Fungi in dialysis water and dialysate: occurrence, susceptibility to antifungal agents and biofilm production capacity

The aim of this study was to investigate the occurrence of fungi in dialysis water and dialysate, in addition to evaluating the susceptibility to antifungals and the biofilm production capacity of isolated microorganisms. The samples were collected in three hemodialysis units in Bauru (Brazil), every 15 days (July 2017–June 2018) at post-reverse osmosis, reuse, and dialysate points. The fungi were isolated by spread plate on Sabouraud dextrose agar. Filamentous fungi were phenotypically identified and yeasts were subjected to molecular evaluation of the ITS region. Susceptibility test to antifungals was carried out by the broth microdilution method and biofilm production capacity was evaluated in microtiter plates using crystal violet staining. Fungi were isolated in 52/216 (24.1%) samples, with an average count of 16.3 (10–40) CFU/mL. Overall, 61 microorganisms were identified, with 54 (88.5%) filamentous fungi and 7 (11.5%) yeasts. The main genera included were Penicillium, Cladosporium, Scedosporium, Rhinocladiella, Fusarium, and Emmonsia. Most isolates showed high values of minimum inhibitory concentration for 5-flucytosine and fluconazole and 35/45 (77.8%) isolates were classified as strong producers of biofilm. In order to increase the safety of the dialysis process, the adoption of control measures and monitoring of fungi in hemodialysis fluids is suggested.

Assessment of water quality status of hemodialysis treatment plants in Baghdad, Iraq

The chemical quality of the water used for dialysis fluid is a crucial factor for patients receiving dialysis. Therefore, strict monitoring of the quality of water is necessary in order to prevent complications and to guarantee the safety and health of patients. The current study aimed to determine the chemical water quality used in hemodialysis treatment plants and compare it to standards of the Association for advancement of medical instrumentation (AAMI) and International Organization for Standardization (ISO) in four hospitals in Baghdad. This cross-sectional study is performed in four seasons in 2019. This research was conducted on samples of dialysis water. Samples were tested by the spectrometry system (AA-7000, Shimadzu, Japan) and colorimeters DR890 for free chlorine. Microsoft 2010 was used for statistical analyses. Based on the results of the research, all concentrations of chemical compounds were within accepted international standards except free chlorine. Also, there were no significant differences between the measured parameters in the dialysis water at four treatment plants during the study period at (P < 0.05). The assessment of water quality hemodialysis showed that these hemodialysis treatment plants were not significantly contaminated and that the quality of the water met the AAMI and ISO standards.

Evaluation of Physicochemical and Microbial Quality Control of Hemodialysis Machines Water in Hospitals

Background and Objectives: Water quality is important for preparation of dialysis solution due to its direct relationship with blood of patients with renal failure. The aim of this study was to evaluate the chemical and microbial quality of inlet and outlet water of dialysis devices in hospitals of East Azerbaijan province. Material and Methods: This study was a descriptive-analytical study in which the water of dialysis ward of three hospitals affiliated to East Azerbaijan University of Medical Sciences was investigated. The results of physicochemical (45 cases) and microbial (163 cases) of dialysis water were extracted from the relevant archives in two stages before and after reverse osmosis treatment during 2014-2016. Independent t-test and one-way ANOVA were used for statistical analysis while extracting descriptive statistical parameters. Data analysis was done using Excel and SPSS 23 software. Results: Evaluation of the efficiency of reverse osmosis system showed that there was a significant difference between water quality, before and after the system. Except for calcium, magnesium, fluoride and nitrate, the concentrations of other cations and anions in 100% of samples were lower than the European Pharmacopoeia standard. Incoming water samples to dialysis machine in 4.9% of cases had total coliform contamination and there was no fecal coliform in any of the samples. The frequency and frequency of tests in hospitals are not observed and despite the risk of heavy metals, heavy metals tests are not performed on dialysis water for the health of dialysis patients. Conclusion: The need to develop a national standard for controlling dialysis water, testing all quality parameters of dialysis water according to standards in regular times and timeframes, informing hospital managers and environmental health experts about the importance of dialysis water quality in health and increasing life expectancy of dialysis patients is felt.

Water Treatment for Hemodialysis in Benghazi Medical Center (BMC)

Background: A single 4-hour dialysis treatment can require up to 400 liters of water per week for dialysis patients compare that with healthy person who drinks less than 15 liters of water per week. Therefore, it is clearly important to know and monitor the chemical and microbiological purity of the dialysis water. Aims: Determine the physicochemical and bacteriological characteristics of water used by hemodialysis services Isolate and identify fungi present in water systems of hemodialysis units in Benghazi Medical center (BMC) in Benghazi, Libya. Methods: Analysis study carried out in hemodialysis unit in BMC collected samples from each places (A & B) sections. Results: Six samples that target to chemical analysis and 32 samples for microbiological test, Chemical parameters of study area A and B for drinking and dialysis water were within international standards, but there was a minute of Calcium elevation in area B that was 3.3mg/l. No contamination with bacteria observed in all samples in section (A), the counts of yeasts and filamentous fungi investigated in the tap water, in the treated water, and dialysis machine in section B and Penicillium spp was the most frequent fungi. Conclusions: Our study demonstrated that the tap and dialysis water success to meet the all-chemical and microbiological requirements in (A) area inside hospital of Benghazi center. In generally to prevent the risk of contaminants for hemodialysis patients need to a high water quality management program and development of water treatment system in hemodialysis centers.

