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Anversa L, Romani CD, Caria ES, Saeki EK, Nascentes GAN, Garbelotti M, Stancari RCA, Dantas STA, Rall VLM, Ruiz LS, Camargo CH, Richini-Pereira VB. Quality of dialysis water and dialysate in hemodialysis centers: highlight for occurrence of non-fermenting gram-negative bacilli. J Appl Microbiol 2022; 132:3416-3429. [PMID: 35108426 DOI: 10.1111/jam.15470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 01/28/2022] [Accepted: 01/31/2022] [Indexed: 11/30/2022]
Abstract
AIMS To evaluate the physicochemical and microbiological quality of dialysis water and dialysate samples from hemodialysis centers. METHODS AND RESULTS Samples were fortnightly collected from three hemodialysis centers in Bauru City, Brazil, between July/2017 and June/2018, at the stages of post-reverse osmosis, reuse and dialysate. Analyses included determination of conductivity, fluoride, nitrate and sulfate; test for total coliform bacteria; count of heterotrophic bacteria; count and identification of non-fermenting gram-negative bacilli (NFGNB); drug susceptibility test; biofilm formation capacity, and genetic similarity among some isolated NFGNB. Of the analyzed samples, only 4/72 (5.6%) had conductivity values ≥ 10 mS/cm, 4/216 (1.9%) presented total coliforms, and 1/216 (0.5%) had heterotrophic bacteria count > 100 CFU/mL. NFGNB were isolated from 99/216 (45.8%) samples, and the major identified microorganisms included Herbaspirillum aquaticum/huttiense, Brevundimonas aurantiaca, Cupriavidus metallidurans, Pseudomonas aeruginosa and Ralstonia insidiosa. Isolates of P. aeruginosa and Burkholderia cepacia complex were sensitive to most antimicrobials and, together with isolates of Ralstonia insidiosa and Ralstonia pickettii, showed strong biofilm formation capacity. Some isolates expressed the same electrophoretic profile on pulsed-field gel electrophoresis, indicating persistence of bacterial clones in the systems over time. CONCLUSIONS NFGNB were observed in several dialysis water and dialysate samples from all investigated centers, which may represent a risk to the health of patients. SIGNIFICANCE AND IMPACT OF THE STUDY Regular inclusion of actions for NFGNB control and monitoring in hemodialysis fluids are suggested for greater safety of the dialytic process.
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Affiliation(s)
- L Anversa
- Adolfo Lutz Institute, Regional Laboratories Center Bauru, Bauru, Brazil
| | - C D Romani
- Adolfo Lutz Institute, Regional Laboratories Center Bauru, Bauru, Brazil
| | - E S Caria
- Adolfo Lutz Institute, Regional Laboratories Center Bauru, Bauru, Brazil
| | - E K Saeki
- Adolfo Lutz Institute, Regional Laboratories Center Presidente Prudente, Presidente Prudente, Brazil
| | - G A N Nascentes
- Federal Institute of Education, Science and Technology of Triângulo Mineiro, Uberaba, Brazil
| | - M Garbelotti
- Adolfo Lutz Institute, Regional Laboratories Center Bauru, Bauru, Brazil
| | - R C A Stancari
- Adolfo Lutz Institute, Regional Laboratories Center Bauru, Bauru, Brazil
| | - S T A Dantas
- Institute of Biosciences, Department of Microbiology and Immunology, São Paulo State University (Unesp), Botucatu, Brazil
| | - V L M Rall
- Institute of Biosciences, Department of Microbiology and Immunology, São Paulo State University (Unesp), Botucatu, Brazil
| | - L S Ruiz
- Adolfo Lutz Institute, Regional Laboratories Center Bauru, Bauru, Brazil
| | - C H Camargo
- Adolfo Lutz Institute, Central Laboratory, São Paulo, Brazil
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Cristina ML, Sartini M, Schinca E, Ottria G, Casini B, Spagnolo AM. Evaluation of Multidrug-Resistant P. aeruginosa in Healthcare Facility Water Systems. Antibiotics (Basel) 2021; 10:1500. [PMID: 34943711 PMCID: PMC8698422 DOI: 10.3390/antibiotics10121500] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 11/29/2021] [Accepted: 12/02/2021] [Indexed: 11/29/2022] Open
Abstract
According to the WHO, P. aeruginosa is one of the antibiotic-resistant bacteria that represent the biggest threat to public health. The aim of the study was to establish the prevalence of antibiotic-resistant P. aeruginosa in the water systems of various healthcare facilities over the course of nine years. A total of 4500 tap water system samples were taken from seventeen healthcare facilities. The culture method was used to detect P. aeruginosa, and the isolates were then tested for antibiotic resistance using the standardised disc diffusion method. Eleven antibiotics from five different classes were tested. P. aeruginosa was found to have contaminated 2.07% (no. 93) of the water samples. The majority of positive samples came from the dental units (30.11%) and the ward kitchens (23.66%). Considering the total isolates, 56.99% (no. 3) were resistant to at least one of the antibiotics tested. A total of 71.43% of P. aeruginosa isolated from water emerging from dental unit handpieces was antibiotic-resistant, with 45% of it resistant to ≥3 classes of antibiotics. Out of the total isolates, 19.35% showed resistance to carbapenems. It would be advisable to systematically screen tap water for opportunistic micro-organisms such as P. aeruginosa, as many countries already do, including this in the Water Safety Plan.
