Routine Cultures of Bone Marrow and Peripheral Stem Cell Harvests: Clinical Impact, Cost Analysis, and Review

Abstract

The American Association of Blood Banks requires routine culture of hematopoietic progenitor cells prior to bone marrow transplantation. We sought to evaluate the cost of that requirement and the incidence and clinical significance of positive cultures. We performed a retrospective analysis of transplant recipients at our institution. Of the 605 patients for whom 1,934 consecutive cultures of harvests were done between December 1992 and February 1996, 11 had positive cultures. Six patients received a culture-positive harvest with no adverse effects. The total cost of cultures was $35,660 (U.S. $). In North America and worldwide in 1995, routine culture of harvests would have prevented 7.9 and 18.9 cases of bacteremia, respectively, at a cost of $95,000 per bacteremia prevented. We conclude that routine culture of hematopoietic progenitor cells yields low rates of positivity and that infusion of contaminated harvests rarely results in clinically adverse outcomes.

Microbial contamination of hematopoietic progenitor cell products: clinical outcome

“…All autologous transplant patients had neutrophil recovery at a median of 10 days (range, [8][9][10][11][12][13][14]. Among the allogeneic transplant patients, all but one engrafted in a median of 13 days (range, 5-21).…”

“…7,8 Several small studies have reported favorable outcomes after infusion of contaminated products with minimal clinical consequences. [9][10][11] The US Food and Drug Administration (FDA) has recently established new rules for 'current good tissue practice for manufacturers of human cellular and tissue-based products', in which they describe a risk of 2.4% for contamination and raise concerns that there was a high rate of morbidity and mortality after receiving a contaminated product. 12 In this report, we retrospectively studied the outcomes of transplantation involving contaminated HPC product infusions performed during a 6-year period in a single institution.…”

Bacteremia after hematopoietic stem cell transplantation: incidence and predictive value of surveillance cultures

“…[4][5][6][7][8][23][24][25][26] Our study shows that routine surveillance cultures can predict the etiology of a bacteremia in 50% of cases. For coagulase-negative staphylococci, the predictive value of such cultures is, in fact, quite low because of the very high rate of colonization observed in our patients (77%).…”

Influence of harvest bacterial contamination on autologous peripheral blood progenitor cells post-transplant

“…The administration of contaminated progenitor cell grafts has been claimed to be harmless by several authors, whether or not prophylactic antibiotics are used. 6,[13][14][15][16][17][18] There are few studies on the effects of contaminated APBPCTs post-transplant apart from documented infection episodes. 9 It is important to know how the infusion of infected products affects the patient's post-transplant course.…”