title: Serratia marcescens strains implicated in adverse transfusion reactions form biofilms in platelet concentrates and demonstrate reduced detection by automated culture.
abstract: OBJECTIVE
  Serratia marcescens is a gram-negative bacterium that has been implicated in adverse transfusion reactions associated with contaminated platelet concentrates. The aim of this study was to investigate whether the ability of S. marcescens to form surface-attached aggregates (biofilms) could account for contaminated platelet units being missed during screening by the BacT/ALERT automated culture system.
  
  
  METHODS
  Seven S. marcescens strains, including biofilm-positive and biofilm-negative control strains and five isolates recovered from contaminated platelet concentrates, were grown in enriched Luria-Bertani medium and in platelets. Biofilm formation was examined by staining assay, dislodging experiments and scanning electron microscopy. Clinical strains were also analysed for their ability to evade detection by the BacT/ALERT system.
  
  
  RESULTS
  All strains exhibited similar growth in medium and platelets. While only the biofilm-positive control strain formed biofilms in medium, this strain and three clinical isolates associated with transfusion reactions formed biofilms in platelet concentrates. The other two clinical strains, which had been captured during platelet screening by BacT/ALERT, failed to form biofilms in platelets. Biofilm-forming clinical isolates were approximately three times (P<0·05) more likely to be missed by BacT/ALERT screening than biofilm-negative strains.
  
  
  CONCLUSIONS
  S. marcescens strains associated with transfusion reactions form biofilms under platelet storage conditions, and initial biofilm formation correlates with missed detection of contaminated platelet concentrates by the BacT/ALERT system.
authors.affiliation: Canadian Blood Services, Ottawa, ON, Canada.
authors.forename: V S
authors.initials: VS
authors.lastname: Greco-Stewart
authors.forename: E E
authors.initials: EE
authors.lastname: Brown
authors.forename: C
authors.initials: C
authors.lastname: Parr
authors.forename: M
authors.initials: M
authors.lastname: Kalab
authors.forename: M R
authors.initials: MR
authors.lastname: Jacobs
authors.forename: R A
authors.initials: RA
authors.lastname: Yomtovian
authors.forename: S M
authors.initials: SM
authors.lastname: Ramírez-Arcos
mesh_terms: D018441:Biofilms / Q000254:growth & development*; D001792:Blood Platelets / Q000382:microbiology* / Q000648:ultrastructure; D001793:Blood Preservation; D015169:Colony Count, Microbial / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D017713:Platelet Transfusion / Q000009:adverse effects*; D016868:Serratia Infections / Q000097:blood / Q000382:microbiology / Q000635:transmission; D012706:Serratia marcescens / Q000254:growth & development* / Q000302:isolation & purification* / Q000648:ultrastructure