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Affiliation(s)
- Maria Luisa Cristina
- Department of Health Sciences, University of Genoa, Via Pastore 1, 16132 Genoa, Italy; (M.L.C.); (E.S.); (G.O.); (A.M.S.)
- S.S.D. U.O. Hospital Hygiene, E.O. Ospedali Galliera, 16128 Genova, Italy
| | - Marina Sartini
- Department of Health Sciences, University of Genoa, Via Pastore 1, 16132 Genoa, Italy; (M.L.C.); (E.S.); (G.O.); (A.M.S.)
- S.S.D. U.O. Hospital Hygiene, E.O. Ospedali Galliera, 16128 Genova, Italy
| | - Elisa Schinca
- Department of Health Sciences, University of Genoa, Via Pastore 1, 16132 Genoa, Italy; (M.L.C.); (E.S.); (G.O.); (A.M.S.)
- S.S.D. U.O. Hospital Hygiene, E.O. Ospedali Galliera, 16128 Genova, Italy
| | - Gianluca Ottria
- Department of Health Sciences, University of Genoa, Via Pastore 1, 16132 Genoa, Italy; (M.L.C.); (E.S.); (G.O.); (A.M.S.)
- S.S.D. U.O. Hospital Hygiene, E.O. Ospedali Galliera, 16128 Genova, Italy
| | - Beatrice Casini
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, 56126 Pisa, Italy;
| | - Anna Maria Spagnolo
- Department of Health Sciences, University of Genoa, Via Pastore 1, 16132 Genoa, Italy; (M.L.C.); (E.S.); (G.O.); (A.M.S.)
- S.S.D. U.O. Hospital Hygiene, E.O. Ospedali Galliera, 16128 Genova, Italy
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Abozahra R, Abdelhamid SM, Wen MM, Abdelwahab I, Baraka K. A Nanoparticles based Microbiological Study on the Effect of Rosemary and Ginger Essential Oils against Klebsiella pneumoniae. Open Microbiol J 2020. [DOI: 10.2174/1874285802014010205] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Background:
Klebsiella pneumoniae is a nosocomial pathogen in outbreaks of hospital infections. It is one of the major factors for morbidity and mortality in hospitalized patients especially those infected with colistin-resistant pathogens. Many plant essential oils have antimicrobial activities and have been investigated as natural sources to combat multiple antibiotic resistances. Moreover, recent advances in phytonanotechnology have created exciting opportunities for the management of many infections.
Objective:
This study aims at investigating the antimicrobial and antibiofilm effect of rosemary and ginger essential oil-based nano-sized formulations on colistin resistant K. pneumonia clinical isolates.
Methods:
Isolation and identification of 30 K. pneumonia isolates from different human samples were done followed by antibiotic susceptibility testing and detection of biofilm gene (mrkD). Examination of the activity of the tested essential oils and their chitosan nanoparticle formulations against the selected isolates was made by determination of their MICs using broth microdilution method followed by biofilm inhibition test and quantitative real-time PCR for the expression of mrkD gene in the presence of the oils and nanoparticles formulations compared to untreated bacterial isolates.
Results:
Our results showed that the minimum inhibitory concentration of rosemary and ginger oils was 1250 μg/ml, that of nanostructured lipid carrier-rosemary oil and nanostructured lipid carrier-ginger oil was 625 μg/ml and rosemary oil loaded chitosan nanoparticles and ginger oil loaded chitosan nanoparticles possessed minimum inhibitory concentration of 156 μg/ml. Results also revealed complete (100%) inhibition for mrkD gene expression when compared to untreated K. pneumonia.
Conclusion:
Oil loaded chitosan nanoparticles showed the highest antimicrobial and antibiofilm activity.
