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LETTERS TO EDITOR
Year : 2019  |  Volume : 63  |  Issue : 7  |  Page : 597-598  

Transfusion transmitted bacterial infection due to a rare organism


1 Department of Anaesthesiology, Muthumeenakshi Hospitals, Pudukkottai, Tamil Nadu, India
2 Department of Anaesthesiology, Kauvery Hospitals, Trichy, Tamil Nadu, India
3 Department of Anaesthesiology, University of Monitoba, Winnipeg, Canada

Date of Web Publication12-Jul-2019

Correspondence Address:
Dr. Khaja Mohideen Sherfudeen
Department of Anaesthesiology, Muthumeenakshi Hospitals, South 4th Street, Pudukkottai - 622 001, Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ija.IJA_127_19

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How to cite this article:
Sherfudeen KM, Kaliannan SK, Chidambaram M V, Jeyakumar SM. Transfusion transmitted bacterial infection due to a rare organism. Indian J Anaesth 2019;63:597-8

How to cite this URL:
Sherfudeen KM, Kaliannan SK, Chidambaram M V, Jeyakumar SM. Transfusion transmitted bacterial infection due to a rare organism. Indian J Anaesth [serial online] 2019 [cited 2019 Oct 15];63:597-8. Available from: http://www.ijaweb.org/text.asp?2019/63/7/597/262604



Sir,

Allogeneic blood for transfusion is a potential source of infection by a variety of known and unknown transmissible agents.[1] Transfusion-associated bacterial sepsis is caused more frequently by contaminated platelets than by red cell components.[2] Gram negative organisms are implicated in greater number of fatalities than gram positive organisms.[2],[3]

A 16-year-old girl was posted for tonsillectomy. Preoperative packed red blood cell(PRBC) transfusion was planned as her haemoglobin was 7.1 g%. Soon after starting PRBC(using a standard blood transfusion set with 170–260 μ filters) she started vomiting. Blood transfusion was stopped immediately, and clerical errors were ruled out. Expiry date on the PRBC bag was checked and it was prepared one day earlier. Slow PRBC transfusion was restarted with intense monitoring. Towards the end of transfusion patient became drowsy. Transfusion was stopped, blood remaining in the blood bag(along with transfusion set) was sent for culture. She was shifted to critical care unit, where she developed hypoxaemia, hypotension, tachycardia and fever. Her condition deteriorated, and she became more hypoxaemic and agitated. Sedation, intubation, mechanical ventilation and vasoactive support were initiated. She was started on piperacillin-tazobactam, flucanozole and corticosteroids. Indirect Coombs test was negative and there was no evidence of any haemolytic transfusion reaction. The following day haemoglobin was 8.9 g%, white cell count 28700cells/mm3, and platelet count was 88000cells/mm. Renal and liver function tests were mildly deranged, lactate dehydrogenase was 659 units/L, and Haptoglobin was normal. On day 3, she was sedated and icteric. Her pupils were 2.5mm, bilaterally equal and reacting to light. She developed petechial rashes over arm with oral bleeding and temperature spikes. She required noradrenaline and dopamine. Although her complete blood count and liver functions had worsened, her renal function was preserved. C-reactive protein was 167mg/L, procalcitonin>100ng/ml, International normalised ratio–2.13, fibrinogen–1.63g/L, fibrin degradation products 25mg/L, and d-dimer 48258ng/ml. The antibiotic cover was broadened to include meropenem and repeat blood culture sent. Haemoglobin and coagulation optimisation required 2 PRBC, 1L fresh frozen plasma(FFP), 4 platelets. Preliminary culture report of blood from donor bag showed the growth of gram-negative bacilli. The final culture and sensitivity report of both donor bag and patient blood was  Stenotrophomonas maltophilia Scientific Name Search ive to cotrimoxazole, doxycycline, levofloxacin, ceftazidime, chloramphenicol and resistant to meropenam and imipenem. Doxycycline and levofloxacin were started and previous antibiotics were stopped. Clinical and biochemical parameters started improving. Tracheostomy was done on day 9. Patient was weaned from ventilator and shifted to ward by day 14.

We encountered transfusion related sepsis due to a rare organism, Stenotrophomonas maltophilia. Only one case of transfusion related sepsis due to Stenotrophomonas maltophilia is reported in literature before.[3] S. maltophilia is a globally emerging Gram-negative bacillus that is widely spread in community and hospital environment. It can cause various serious(community and hospital acquired) infections in humans. It is associated with wet surfaces and aqueous solutions. It is able to survive with minimal nutrients, e.g.,in drinking water, ultrapure water, treated water and dialysate effluent. In response to starvation or stress, S. maltophilia forms ultramicrocells (0.1 to 0.2 μ) that can pass through a 0.2 μ filter. Another significant feature of S. maltophilia is its ability to adhere to plastics and form biofilms.

S. maltophilia has been identified on the surfaces of materials used in intravenous cannulae, prosthetic devices, dental unit waterlines, and nebuliser. S. maltophilia is found to survive water treatment process and missed by routine heterotrophic plate counts detection method. It is identified only by PCR-denaturing gradient gel electrophoresis.[4]

In our patient, both the PRBC bag and patient blood sample had S. maltophilia. Contamination of the PRBC bag from blood donor is rare as the donor with prior infections are rejected by pre donor counseling and questionnaire. Contamination of PRBC bag from the hands of healthcare personnel either at the time of blood collection or during transfusion is also possible. The blood bank was alerted for screening of other blood components and water supply systems. Cultures were also sent from aqueous related environment from the hospital ward. S. maltophilia undergoes higher rates of mutation and shows resistance to wide array of antibiotics.[4] In our case it was resistant to carbapenems but sensitive to doxycycline, levofloxacin, chloramphenicol, co-trimoxazole and ceftazidime and responded to these antibiotics.

Apart from routine education and hand hygiene techniques for healthcare personnel, regular screening of aqueous-associated environments in the hospital should be done to prevent S. maltophilia growth and infection.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
BrecherME, HaySN. Bacterial contamination of blood components. Clin Microbiol Rev 2005;18:195-204.  Back to cited text no. 1
    
2.
WagnerSJ. Transfusion-transmitted bacterial infection: Risks, sources and interventions. Vox Sang 2005;88:60.  Back to cited text no. 2
    
3.
FunkMB, LohmannA, GuenayS, HenselerO. Transfusion-transmitted bacterial infections - Haemovigilance data of German blood establishments(1997-2010). Transfus Med Hemother 2011;38:266-71.  Back to cited text no. 3
    
4.
BrookeJS. Stenotrophomonas maltophilia: An emerging global opportunistic pathogen. Clin Microbiol Rev 2012;25:2-41.  Back to cited text no. 4
    




 

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