Evaluation of Dialysis Water Quality at Hospitals in Baghdad, Iraq

Background. Dialysis water quality is one of the most important factors for ensuring the safe and effective delivery of hemodialysis. It has been known for over a decade that there might be hazardous contaminants in the water and concentrates used to prepare dialysis fluid. Rigorous international standards for the purification of dialysis fluids have been established, which were used in the present study to compare the quality of dialysis water as there is no national standard for dialysis water quality in Iraq. Objectives. There are more than 20 dialysis centers in Iraq, most of which contain similar units for the processing of dialysis water. The present study evaluated the quality of water used for dialysis in four dialysis centers located within Baghdad hospitals. Methods. Physical and chemical tests were carried out in the laboratory after sampling water from each dialysis center. Water samples were collected from three locations in each dialysis center. Hospital municipal water samples were collected from the tanks feeding dialysis units; samples of dialysis water were collected from the dialysis water treatment unit outlets; and samples of dialysis water were collected from the distribution network in dialysis rooms. Results. The results showed a fluctuation in the quality of the dialysis water (dialysis water and water from the dialysis distribution network), indicating that it is unacceptable compared to international standards. Chemical analysis showed that 75% of the dialysis water had elevated aluminum concentrations. Chemical analysis also found that dialysis water had elevated concentrations of free residual chlorine at some dialysis centers. Conclusions. All hemodialysis centers need careful monitoring and preventive maintenance to ensure good water quality. In addition, it is important to revise the design of the water treatment units according to water quality. Competing Interests. The authors declare no competing financial interests

BACTERIAL CONTAMINATION OF DIALYSIS WATER AND DIALYSATE AT MUKALLA ARTIFICIAL KIDNEY CENTER IN MUKALLA CITY - HADHRAMAUT - YEMEN: RATE OF CONTAMINATION AND SENSITIVITY OF BACTERIAL ISOLATES TO ANTIBIOTICS

Water treatment systems are a vital factor in dialysis therapy and precise control of hemodialysis water bacteriological quality is predominantly important in order to assurance a better quality of life of the hemodialysis patients. The purpose of this study was to detect the level of contamination in hemodialysis water and dialysate by bacteria in Mukalla Artificial Kidney Center and investigate the antimicrobial resistance patterns of isolated bacteria. Forty eight samples of water and dialysate were assembled weekly over a period of 3 months from 4 points. Bacteriological analysis of samples was carried out then antimicrobial susceptibilities patterns of isolated bacteria were concluded by disk diffusion method. The mean of total count of bacteria for dialysis water and dialysate were higher than the recommended values (100 CFU/ ml). The isolated bacteria which colonized the hemodialysis systems were mostly Gram-negative bacilli as Pseudomonas sp., Serratia sp., Citrobacter sp. and Enterobater sp. In general, most of the isolated bacteria were poorly responsive to antibiotics. In conclusion: Dialysis water and dialysate not passed to meet the bacteriological provisions for hemodialysis. To reduce the hazard of contaminants for hemodialysis patients, a sufficient system for water treatment, disinfection of hemodialysis system, and bacteriological contamination monitoring of the water and dialysate are necessary. Peer Review History: UJPR follows the most transparent and toughest ‘Advanced OPEN peer review’ system. The identity of the authors and, reviewers will be known to each other. This transparent process will help to eradicate any possible malicious/purposeful interference by any person (publishing staff, reviewer, editor, author, etc) during peer review. As a result of this unique system, all reviewers will get their due recognition and respect, once their names are published in the papers. We expect that, by publishing peer review reports with published papers, will be helpful to many authors for drafting their article according to the specifications. Auhors will remove any error of their article and they will improve their article(s) according to the previous reports displayed with published article(s). The main purpose of it is ‘to improve the quality of a candidate manuscript’. Our reviewers check the ‘strength and weakness of a manuscript honestly’. There will increase in the perfection, and transparency. Received file Average Peer review marks at initial stage: 6.0/10 Average Peer review marks at publication stage: 8.5/10 Reviewer(s) detail: Name: Dr. Maya Shaaban Eissa Hussein Affiliation: Egyptian Russian University, Egypt E-mail: [email protected] Name: Dr. Ali Abdullah A. Al-Mehdar Affiliation: University of Basrah, Iraq E-mail: [email protected] Comments of reviewer(s): Similar Articles: EXPLOSION OF HEPATITIS B AND C VIRUSES AMONG HEMODIALYSIS PATIENTS AS A RESULT OF HEMODIALYSIS CRISIS IN YEMEN PREVALENCE AND GENOTYPING OF HEPATITIS C VIRUS IN HEMODIALYSIS PATIENTS AND EVALUATION OF HCV-CORE ANTIGEN TEST IN SCREENING PATIENTS FOR DIALYSIS IN SANA'A CITY, YEMEN