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Water as a Source of Antimicrobial Resistance and Healthcare-Associated Infections. Pathogens 2020; 9:pathogens9080667. [PMID: 32824770 PMCID: PMC7459458 DOI: 10.3390/pathogens9080667] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 08/13/2020] [Accepted: 08/14/2020] [Indexed: 12/13/2022] Open
Abstract
Healthcare-associated infections (HAIs) are one of the most common patient complications, affecting 7% of patients in developed countries each year. The rise of antimicrobial resistant (AMR) bacteria has been identified as one of the biggest global health challenges, resulting in an estimated 23,000 deaths in the US annually. Environmental reservoirs for AMR bacteria such as bed rails, light switches and doorknobs have been identified in the past and addressed with infection prevention guidelines. However, water and water-related devices are often overlooked as potential sources of HAI outbreaks. This systematic review examines the role of water and water-related devices in the transmission of AMR bacteria responsible for HAIs, discussing common waterborne devices, pathogens, and surveillance strategies. AMR strains of previously described waterborne pathogens including Pseudomonas aeruginosa, Mycobacterium spp., and Legionella spp. were commonly isolated. However, methicillin-resistant Staphylococcus aureus and carbapenem-resistant Enterobacteriaceae that are not typically associated with water were also isolated. Biofilms were identified as a hot spot for the dissemination of genes responsible for survival functions. A limitation identified was a lack of consistency between environmental screening scope, isolation methodology, and antimicrobial resistance characterization. Broad universal environmental surveillance guidelines must be developed and adopted to monitor AMR pathogens, allowing prediction of future threats before waterborne infection outbreaks occur.
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Carvalho GC, Bugno A, Almodovar AAB, Silva FPDLE, Pinto TDJA. Validation and applicability of an alternative method for dialysis water and dialysate quality analysis. J Bras Nefrol 2020; 42:163-174. [PMID: 32364558 PMCID: PMC7427643 DOI: 10.1590/2175-8239-jbn-2019-0203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Accepted: 11/12/2019] [Indexed: 05/30/2023] Open
Abstract
INTRODUCTION In hemodialysis, patients are exposed to a large volume of water, which may lead to fatal risks if not meeting quality standards. This study aimed to validate an alternative method for monitoring microbiological quality of treated water and assess its applicability in dialysis and dialysate analysis, to allow corrective actions in real-time. METHODS Validation and applicability were analyzed by conventional and alternative methods. For validation, E. coli standard endotoxin was diluted with apyrogenic water in five concentrations. For the applicability analysis, treated water for dialysis was collected from different points in the treatment system (reverse osmosis, drainage canalization at the storage tank bottom, reuse, and loop), and dialysate was collected from four machines located in different rooms in the hemodialysis sector. RESULTS The validation results were in accordance with the Brazilian Pharmacopoeia acceptance criteria, except for the last two concentrations analyzed. In addition, the ruggedness criterion performed under the US Pharmacopoeia was in agreement with the results. DISCUSSION A limiting factor in the applicability analysis was the absence of the endotoxin maximum permitted level in dialysate by the Brazilian legislation. When comparing the analysis time, the alternative method was more time-consuming than the conventional one. This suggests that the alternative method is effective in the case of few analyses, that is, real-time analyses, favoring corrective actions promptly. On the other hand, it does not support the implementation of the alternative method in a laboratory routine due to the high demand for analyses.
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Affiliation(s)
- Gabriela Corrêa Carvalho
- Universidade de São Paulo, Faculdade de Ciências Farmacêuticas, Departamento de Farmácia, São Paulo, SP, Brasil
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Hilinski EG, Almodovar AAB, Silva FPDLE, Pinto TDJA, Bugno A. Is dialysis water a safe component for hemodialysis treatment in São Paulo State, Brazil? BRAZ J PHARM SCI 2020. [DOI: 10.1590/s2175-97902019000417835] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Suzuki MN, Fregonesi BM, Machado CS, Zagui GS, Kusumota L, Suzuki AK, da Costa JAC, Llopart JS, Nadal M, Domingo JL, Segura-Muñoz S. Hemodialysis Water Parameters as Predisposing Factors for Anemia in Patients in Dialytic Treatment: Application of Mixed Regression Models. Biol Trace Elem Res 2019; 190:30-37. [PMID: 30218313 DOI: 10.1007/s12011-018-1515-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Accepted: 09/06/2018] [Indexed: 11/30/2022]
Abstract
Contamination by metals and microbiological agents in hemodialysis water can cause clinical intercurrences in hemodialysis patients. Evaluating and assuring minimum levels of contamination from metals and microorganisms in hemodialysis water can improve patient safety. The objective of this study was to assess hemodialysis water quality in a major tertiary hospital in Brazil and investigate the relationship between hemodialysis water quality and clinical intercurrences in hemodialysis patients. A prospective-observational cohort study for evaluation of water quality parameters and clinical intercurrences present by patients (n = 52) were performed from May 2014 to April 2015. Mixed linear regression models and binary regression models were fitted for water quality parameters and patients' clinical parameters. The increase in the levels of copper and nitrate in hemodialysis water was significant (p < 0.05) to explain anemia. Bone pain was related to age, sex (female), and hemodialysis treatment duration (years). Hypotensive episodes were related to serum sodium decrease. Aluminum in hemodialysis water was present in an average concentration higher than the permitted threshold (15.35 ± 14.53 μg/L). Cadmium, total coliforms, Escherichia coli, and endotoxins in hemodialysis water were not detected and the heterotrophic bacteria count was below the reference limit. These parameters' concentrations varied during the study, evidencing the need for continuous monitoring.
