; D005312:Fetal Blood / Q000382:microbiology; D018380:Hematopoietic Stem Cell Transplantation; D006412:Hematopoietic Stem Cells / Q000382:microbiology*; D006801:Humans; D015994:Incidence; D012189:Retrospective Studies; D013048:Specimen Handling; D016896:Treatment Outcome
D000890:Anti-Infective Agents; D002939:Ciprofloxacin