Heidarieh Parvin, Hashemi Shahraki Abodolrazagh, Yaghoubfar Rezvan, Hajehasani Azadeh, Mirsaeidi Mehdi
From the *Department of Microbiology, School of Medicine, Alborz University of Medical Sciences, Alborz, Iran; †Department of Epidemiology, Pasture Institute of Iran, Tehran, Iran; and ‡Division of Pulmonary, Critical Care, Sleep and Allergy, Department of Medicine, University of Miami, Miami, Florida.
ASAIO J. 2016 May-Jun;62(3):332-9. doi: 10.1097/MAT.0000000000000353.
Microbiological control of hemodialysis fluid is important for the prevention of hemodialysis-associated illness. Bacterial populations inhabiting a distribution system for hemodialysis water were studied over a 4 month period in five hospitals (one in Tehran, and the others at Alborz). All the samples from the four hospitals at Alborz had colony counts of ≥100 CFU/ml, which at different points of sampling were higher than the maximum recommended values. A total of 80 samples taken at different points in each hospital's hemodialysis distribution system were collected, and 229 planktonic bacteria isolated on R2A medium. No growth was detected by culturing the samples on Blood agar or Mueller-Hinton agar, according to routine procedures currently used in the five hospitals. A representative of isolates from each of 45 different morphotypes were identified using 16S RNA sequencing. A diverse bacterial community, containing predominantly gram-positive members of Kocuria, Arthrobacter and Staphylococcus and Mycobacterium, was detected. Bacteria from the genera Acinetobacter, Burkholderia, Halomonas, Herbaspirillum, Pseudomonas, and Sphingomonas were identified, which has been described in the build-up of biofilms. Some of the species reported here may represent a health risk to patients receiving hemodialysis treatment. In conclusion, it is recommended that standard protocols for evaluation of microbial contamination be used for regular monitoring and identification of culturable bacteria.
血液透析液的微生物控制对于预防血液透析相关疾病至关重要。在五个医院（一个位于德黑兰，其他位于阿尔伯兹）对血液透析用水分配系统中的细菌群落进行了为期4个月的研究。阿尔伯兹的四家医院的所有样本菌落计数均≥100 CFU/ml，在不同采样点均高于最大推荐值。在每个医院的血液透析分配系统的不同点共采集了80个样本，并在R2A培养基上分离出229株浮游细菌。按照这五家医院目前使用的常规程序，在血琼脂或穆勒-欣顿琼脂上培养样本未检测到生长。使用16S RNA测序对45种不同形态类型的每种分离株的一个代表进行了鉴定。检测到一个多样的细菌群落，主要包含科氏葡萄球菌、节杆菌、葡萄球菌和分枝杆菌等革兰氏阳性菌。鉴定出了不动杆菌属、伯克霍尔德菌属、嗜盐单胞菌属、草螺菌属、假单胞菌属和鞘氨醇单胞菌属的细菌，这些细菌已在生物膜形成中被描述。这里报告的一些物种可能对接受血液透析治疗的患者构成健康风险。总之，建议使用微生物污染评估的标准方案对可培养细菌进行定期监测和鉴定。