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Affiliation(s)
- Meire Nikaido Suzuki
- Laboratory of Ecotoxicology and Environmental Parasitology, College of Nursing of Ribeirão Preto, University of São Paulo, Av. Bandeirantes 3900, Ribeirão Preto, São Paulo, 14040-902, Brazil
| | - Brisa Maria Fregonesi
- Laboratory of Ecotoxicology and Environmental Parasitology, College of Nursing of Ribeirão Preto, University of São Paulo, Av. Bandeirantes 3900, Ribeirão Preto, São Paulo, 14040-902, Brazil
| | - Carolina Sampaio Machado
- Laboratory of Ecotoxicology and Environmental Parasitology, College of Nursing of Ribeirão Preto, University of São Paulo, Av. Bandeirantes 3900, Ribeirão Preto, São Paulo, 14040-902, Brazil
| | - Guilherme Sgobbi Zagui
- Laboratory of Ecotoxicology and Environmental Parasitology, College of Nursing of Ribeirão Preto, University of São Paulo, Av. Bandeirantes 3900, Ribeirão Preto, São Paulo, 14040-902, Brazil
| | - Luciana Kusumota
- Department of Fundamental Nursing, College of Nursing of Ribeirão Preto, University of São Paulo, Av. Bandeirantes 3900, Ribeirão Preto, São Paulo, 14040-902, Brazil
| | - Adriano Kamimura Suzuki
- Department of Applied Mathematics and Statistics, Institute of Mathematical and Computing Sciences, University of São Paulo, Av. Trabalhador São Carlense 400, São Carlos, São Paulo, 13560-970, Brazil
| | - José Abrão Cardeal da Costa
- Department of Internal Medicine, Faculty of Medicine of Ribeirão Preto, University of São Paulo, Av. Bandeirantes 3900, Ribeirão Preto, São Paulo, 14049-900, Brazil
| | - Jordi Sierra Llopart
- Laboratory of Toxicology and Environmental Health, School of Medicine, IISPV, Universitat Rovira i Virgili, Sant Llorenç 21, 43201, Reus, Catalonia, Spain
- Laboratory of Soil Science, Faculty of Pharmacy, Universitat de Barcelona, Avda. Joan XXIII s/n., 08020, Barcelona, Catalonia, Spain
| | - Martí Nadal
- Laboratory of Toxicology and Environmental Health, School of Medicine, IISPV, Universitat Rovira i Virgili, Sant Llorenç 21, 43201, Reus, Catalonia, Spain
| | - Jose Luis Domingo
- Laboratory of Toxicology and Environmental Health, School of Medicine, IISPV, Universitat Rovira i Virgili, Sant Llorenç 21, 43201, Reus, Catalonia, Spain
| | - Susana Segura-Muñoz
- Laboratory of Ecotoxicology and Environmental Parasitology, College of Nursing of Ribeirão Preto, University of São Paulo, Av. Bandeirantes 3900, Ribeirão Preto, São Paulo, 14040-902, Brazil.
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Abualhasan M, Basim A, Salahat A, Sofan S, Al-Atrash M. Quality of water used in Palestinian hemodialysis centers. Public Health 2018; 165:136-141. [PMID: 30390426 DOI: 10.1016/j.puhe.2018.09.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Revised: 04/07/2018] [Accepted: 09/16/2018] [Indexed: 11/19/2022]
Abstract
OBJECTIVES Worldwide, hemodialysis (HD) patients are increasing every year, including Palestine. Dialysis fluid contamination due to the use of unpurified water is a common problem worldwide. Chemical and microbiological contaminants in the dialysis fluid could cross the dialyzer membrane and cause harm to dialysis patients. The objectives of this study were to evaluate the water quality used in centers in the West Bank, Palestine. The outcomes of this study will reflect the water purification system situation and come up with valuable recommendations to health decision makers. STUDY DESIGN This is a laboratory-based study that covered all dialysis centers in the West Bank, Palestine. METHODS Water samples were collected from all dialysis centers, and the samples were tested chemically and microbiologically according to the standard international and pharmacopeial methods. RESULTS The results showed that the water quality in most dialysis centers did not comply with the minimum requirements of HD water. Microbiological contamination was detected in 12.5% of the dialysis centers. The test for chloride failed in 87% of the dialysis centers. Moreover, tests for conductivity, total organic carbon (TOC), and lead were not within the allowed limits in all the dialysis centers. CONCLUSIONS Our study revealed evidence of chemical and bacterial contamination in the dialysis centers in Palestine. The outcomes of this study showed an urgent need for immediate steps to be taken by the concerned authorities to improve the water quality used in Palestinian HD centers.
