Department of Biomolecular Science, Section of Hygiene, University of Urbino 'Carlo Bo' Urbino, Italy.
Laboratory of Public Health and Hygiene, Department of Prevention, Area Vasta n. 1 - AZUR Marche, Italy.
J Hosp Infect. 2014 Mar;86(3):194-200. doi: 10.1016/j.jhin.2013.11.010. Epub 2014 Jan 8.
Fungal contamination of dialysis fluids may be a serious problem in therapy, particularly due to the debilitated immune system of haemodialysis patients.
To investigate the occurrence, distribution, and diversity of fungi in dialysis water and dialysis solution of eight haemodialysis units in a region of central Italy.
Samples were collected over a one-year period from different points of the haemodialysis circuits in accordance with the guidelines of the Italian Society of Nephrology. Isolation and identification of fungi was performed according to the ISTISAN method Reports (2007/05 and 2008/10).
Of the 976 samples analysed, 96 grew filamentous fungi, 28 were positive for yeast, and six samples contained both mould and yeast. A wide variety of filamentous fungi (26 genera, of which 15 identified at species level, and 'mycelia sterilia') were recovered, many of which are known as opportunistic pathogens. Cladosporium spp. were most frequently found (39%), followed by Alternaria spp. and Tricophyton spp. Fungal counts in treated water and standard dialysate solution were always below the threshold (<10 cfu/mL), and thus are in agreement with the Italian guidelines for dialysis fluid quality, whereas 10.9% of the samples of ultrapure dialysate solution were contaminated by one or several fungi types, in contravention of the guidelines.
The large variety of opportunistic fungi recovered in the haemodialysis circuits proves the importance of including an analysis of fungi to check the microbial quality of dialysis water and dialysate.
真菌污染透析液可能是治疗中的一个严重问题，尤其是在血液透析患者免疫系统受损的情况下。
调查意大利中部地区 8 个血液透析单位的透析用水和透析液中真菌的发生、分布和多样性。
根据意大利肾脏病学会的指南，在一年的时间内从血液透析回路的不同部位采集样本。根据 ISTISAN 方法报告（2007/05 和 2008/10）进行真菌的分离和鉴定。
在分析的 976 个样本中，96 个样本长出丝状真菌，28 个样本为酵母阳性，6 个样本同时含有霉菌和酵母。回收了各种各样的丝状真菌（26 个属，其中 15 个属在种水平上被鉴定，以及“无菌菌丝体”），其中许多是机会性病原体。最常发现的是枝孢属（39%），其次是交链孢属和毛癣菌属。处理过的水中和标准透析液中的真菌计数始终低于阈值（<10 cfu/mL），因此符合意大利透析液质量指南，而超纯水透析液的 10.9%的样本受到一种或多种真菌类型的污染，违反了指南。
从血液透析回路中回收的大量机会性真菌证明了包括真菌分析以检查透析用水和透析液微生物质量的重要性。
