Growth and endotoxin production of Yersinia enterocolitica and Enterobacter agglomerans in packed erythrocytes

Abstract

Since 1987, the Centers for Disease Control investigated six cases of transfusion-associated sepsis. All six patients developed septic shock after receiving units of packed erythrocytes (PRBCs) contaminated with Yersinia enterocolitica (five patients) and Enterobacter agglomerans (one patient); three of the blood recipients died. We studied the growth and endotoxin production of Y. enterocolitica and E. agglomerans in units of PRBCs stored at 4 degrees C for 60 days. When PRBCs were inoculated with 0.1 to 1.0 CFU of these organisms per ml, both Y. enterocolitica and E. agglomerans entered log-phase growth 2 to 3 weeks after inoculation; generation times were 15 and 22 h, respectively. Endotoxin was first detected at 3 weeks following inoculation, and the concentration paralleled the log phase of growth of the strains tested. These data show that prolonged storage of PRBCs at 4 degrees C provides conditions that allow these two organisms to grow and subsequently produce high concentrations of endotoxin.

Prevention ofYersinia enterocolitica,Pseudomonas fluorescens, andPseudomonas putidaoutgrowth in deliberately inoculated blood by a novel pathogen‐reduction process

“…7,8 Unlike other types of bacteria, psychrophilic species can proliferate during the storage of RBCs at 1 to 6ЊC from a very low (usually Յ1 CFU/mL) titers at the time of blood collection to clinically significant levels (>10 5 CFU/ mL). 9,10 Because transfusion of blood contaminated with bacteria is associated with severe adverse effects, the development of an effective pathogen-reduction process that would eradicate bacterial contamination would be an important advancement in transfusion safety.…”

Fatal Yersinia enterocolitica biotype 4 serovar O:3 sepsis after red blood cell transfusion

“…Because adverse reactions to blood transfusion due to bacterial contamination are rare, the real incidence of posttransfusion sepsis is largely unknown in most countries. 1,4,[11][12][13][14][15] In the United States, the incidence of Y. enterocolitica -related septic shock was estimated to be one case per 23.7 million RBC units distributed between 1998 and 2000. 16 Cases of septic shock due to Y. enterocolitica appear to be much more frequent in New Zealand.…”

Transfusion reaction due to Klebsiella pneumoniae‐contaminated red blood cells: a case report

“…Testing for bacterial contamination of rbc concentrates yielded confirmed positive results in 0·03% in a German study performed in 1995-1996(Walther-Wenke, 2008), current contamination rates for platelets are measured to be at 1 : 2000 transfused platelet products (Yomtovian et al, 2006). Some enterobacteria are able to proliferate even at temperatures considered adequate for rbc storage (Arduino et al, 1989). Organisms involved in sepsis resulting from erythrocyte transfusions are particularly Yersinia enterocolitica (51·0%), Pseudomonas species (30·6%), Treponema pallidum (4·1%) and other species (14·3%) (Wagner et al, 1994).…”