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Affiliation(s)
- M Abualhasan
- Faculty of Medicine and Health Sciences, Department of Pharmacy, An-Najah National University, Nablus, Palestine.
| | - A Basim
- Faculty of Medicine and Health Sciences, Department of Pharmacy, An-Najah National University, Nablus, Palestine
| | - A Salahat
- Faculty of Medicine and Health Sciences, Department of Pharmacy, An-Najah National University, Nablus, Palestine
| | - S Sofan
- Faculty of Medicine and Health Sciences, Department of Pharmacy, An-Najah National University, Nablus, Palestine
| | - M Al-Atrash
- Jerusalem Pharmaceutical Company, Quality Control Department, Ramallah, Palestine
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Montanari LB, Sartori FG, Ribeiro DBM, Leandro LF, Pires RH, Melhem MDSC, de Mello CA, Martins CHG. Yeast isolation and identification in water used in a Brazilian hemodialysis unit by classic microbiological techniques and Raman spectroscopy. JOURNAL OF WATER AND HEALTH 2018; 16:311-320. [PMID: 29676766 DOI: 10.2166/wh.2017.334] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
The use of poorly treated water in hemodialysis centers may lead to fungal contamination, which poses a serious threat to immunologically debilitated hemodialysis patients. This study aimed to isolate and identify yeast species in the water of a Brazilian hemodialysis center by using classic microbiological techniques and Raman spectroscopy. For 12 months, a total of 288 water samples were collected from different points of the hemodialysis treatment distribution center. One hundred and forty-six yeast species were isolated and identified in the samples that tested positive for the presence of yeasts such as Candida parapsilosis (100 isolates, or 68.50%), C. guilliermondii (17 isolates, or 11.65%), Rhodotorula mucilaginosa (23 isolates, or 15.75%), R. glutinis (three isolates, or 2.05%), and Trichosporon inkin (three isolates, or 2.05%). Yeast susceptibility to the antifungal fluconazole was also assayed. Only two C. guilliermondii isolates were resistant to fluconazole: the minimal inhibitory concentrations were higher than 64 μg/mL. The different yeast species present in the water of a Brazilian hemodialysis center call for more effective water disinfection procedures in this unit. Raman spectroscopy is an excellent tool to identify yeast species and is potentially applicable in routine water monitoring in hemodialysis units.
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Affiliation(s)
- Lilian Bueno Montanari
- Laboratory of Research in Applied Microbiology, University of Franca - UNIFRAN, Franca, 14404-600 São Paulo, Brazil E-mail:
| | - Flávio Garcia Sartori
- Laboratory of Research in Applied Microbiology, University of Franca - UNIFRAN, Franca, 14404-600 São Paulo, Brazil E-mail:
| | | | - Luís Fernando Leandro
- Laboratory of Research in Applied Microbiology, University of Franca - UNIFRAN, Franca, 14404-600 São Paulo, Brazil E-mail:
| | - Regina Helena Pires
- Laboratory of Research in Applied Microbiology, University of Franca - UNIFRAN, Franca, 14404-600 São Paulo, Brazil E-mail:
| | | | - César Alexandre de Mello
- Nucleus of Research in Sciences and Technology, University of Franca - UNIFRAN, Franca, 14404-600 São Paulo, Brazil
| | - Carlos Henrique Gomes Martins
- Laboratory of Research in Applied Microbiology, University of Franca - UNIFRAN, Franca, 14404-600 São Paulo, Brazil E-mail:
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Vieira RGL, Moraes TDS, Silva LDO, Bianchi TC, Veneziani RCS, Ambrósio SR, Bastos JK, Pires RH, Martins CHG. In vitro studies of the antibacterial activity of Copaifera spp. oleoresins, sodium hypochlorite, and peracetic acid against clinical and environmental isolates recovered from a hemodialysis unit. Antimicrob Resist Infect Control 2018; 7:14. [PMID: 29410782 PMCID: PMC5782372 DOI: 10.1186/s13756-018-0307-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Accepted: 01/15/2018] [Indexed: 02/06/2023] Open
Abstract
