Saori Miura

Outbreak of extended-spectrum β-lactamase-producing Escherichia coli transmitted through breast milk sharing in a neonatal intensive care unit

BACKGROUND Routine surveillance in a neonatal intensive care unit (NICU) showed an increased detection of extended-spectrum β-lactamase (ESBL)-producing Escherichia coli (ESBL-E. coli) in August 2012, following nearly a year without detection. AIM To describe the investigation and interventions by a hospital infection control team of an outbreak of ESBL-E. coli in a NICU. METHODS Six neonates with positive cultures of ESBL-E. coli (five with respiratory colonization, one with a urinary tract infection), control infants who were negative for ESBL-E. coli during the study period, and mothers who donated their breast milk were included. A case-control study was performed to identify possible risk factors for positive ESBL-E. coli cultures and molecular typing of isolated strains by pulsed-field gel electrophoresis. FINDINGS The odds ratio for ESBL-E. coli infection after receiving shared unpasteurized breast milk during the study period was 49.17 (95% confidence interval: 6.02-354.68; P < 0.05). The pulsed-field gel electrophoresis pattern showed that all strains were identical, and the same pathogen was detected in freshly expressed milk of a particular donor. After ceasing the breast milk sharing, the outbreak was successfully terminated. CONCLUSION This outbreak indicates that contamination of milk packs can result in transmission of a drug-resistant pathogen to newborn infants. Providers of human breast milk need to be aware of the necessity for low-temperature pasteurization and bacterial cultures, which should be conducted before and after freezing, before prescribing to infants.

Hemolytic disease of the newborn due to anti-Dib : a case study and review of the literature

BACKGROUND:  The severity of hemolytic disease of the newborn (HDN) due to Diegob (Dib) mismatch ranges from no symptoms to severe jaundice that requires exchange transfusion (ET). The clinical significance of anti‐Dib is incompletely recognized.

Delayed and acute hemolytic transfusion reactions resulting from red cell antibodies and red cell–reactive HLA antibodies

BACKGROUND: It has been controversial whether HLA antibodies cause hemolytic transfusion reactions (HTR) or shortened red blood cell (RBC) survival. A patient is reported who had two episodes of HTR, the latter of which was likely due to RBC‐reactive HLA antibodies.

Efficacy of 1.0% chlorhexidine-gluconate ethanol compared with 10% povidone-iodine for long-term central venous catheter care in hematology departments: a prospective study.

The efficacy of 1% chlorhexidine-gluconate ethanol and 10% povidone-iodine for skin antisepsis of central venous catheter (CVC) sites were compared among hematology patients. The CVC site colonization rates of those groups were 11.9% and 29.2%, respectively, and the catheter-associated blood stream infections were 0.75 and 3.62 per 1,000 catheter-days, respectively. One percent chlorhexidine-gluconate ethanol was superior to povidone-iodine to reduce skin colonizers at CVC sites even when catheters were used for long duration.

Increased detection of clinically significant antibodies and decreased incidence of delayed haemolytic transfusion reaction with the indirect antiglobulin test potentiated by polyethylene glycol compared to albumin: a Japanese study

BACKGROUND The indirect antiglobulin test (IAT) can be potentiated by agents such as polyethylene glycol (PEG-IAT) and albumin (Alb-IAT). PEG-IAT is generally regarded as superior to Alb-IAT for the detection of clinically significant red blood cell (RBC) antibodies. However, supporting data come from Caucasian-dominant populations. Non-Caucasian populations should be investigated as well. MATERIAL AND METHODS In this single-centre, retrospective, sequential study, Alb-IAT was used from 1989 to 1996 (8 years) and PEG-IAT from 1997 to 2008 (12 years). Pre-transfusion RBC alloantibody detection rates and specificity, post-transfusion alloantibody production, and the incidence of delayed haemolytic transfusion reaction were assessed and compared for the two periods. RESULTS Although overall RBC alloantibody detection rates were comparable, PEG-IAT more frequently detected clinically significant antibodies such as anti-E, anti-Fy(b), and anti-Jk(a), and less frequently detected insignificant antibodies such as anti-Le(b) and anti-P(1). New alloantibodies emerged comparably during the two periods. Delayed haemolytic transfusion reaction was less frequent during the PEG-IAT period (0.30% versus 0.12%, p<0.05). CONCLUSION PEG-IAT was superior in the detection of clinically significant antibodies, reduced the detection of insignificant antibodies, and prevented delayed haemolytic transfusion reaction better than Alb-IAT among Japanese transfusion recipients in this retrospective survey of limited power.

Second Japanese case of neonatal alloimmune thrombocytopenia due to anti-human platelet antigen-5a

Takashi Imamura, Yoshinobu Honda, Hiromichi Ariga, Tsutomu Ishii, Saori Miura and Hitoshi Ohto General Center for Perinatal Medicine, Fukushima Medical University Hospital, Center for Perinatal Medicine, National Hospital Organization Fukushima Hospital, Division of Blood Transfusion and Transplantation Immunology, Fukushima Medical University Hospital, Fukushima and Department of Premature and Neonatal Medicine, Iwaki Kyoritsu General Hospital, Iwaki, Japan

Transfusion-related alloimmunization to red cell antigens among pediatric recipients

