Abstract
INTRODUCTION: Platelet-rich plasma (PRP) is widely used for pain relief, wound healing, and so on. However, recent reports have documented cases of infections occurring after PRP therapy. In this study, we aimed to examine potential microbial contamination risks associated with PRP therapy and evaluate rapid microbial detection methods suitable for clinical use. METHODS: We assessed the risk of microbial contamination during blood collection, PRP preparation, and sterility testing. To evaluate suitable detection methods, we compared the microbial detection sensitivities of flow cytometry (FCM) and polymerase chain reaction (PCR) for identifying microbial contamination in PRP. For this purpose, PRP samples were inoculated with Staphylococcus aureus, Streptococcus spp., Cutibacterium acnes, Micrococcus spp., Bacillus subtilis, and Candida albicans. RESULTS: Following skin disinfection, microbial colonies were detected at the venipuncture site in six out of ten patients. Environmental monitoring identified airborne microbial colonies in two out of three anonymous PRP preparation facilities. Sterility tests revealed negative results for all 85 residual PRP and 15 platelet-poor plasma (PPP) cases. FCM sensitivity for microbial detection in PRP was effective at a concentration of 10(2)-10(3) colony forming units (cfu)/mL or higher. While C. albicans could not be detected separately from non-specific PRP signals using FCM, it was detectable in PPP at ≥10(2) cfu/mL. PCR sensitivity for microbial detection was excellent when analyzing pure microbial suspensions, however, it yielded a high rate of false-negative and false-positive results when PRP samples contained certain microbial strains. CONCLUSION: The risks of microbial contamination were identified during both venipuncture and PRP production. To reduce these risks, it may be necessary to improve disinfection protocols for venipuncture sites and blood collection methods, implementing appropriate facility-specific measures. Although requiring further detection sensitivity improvements, FCM is a promising method for detecting viable bacteria in PRP. Given that microbial contamination cannot be completely eliminated, clinicians providing PRP therapy should remain alert to the potential for postoperative infections and ensure appropriate follow-up protocols are established.