Background Patients submitted to hemodialysis therapy are more susceptible to infection, especially to infection by Gram-positive bacteria. Various research works have attempted to discover new antimicrobial agents from plant extracts and other natural products. Methods The present study aimed to assess the antibacterial activities of Copaifera duckei, C. reticulata, and C. oblongifolia oleoresins; sodium hypochlorite; and peracetic acid against clinical and environmental isolates recovered from a Hemodialysis Unit. The Minimum Inhibitory Concentration and the Fractionated Inhibitory Concentration Index were determined; the ability of the tested compounds/extracts to inhibit biofilm formation was evaluated by calculating the MICB50 and IC50. Results C. duckei was the most efficient among the assayed Copaifera species, and its oleoresin was more effective than peracetic acid and sodium hypochlorite. Copaifera oleoresins and disinfectants did not act synergistically at any of the tested combinations. Certain of C. duckei oleoresin, peracetic acid, and sodium hypochlorite concentrations inhibited biofilm formation and eradicated 50% of the biofilm population. Conclusion C. duckei oleoresin is a potential candidate for disinfectant formulations. Based on these results and given the high incidence of multi-resistant bacteria in hemodialysis patients, it is imperative that new potential antibacterial agents like C. duckei oleoresin, which is active against Staphylococcus, be included in disinfectant formulations.
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Affiliation(s)
- Rosimara Gonçalves Leite Vieira
- Nucleus of Research in Sciences and Technology, Laboratory of Research in Applied Microbiology, University of Franca, Avenida Armando Salles de Oliveira, 201, Franca - São Paulo, 14404-600 Brazil
| | - Thaís da Silva Moraes
- Nucleus of Research in Sciences and Technology, Laboratory of Research in Applied Microbiology, University of Franca, Avenida Armando Salles de Oliveira, 201, Franca - São Paulo, 14404-600 Brazil
| | - Larissa de Oliveira Silva
- Nucleus of Research in Sciences and Technology, Laboratory of Research in Applied Microbiology, University of Franca, Avenida Armando Salles de Oliveira, 201, Franca - São Paulo, 14404-600 Brazil
| | - Thamires Chiquini Bianchi
- Nucleus of Research in Sciences and Technology, Laboratory of Research in Applied Microbiology, University of Franca, Avenida Armando Salles de Oliveira, 201, Franca - São Paulo, 14404-600 Brazil
| | - Rodrigo Cassio Sola Veneziani
- Nucleus of Research in Sciences and Technology, Laboratory of Research in Applied Microbiology, University of Franca, Avenida Armando Salles de Oliveira, 201, Franca - São Paulo, 14404-600 Brazil
| | - Sérgio Ricardo Ambrósio
- Nucleus of Research in Sciences and Technology, Laboratory of Research in Applied Microbiology, University of Franca, Avenida Armando Salles de Oliveira, 201, Franca - São Paulo, 14404-600 Brazil
| | - Jairo Kenupp Bastos
- School of Pharmaceutical Sciences of Ribeirão Preto, University of São Paulo, Avenida do Café, s/n, Ribeirão Preto - São Paulo, 14040-903 Brazil
| | - Regina Helena Pires
- Nucleus of Research in Sciences and Technology, Laboratory of Research in Applied Microbiology, University of Franca, Avenida Armando Salles de Oliveira, 201, Franca - São Paulo, 14404-600 Brazil
| | - Carlos Henrique Gomes Martins
- Nucleus of Research in Sciences and Technology, Laboratory of Research in Applied Microbiology, University of Franca, Avenida Armando Salles de Oliveira, 201, Franca - São Paulo, 14404-600 Brazil
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Maltais JAB, Meyer KB, Foster MC. Comparison of techniques for culture of dialysis water and fluid. Hemodial Int 2016; 21:197-205. [DOI: 10.1111/hdi.12477] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Revised: 07/17/2016] [Indexed: 11/28/2022]
Affiliation(s)
| | - Klemens B. Meyer
- William B. Schwartz Division of Nephrology; Tufts Medical Center; Boston Massachusetts USA
| | - Meredith C. Foster
- William B. Schwartz Division of Nephrology; Tufts Medical Center; Boston Massachusetts USA
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Canada MLM, Abelan US, Zangaro RA, Kozusny-Andreani DI, Yamazaki RDFC. Effectiveness of ozonated water in the reprocessing of blood dialyzers. ACTA ACUST UNITED AC 2014. [DOI: 10.1590/rbeb.2014.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Oumokhtar B, Lalami AEO, Mahmoud M, Berrada S, Arrayhani M, Houssaini TS. Prevent infection linked to the dialysis water in a hemodialysis center in Fez city (Morocco). Pan Afr Med J 2013; 16:122. [PMID: 24839530 PMCID: PMC4021988 DOI: 10.11604/pamj.2013.16.122.2877] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2013] [Accepted: 09/02/2013] [Indexed: 11/11/2022] Open
Abstract
