[Decolonization of autologous blood with cefuroxime during hardware reinfusion in neurosurgical patients].

Abstract

Autologous blood obtained during hardware reinfusion can be bacterially contaminated with skin microflora in most cases (up to 90%) regardless of the area of surgical intervention. Increased volume of washing solution for red blood cell management, white blood cell filtration and X-ray irradiation do not always provide complete decontamination.

Objective: To analyze the effectiveness of adding cefuroxime to extracorporeal circuit during hardware blood reinfusion.

Material and methods: The study included 50 patients with intracranial tumors. Hardware blood reinfusion was used due to baseline disease, blood supply to the neoplasm and high risk of intraoperative blood loss. All patients received perioperative antibiotic prophylaxis. We assessed the effectiveness of decontamination using microbiological control at all stages of the procedure. We used the XTRA Liva Nova complex autologous blood recovery system (Popt protocol), PALL Purecell RC2VAE leukocyte filters, BacT/ALERT 3D automatic microbiological analyzer and vials with FA Plus and FN Plus medium and adsorbent. X-ray irradiation of autologous erythrocytes was performed at a dose of 25 Gy (ARDOK-1 device).

Results: Addition of cefuroxime 1.5 g to blood collection reservoir excluded bacterial growth in autologous blood samples from this reservoir in 100% of cases. At subsequent stages of blood processing, we isolated S. epidermidis, S. aureus, S. hominis, S. capitis, as well as Acinetobacter ursingii, Morganella morganii and Klebsiella aerogenes from some samples. Maximum bacterial contamination was observed at the stage of erythrocyte washing (34% of samples). After leukocyte filtration and blood irradiation, this value was 8%.

Conclusion: Combination of all decontamination methods (erythrocyte washing in large volume of solution, leukocyte filtration and irradiation) together with adding cefuroxime into extracorporeal circuit excluded bacterial growth in 92% of samples of autologous erythrocytes.