编者按：这是来自于最新美国血液学会年会上报告，提到了被我们忽视的问题，这篇研究对促进造血干细胞移植有一定的帮助
Bacterial Contamination of Hematopoietic Stem Cell Transplants.
Alexander S.B. Platz, Peter Wernet, Ulrich Kiesel, Johannes Fischer University Medical Center, Institute for Transplantation Diagnostics and Cell Therapeutics, Duesseldorf, Germany
Purpose : Bacterial contamination (bc) of blood products may represent a serious risk for allogeneic stem cell transplant recipients. Thus, we have retrospectively analyzed transplant outcome in cases of bc. Methods : As a standard procedure all allogeneic peripheral blood progenitor cell (PBPC) and bone marrow (BM) products of the ITZ are regularly tested for bc. In case of a positive result the corresponding transplant centre is informed about specifity and antibiotic sensitivity. All centres were requested to send back a questionnaire to the ITZ 30 and 90 days after transplantation. Results : Between 1997 and 2002 823 PBPC and 87 BM produced in the ITZ were analyzed. 17/823 (2,0%) PBPC and 13/87 (14,6%) BM were tested positive for bc. Microbial contamination included coagulase-negative staphylococci (cns) (n=8), staphylococci aurei (sa) (n=3), peptococci (n=2), micrococci, corynebacteria, streptococcus viridans, enterococcus faecium (each 1) in the PBPC group and cns (n=10), microaerophile streptococci, peptococci, sa (each 1) in the BM group. All donors were free of clinically apparent infection at time of collection. Overall 14/17 of PBPC (82,3%) and 9/11 of BM (81,8%) recipients had no signs of systemical infection or sepsis. Cause of infection was aspergillosis, CMV, staphylococci, no specifity found (each 1) in the PBPC group and aspergillosis, no specifity found (each 1) in the BM group, leading to a state of sepsis in between 30 days after transplantation. Importantly in no case the infection with bacterial contaminants of the transplant could be shown. Conclusion : Clinical infection caused by contaminated transplants is not inevitable. Our follow-up data , however, indicate that bc of transplants was not of serious clinical relevance in this large patient cohort. Reasons may include the low number of organisms, short storage-time and prophylaxis with antibiotics at time of transplantation. Most of bacteria found are classified as part of the skin flora and are suspicious of secondary contamination. Nevertheless, any bc in transplants must be avoided by skin desinfection, diversion of the initial volume after phlebotomy and any product manipulation must be performed accurately.
Abstract #5529 appears in Blood, Volume 102, issue 11, November 16, 2003