Background Water treatment systems are a critical variable in dialysis therapy. Rigorous control of hemodialysis water quality is particularly important in order to guarantee a better quality of life of the hemodialysis patients. The objective of the study was to evaluate the chemical, microbiological quality and antimicrobial resistance of bacteria isolated from water and dialysate in a public HD center. Methods Fifty five samples of water and dialysate were collected weekly over a period of 4 months. The samples were collected from 4 points in the distribution loop. The microbiological and chemical analyses were performed according to our national standards. Antimicrobial susceptibilities patterns of isolated bacteria were determined by disk diffusion method. Results The chemical and microbiological parameters in all dialysis water and dialysate samples are in accordance with national standards. However, 70 Gram-negative bacteria were identified: Pseudomonas sp, Ochrobactrum antropi and Burkholderia cepacia, isolated at 52.8%, 12.8% and 17% simultaneously. Fourteen per cent of the isolates were resistant to three or more antibiotics. All resistant bacteria belong to the genus of Pseudomonas, 80% were resistant to tetracycline and to co-trimoxazole, 30% to ceftazidime. No colistin and imipenem resistance was observed. Conclusion To avoid a health risk due to bacterial contamination, an adequate system for water treatment, disinfection of the hemodialysis system and microbiological monitoring of the water and dialysate are necessary.
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Affiliation(s)
- Bouchra Oumokhtar
- Laboratoire de Microbiologie, Faculté de médecine et de pharmacie, Université Sidi Mohammed Ben Abdallah, Fès, Maroc
| | - Abdelhakim El Ouali Lalami
- Laboratoire de Diagnostic épidémiologique et d'hygiène du milieu. Direction régionale de la santé, Fès, Maroc
| | - Mustapha Mahmoud
- Laboratoire de Microbiologie, Faculté de médecine et de pharmacie, Université Sidi Mohammed Ben Abdallah, Fès, Maroc
| | - Sanae Berrada
- Laboratoire de Diagnostic épidémiologique et d'hygiène du milieu. Direction régionale de la santé, Fès, Maroc
| | - Mohammed Arrayhani
- Service de néphrologie, CHU Hassan II, Faculté de médecine et de pharmacie, Université Sidi Mohammed Ben Abdallah, Fès, Maroc
| | - Tarik Squalli Houssaini
- Service de néphrologie, CHU Hassan II, Faculté de médecine et de pharmacie, Université Sidi Mohammed Ben Abdallah, Fès, Maroc
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Suman E, Varghese B, Joseph N, Nisha K, Kotian MS. The bacterial biofilms in dialysis water systems and the effect of the sub inhibitory concentrations of chlorine on them. J Clin Diagn Res 2013; 7:849-52. [PMID: 23814726 PMCID: PMC3681053 DOI: 10.7860/jcdr/2013/5118.2956] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2012] [Accepted: 02/16/2013] [Indexed: 11/24/2022]
Abstract
INTRODUCTION The presence of bacteria in the form of biofilms poses a problem in the fluid pathways of haemodialysis plants and procedures which are aimed to detach and neutralize biofilms are necessary to improve the patient safety and the quality of the healthcare. The present study was therefore aimed at isolating the organisms which colonized dialysis water systems as biofilms, as well as to study the effect of the sub inhibitory concentrations of chlorine on the biofilms which were produced by these isolates. METHODS Swabs were used to collect the biofilms which were produced on the internal surface of the dialysis tubing from the dialysis units. This study was conducted at the Department of Microbiology, Kasturba Medical College (KMC), Mangalore, India. The cultures were performed on MacConkey's agar and blood agar. The organisms which were isolated were identified and antibiotic sensitivity tests were performed. The biofilm production was done by the microtitre plate method of O'Toole and Kolter. The biofilm production was also studied in the presence of sub inhibitory concentrations of chlorine. RESULTS Acinetobacter spp and Pseudomonas aeruginosa were the two predominant organisms which colonized the dialysis water systems as biofilms. The sub inhibitory concentrations of chlorine did not bring about any decrease in the biofilm production by the isolates. On the contrary, there was an increase in the biofilm production. CONCLUSION Our study highlighted the importance of using appropriate methods to improve the quality of the water in dialysis units. This in turn, may help in reducing the biofilm formation in the water systems of dialysis units and thus, contribute to the prevention of hospital acquired infections in the patients who need haemodialysis.
