Management of Micrococcus Contamination in Transfused Blood
When Micrococcus contamination is identified in transfused blood, the transfusion should be immediately discontinued, blood cultures should be obtained from both the patient and the blood product, and antibiotic treatment should be initiated, particularly in neutropenic patients. 1
Immediate Actions
- Stop the transfusion immediately upon suspecting bacterial contamination, which may present as fever, chills, hypotension, or other signs of a transfusion reaction 2
- Maintain intravenous access with normal saline for medication administration and fluid resuscitation 2
- Contact the transfusion laboratory immediately and send the blood unit with administration set for investigation 2
- Obtain blood cultures from the patient and from the suspected contaminated blood product 1
- Monitor vital signs closely, including heart rate, blood pressure, temperature, and respiratory rate 2
Diagnostic Confirmation
- Diagnosis of catheter-related bloodstream infection (CRBSI) due to Micrococcus requires at least 2 positive results of blood cultures performed on samples obtained from different sites 1
- Aseptic collection of as much body fluid as possible by needle aspiration or surgical procedures is recommended for accurate diagnosis 1
- Swabs are not recommended for sample collection as they often result in limited culture material 1
Treatment Approach
- Initiate empiric antibiotic therapy promptly, especially in neutropenic patients 1
- For patients with a short-term central venous catheter (CVC), catheter removal is indicated 1
- For patients with an infected long-term catheter or implanted port, catheter removal is indicated unless there are no alternative intravascular access sites 1
- CRBSIs due to Micrococcus species are difficult to treat successfully unless the infected catheter is removed 1
Special Considerations
- A high incidence of CRBSI due to Micrococcus species has been reported among patients treated for pulmonary arterial hypertension with continuous epoprostenol 1
- Bacterial contamination of blood products, especially platelets, is a longstanding problem that has been partially controlled through modern phlebotomy practices 3
- Bacterial contamination is considered the second most common cause of death overall from transfusion (after clerical errors) 3
Prevention Strategies
- Blood banks have implemented measures to reduce the risk of bacterial contamination, including improved donor skin disinfection and removal of first aliquot of donor blood 3, 4
- Commercial methods of pathogen reduction using UV irradiation after incubation with a photosensitizer have been developed and approved in the United States and the European Union 1
- Storage time from collection to transfusion is limited to 5 days, though in some jurisdictions this can be extended to 7 days if approved tests for bacterial detection or pathogen reduction technologies are used 1
Reporting Requirements
- Suspected transfusion-associated transmission of bacterial contamination should be reported as early as possible to the blood product supplier and public health authorities 1
- Early reporting is essential in facilitating timely tracking and quarantining of potentially infectious co-components and notification of the infected donor and blood product recipients 1
- If a recent blood donor develops symptoms of infection, the blood bank should be notified so that donated blood can be appropriately quarantined or recalled 1
Common Pitfalls
- General anesthesia may mask the symptoms of both hemolytic and nonhemolytic transfusion reactions 2
- Diagnosis of a transfusion reaction during ongoing hemorrhage may be difficult 2
- Many transfusion reactions due to bacterial contamination are probably misdiagnosed or overlooked, resulting in underestimation of the extent of the problem 5
- Bacterial contamination can present with similar symptoms to Transfusion-Associated Circulatory Overload (TACO) and Transfusion-Related Acute Lung Injury (TRALI), and should be considered in the differential diagnosis 6