Resumen
Infectious diseases in renal patients may be associated with the dialysis water quality, which may be contaminated with microorganisms. In Brazil, the water quality is evaluated by analyzing total coliforms, heterotrophic bacteria, and bacterial endotoxin, but not Pseudomonas sp. and fungi. Water samples from haemodialysis units in Curitiba/PR were investigated on their conformity with the standard established by the Brazilian Health Ministry. Total coliforms, heterotrophic bacteria, P. aeruginosa and fungi counts were performed according to APHA, and LAL methodology for detecting bacterial endotoxin. All of the samples showed the total coliforms counts ≤1.1 MPN/100 mL,and ≥ 95 % of analyzed samples complied with the standards for heterotrophic bacteria counting. P. aeruginosa was recovered from 4 % of samples. In 15 % of samples, bacterial endotoxin was detected in values above the limit established by legislation. Yeasts were isolated from 26 % samples and filamentous fungi from 58 %, being 46 % characterized as melanized fungi. The fungi genera were Cladosporium spp., Penicillium spp., Beauveria spp., Exophiala spp., Fusarium spp., Aspergillus spp., Trichoderma spp, Acremonium spp. and Rinocladiella spp.. The study highlights the significance of P. aeruginosa and fungi detection in those systems, as these microorganisms are potentially pathogenic to immunocompromised patients.Citas
1. Sesso RC, Lopes AA, Thomé FS, Lugon JR, Santos DR. Relatório do censo brasileiro de diálise de 2010. J Bras Nefrol.2011;33(4):442-7. http://dx.doi.org/10.1590/S0101-28002011000400009
2. Sesso R, Lopes AA, Thomé FS, Bevilacqua JL, Romão Jr JE, Lugon J. Relatório do Censo Brasileiro de Diálise, 2008. J Bras Nefrol.2008;30(4):233-8.
3. De Filippis P, Spitaleri G, Damiani F, Panà A. Microbiological quality of haemodialysis water in various hospitals and private clinics in the Lazio region (Italy): 2000-2004. Ig Sanita Pubbl.2007;63(1):21-9.
4. Figel IC, Marangoni PRD, Tralamazza SM, Vicente VA, Dalzoto P do R, do Nascimento MM, et al. Black yeasts-like fungi isolated from dialisys water from Brazilian hemodialysis units. Mycopathol.2013;175(5-6):413-20. doi: 10.1007/s11046-013-9633-4
5. Schindler R, Christ-Kohlrausch F, Frei U, Shaldon S. Differences in the permeability of high-flux dialyzer membranes for bacterial pyrogens. Clin Nephrol.2003;59(6):447-54.
6. Brasil. Resolução RDC nº 154, de 15 jun. 2004. Estabelece o Regulamento Técnico para o funcionamento dos Serviços de Diálise. Diário Oficial [da] União, Brasília, DF, 17 jun 2004.
7. Montanari LB, Sartori FG, Cardoso MJO, Varo SD, Pires RH, Leite CQF, et al. Microbiological contamination of a hemodialysis center water distribution system. Rev Inst Med Trop S Paulo.2009;51(1):37-43. http://dx.doi.org/10.1590/S0036-46652009000100007
8. Pires-Gonçalves RH, Sartori FG, Montanari LB, Zaia JE, Melhem MS, Mendes-Giannini MJ, et al. Occurrence of fungi in water used at a haemodialysis centre. Lett App Microbiol.2008;46(5):542-7. doi: 10.1111/j.1472-765X.2008.02349.x
9. American Public Health Association (US). Standard methods for the examination of water and wastewater. 21ª ed. Washington: American Public Health Assoc; 2005.
10. United States Pharmacopeia (US). 31ª ed. Rockville: The United Stated Pharmacopeial Convention; 2008.
11. Kern ME, Blevins KS. Micologia Médica. São Paulo: Premier; 1999.
12. El-Koraie AF, Hazzah WA, Abbass AA, El-Shazly SA. Bacteriological monitoring of dialysis fluid in 2 haemodialysis units in Alexandria, Egypt. Saudi Med J. 2007;28(8):1234-8.
13. Nystrand R. Microbiology of water and fluids for hemodialysis. J Chin Med Assoc. 2008;71(5):223-9. doi: 10.1016/S1726-4901(08)70110-2
14. Schiavano GF, Parlani L, Sisti M, Sebastianelli G, Brandi G. Occurrence of fungi in dialysis water and dialysate from eight haemodialysis units in central Italy. J Hosp Infect. 2014;86(3):194-200. doi: 10.1016/j.jhin.2013.11.010
15. Revankar SG. Clinical and Treatment Aspects of Brown–Black Fungi. Curr Fung Infect Rep. 2010;4(1):46–51. doi: 10.1007/s12281-010-0004-z.
Esta obra está bajo una licencia internacional Creative Commons Atribución 4.0.
Derechos de autor 2015 Revista del Instituto Adolfo Lutz