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Affiliation(s)
- Ethel Suman
- Associate Professor, Department of Microbiology Kasturba Medical College, Mangalore, Manipal University, Karnataka State, India
| | - Benji Varghese
- MBBS Student, Kasturba Medical College, Mangalore, Manipal University, Karnataka State, India
| | - Neethu Joseph
- M.Sc Student, Kasturba Medical College, Mangalore, Manipal University, Karnataka State, India
| | - Kumari Nisha
- M.Sc Student, Kasturba Medical College, Mangalore, Manipal University, Karnataka State, India
| | - M. Shashidhar Kotian
- Selection Grade Lecturer, Department of Community Medicine Kasturba Medical College, Mangalore, Manipal University, Karnataka State, India
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Damasiewicz MJ, Polkinghorne KR, Kerr PG. Water quality in conventional and home haemodialysis. Nat Rev Nephrol 2012; 8:725-34. [PMID: 23090444 DOI: 10.1038/nrneph.2012.241] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Dialysis water can be contaminated by chemical and microbiological factors, all of which are potentially hazardous to patients on haemodialysis. The quality of dialysis water has seen incremental improvements over the years, with advances in water preparation, monitoring and disinfection methods, and high standards are now readily achievable in clinical practice. Advances in dialysis membrane technology have refocused attention on water quality and its potential role in the bioincompatibility of haemodialysis circuits and adverse patient outcomes. The role of ultrapure dialysate is increasingly being advocated, given its proposed clinical benefits and relative ease of production as a result of the widespread use of reverse osmosis and ultrafiltration. Many of the issues pertaining to water quality in hospital-based dialysis units are also pertinent to haemodialysis in the home. Furthermore, an increased awareness of the environmental and financial consequences of home haemodialysis has resulted in the development of automated and more efficient dialysis machines. These new machines have an increased emphasis on water conservation and recycling along with a decreased need for a complex infrastructure for water purification and maintenance.
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Affiliation(s)
- Matthew J Damasiewicz
- Department of Nephrology, Monash Medical Centre, Locked Bag 29, Clayton, VIC 3168, Australia
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Riepl M, Schauer S, Knetsch S, Holzhammer E, Farnleitner AH, Sommer R, Kirschner AKT. Applicability of solid-phase cytometry and epifluorescence microscopy for rapid assessment of the microbiological quality of dialysis water. Nephrol Dial Transplant 2011; 26:3640-5. [PMID: 21948860 DOI: 10.1093/ndt/gfr471] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Currently, the gold standard to assess the microbiological quality of dialysis water is the determination of heterotrophic plate counts (HPC). The long waiting time of the HPC method and the fact that most bacteria are not culturable on agar plates provokes the search for rapid alternative methods for monitoring the microbiological quality of dialysis water. METHODS We tested the applicability of total viable counts (TVC) and total direct counts (TDC), determined via solid-phase cytometry and epifluorescence microscopy (EFM), in comparison to the standard HPC determination method in 113 samples from 13 dialysis water treatment units (59 drinking water and 54 dialysis water samples). Additionally, for a set of dialysis water samples (n = 22) endotoxin concentrations were also determined. RESULTS TVC showed high correlation with HPC and results were of comparable magnitude for most investigated dialysis water samples [median: 3 cells/colony forming units (CFU) 100 mL(-1)]. However, in one dialysis water sample, HPC values (5800 CFU 100 mL(-1)) were >35-fold lower than TVC values (2.05 × 10(5) cells 100 mL(-1)) indicating severe limits of the HPC method to assess the microbiological quality of dialysis water. For drinking water, TVC (median: 4.8 × 10(4) cells 100 mL(-1)) was on average one order of magnitude higher than HPC (median: 2.5 × 10(3) cells 100 mL(-1)). TDCs (median dialysis water: 1.1 × 10(4) cells 100 mL(-1) and median drinking water: 4.9 × 10(6) cells 100 mL(-1)) were always several orders of magnitude higher than HPC or TVC. CONCLUSIONS We propose that the TVC/solid-phase cytometry approach is a reliable and rapid alternative to the culture-dependent approach for assessment of the microbiological quality of dialysis water, especially when fast results are needed. TDC determined via EFM lacks sensitivity and reliability for assessing microbial concentrations in low-cell dialysis water samples since the limits of detection and quantification are high.
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Affiliation(s)
- Michael Riepl
- Water Hygiene, Institute for Hygiene and Applied Immunology, Centre for Pathophysiology, Infectiology and Immunology, Medical University Vienna, Vienna, Austria
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