Aims: Alloimmune response to red cell transfusion has not been widely investigated in pediatric patients. We retrospectively compared the frequency and specificity of red cell antibody formation among pediatric recipients grouped by age, versus an adult control cohort. Methods: A total of 331 pediatric red cell transfusion recipients were studied in four age groups: 0 to 4.9 months (Group A), 5.0 to 11.9 months (Group B), 1.0 to 5.9 years (Group C), and 6.0 to 14.9 years (Group D). Similarly transfused adult males, 20.0 to 59.9 years old, as a control cohort group. Alloimmunization was defined as posttransfusion detection of red cell alloantibodies not detected prior to transfusion. Results: After red cell transfusion, no one in Group A (0 of 106) developed alloantibodies, whereas 8.0% (2 of 25) Maiko Abe1, Hitoshi Ohto1, Keiji Minakawa1, Kinuyo Kawabata1, Satoshi Ono1, Nozomi Takano1, Hiroe Suzuki1, Mao Watanabe1, Akiko Sugawara1, Masami Kikuchi1, Saori Miura1, Chikako Takeuchi-Baba1, Hiroyasu Yasuda1, Kenneth E. Nollet1, Yoshiko Tamai2, Junichi Kitazawa1,3, Kazuhiko Ikeda1 Affiliations: 1Department of Blood Transfusion and Transplantation Immunology, Fukushima Medical University Hospital, Fukushima, Japan; 2Division of Blood Transfusion Medicine, Hirosaki University Hospital, Hirosaki, Japan; 3Department of Clinical Laboratory, Aomori Prefectural Central Hospital, Aomori, Japan. Corresponding Author: Hitoshi Ohto, MD, PhD, Department of Blood Transfusion and Transplantation Immunology and Department of Advanced Cancer Immunology, Fukushima Medical University, Fukushima City, Fukushima-960-1295, Japan; Email: hit-ohto@fmu.ac.jp Received: 17 March 2018 Accepted: 10 May 2018 Published: 07 June 2018 in Group B, 1.1% (1 of 95) in Group C, and 2.9% (3 of 105) in Group D, versus 2.1% (8 of 380) of adult male controls who developed alloantibodies. However, these differences did not achieve statistical significance. Conclusion: This investigation of alloimmunization in pediatric recipients found no cases in patients younger than five months old, however, the incidence rates of older age groups were statistically indistinguishable from a control cohort of male adults. Until larger studies suggest otherwise, current antibody screening and cross-matching policies should be continued.

Shortened antibody screening interval has decreased the incidence of delayed hemolytic transfusion reactions

Aims: To ascertain the effects of allowable sampling time prior to red cell transfusion when screening for alloantibodies, we compared antibody detection rates and frequencies of delayed hemolytic transfusion reactions (DHTRs) among patients drawn within two weeks versus patients drawn within one week of transfusion. Methods: Alloantibody screening for 32,601 patients from January 1997 through August 2006 was done within two weeks of transfusion, and for 44,896 patients from September 2006 through March 2017 was done within one week. Among transfusion recipients, 6,234 screened within two weeks and 8,066 screened within one week were evaluated for DHTR. Results: Alloantibodies were detected in 1.2% of cases screened within two weeks and in 1.3% of cases Nozomi Takano1, Hiroyasu Yasuda1, Masami Kikuchi1, Kinuyo Kawabata1, Chikako Takeuchi-Baba1, Satoshi Ono1, Takako Ono1, Keiji Minakawa1, Akiko Sugawara1, Saori Miura1, Kazuya Watanabe1, Maiko Abe1, Hiroe Suzuki1, Mao Watanabe1, Mutsumi Sasaki1, Kazuhiko Ikeda1, Kenneth E. Nollet1, Hitoshi Ohto1,2 Affiliations: 1Department of Blood Transfusion and Transplantation Immunology, Fukushima Medical University Hospital, Fukushima, Japan; 2Department of Advanced Cancer Immunotherapy, Fukushima Medical University, Fukushima, Japan. Corresponding Author: Hitoshi Ohto, MD, PhD, Department of Blood Transfusion and Transplantation Immunology, Fukushima Medical University School of Medicine, Fukushima City, Fukushima 960-1295, Japan; Email: hit-ohto@ fmu.ac.jp Received: 03 May 2018 Accepted: 12 June 2018 Published: 23 June 2018 screened within one week, with no statistical difference. Anti-Fyb was more frequently detected (115.8 versus 39.9 per 100,000 patients) among those screened within one week (p <0.001); antiDia showed a similar trend, but without statistical significance (p =0.065), whereas anti-c was less frequently detected (p <0.05). The number of DHTRs observed was significantly lower among those screened within one week, with two cases (1 in 4,031) versus eight (1 in 779) among those screened within 2 weeks (p <0.05). Conclusion: By shortening allowable sampling period for red cell alloantibody screening from within two weeks to within one week of transfusion, the detection rate of clinically significant antibodies, except for anti-c, increased, and the frequency of DHTR recipients decreased.

Pertussis outbreak among patients and healthcare workers in a provincial dialysis facility in Japan

BACKGROUND Sixteen pertussis cases in haemodialysis patients and healthcare workers were detected in a 25-bed outpatient haemodialysis facility in Japan between October 2013 and April 2014. AIM To describe an outbreak of pertussis among patients and healthcare workers, and to identify risk factors for pertussis infection. METHODS Sputum cultures, loop-mediated isothermal amplification assays performed on nasopharyngeal swabs to detect respiratory pathogens including Bordetella pertussis, and serum anti-pertussis toxin immunoglobulin G measurements were performed for all haemodialysis patients and healthcare workers. A retrospective case-control study was performed to identify the risk factors for pertussis infection in the clinic. FINDINGS Only six of the 16 pertussis patients (37.5%) had respiratory symptoms. Recent exposure to an unmasked individual with a cough was associated with pertussis infection (odds ratio 6.25, P<0.05). The outbreak was terminated successfully after enforcing the use of surgical masks among both patients and healthcare workers. CONCLUSION This report demonstrates the risk of pertussis transmission in a haemodialysis facility, and underscores the importance of wearing surgical masks to control a pertussis outbreak.