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Background: The current approach to reducing bacterial contamination in blood transfusion products is through detection or pathogen reduction methods, some of which utilize ultraviolet (UV) light photosensitizers. A small number of photosensitizers are being used as single agents in combination with UV light, but their efficacy can be limited against some pathogens. Benzophenone (BP) and vitamins B1, B6, and K3 have been identified as effective UVA photosensitizers for inactivation of bacteria. We evaluated whether combining pairs of photosensitizers in this group would have synergistic bactericidal effects on Gram-negative and Gram-positive bacteria., Study Design and Methods: Bacteria species of Escherichia coli, Bacillus cereus, Staphylococcus aureus, and Klebsiella pneumoniae were mixed with 0 to 100 mM concentrations of photosensitizers and exposed to UVA irradiation at 18 J/cm 2 to assess their bactericidal effects., Results: Single photosensitizers irradiated with UVA produced a range of bactericidal activity. When combined in pairs, all demonstrated some synergistic bactericidal effects with up to 4-log reduction above the sum of activities of individual molecules in the pair against bacteria in plasma. Photosensitizer pairs with BP had the highest synergism across all bacteria. With vitamin K3 in the pair, synergism was evident for Gram-positive but not for Gram-negative bacteria. Vitamin B1 and vitamin B6 had the least synergism. These results indicate that a combination approach with multiple photosensitizers may extend effectiveness of pathogen reduction in plasma., Conclusions: Combining photosensitizers in pathogen reduction methods could improve bactericidal efficacy and lead to use of lower concentrations of photosensitizers to reduce toxicities and unwanted side effects., (© 2020 AABB.)

Background: Photochemical treatment (PCT) with amotosalen and ultraviolet light was developed to inactivate pathogens in platelet (PLT) components suspended in 35 percent plasma and 65 percent additive solution (AS). Because PLT additive solutions (ASs) are not used in the United States, this study evaluated the ability of the PCT process to inactivate low levels of bacteria in pooled whole blood-derived PLTs (RDP) suspended in 100 percent plasma., Study Design and Methods: Four replicate experiments were performed with two Gram-positive organisms, Staphylococcus epidermidis and Staphylococcus aureus, and two Gram-negative organisms, Klebsiella pneumoniae and Escherichia coli. For each experiment, 6 ABO-identical RDP units were pooled, leukoreduced before or after pooling, inoculated to approximately 1 to 10 colony-forming units per mL with plasma-resistant bacteria, and treated with the PCT process. Residual viable bacterial levels were measured before and after each step and 4 and 6 days after inoculation. For each bacterium studied, a fifth RDP pool was prepared and contaminated, but not treated. These units served as controls for bacterial growth., Results: Growth of S. epidermidis, S. aureus, and K. pneumoniae was eliminated in all four treated pools while growth continued in the control pools. There was no growth of E. coli in the treated pools and the control pool., Conclusion: These pilot experiments demonstrate inactivation of bacteria in PLTs suspended in plasma, suggesting that the PCT process may address contamination in conventional RDPs. Additional experiments with a wider range of bacteria and evaluation of PLT function in 100 percent plasma will be needed before implementation.