Avaliação da técnica de detecção por fluorescência como alternativa para contagem de bactérias heterotróficas em água para hemodiálise

Introduction: The microbiological quality of hemodialysis treated water is directly related to the occurrence of infections and pyrogenic reactions in patients. Objective: Determine the minimum incubation time and evaluate the alternative microbiological method performance for heterotrophic bacteria count in hemodialysis water through the fluorescence microbial detection technique. Method: The analyses were conducted by concentration levels of 2,5 x 10-1 to 1,0 x 102 CFU/plate for Pseudomonas aeruginosa, Burkholderia cepacia, Escherichia coli and Staphylococcus aureus. The tests were performed simultaneously by the alternative and the traditional methods, using culture medium R2A and incubation temperature of 24.0°C ± 4.0°C. The incubation times were 40 h and 120 h, respectively. Fourteen hemodialysis water samples were analyzed to assess the equivalence between the methods evaluated. Results: The results demonstrated that the alternative method allows quantification of heterotrophic bacteria after 40 h of incubation, with accuracy, precision, specificity and linearity for the range of 5 to 100 CFU/plate. The detection limit of the alternative method is 1 CFU/plate. Conclusions: It was possible to conclude that the alternative method has equivalent results to the traditional method, since the confidence interval of the alternative method was entirely within the equivalence range. Therefore, the microbial detection technique by fluorescence showed a viable option for the implementation of a rapid microbiological method for the heterotrophic bacteria count in samples of treated water for hemodialysis.Introdução: A qualidade microbiológica da água tratada para hemodiálise está diretamente relacionada à ocorrência de infecções e de reações pirogênicas nos pacientes. Objetivo: Determinar o tempo de incubação mínimo e avaliar o desempenho do método microbiológico alternativo para a contagem de bactérias heterotróficas em água de hemodiálise por meio da técnica de detecção microbiana por fluorescência. Método: As análises foram conduzidas com níveis de concentração entre 2,5 x 10-1 e 1,0 x 102 UFC/placa para Pseudomonas aeruginosa, Burkholderia cepacia, Escherichia coli e Staphylococcus aureus. Os testes foram realizados simultaneamente pelos métodos alternativo e tradicional, utilizando o meio de cultura R2A e temperatura de incubação de 24,0°C ± 4,0°C. Os tempos de incubação empregados foram os de 40 h e 120 h, respectivamente. Quatorze amostras de água para hemodiálise foram analisadas para avaliação da equivalência entre os métodos avaliados. Resultados: Os resultados demonstraram que o método alternativo permite a quantificação de bactérias heterotróficas após 40 h de incubação, com precisão, exatidão, especificidade e linearidade para a faixa de 5 a 100 UFC/placa. O limite de detecção do método alternativo é 1 UFC/placa. Conclusões: O método alternativo possui resultados equivalentes ao método tradicional, uma vez que o intervalo de confiança do método alternativo obtido esteve compreendido inteiramente dentro da faixa de equivalência. Portanto, a técnica de detecção microbiana por fluorescência mostrou ser uma opção viável para a implementação de um método microbiológico rápido para a contagem de bactérias heterotróficas em amostras de água tratada para hemodiálise

Use of a rapid microbiological method for the enumeration of heterotrophic bacteria in treated water for dialysis: microbial detection technique by fluorescence

O monitoramento da qualidade da água de diálise caracteriza uma importante ferramenta para a tomada de decisões quando resultados laboratoriais insatisfatórios são disponibilizados em curto período de tempo. Os inconvenientes relacionados ao tempo de espera para a obtenção dos resultados têm conduzido à busca de métodos microbiológicos alternativos que permitam obter dados exatos, precisos e em menor tempo do que os obtidos por métodos clássicos. Este projeto teve por finalidade avaliar o desempenho do método microbiológico alternativo para a contagem de bactérias heterotróficas em água tratada para diálise através da técnica de detecção microbiana pelo uso de fluorescência. Inicialmente foi realizada a determinação do tempo mínimo de incubação para obtenção de valores de contagem confiáveis pelo método alternativo, seguido pela avaliação de desempenho do método contemplando todos os parâmetros estabelecidos em compêndios nacionais e internacionais e a demonstração da equivalência do método alternativo frente ao método tradicional, através da avaliação de 23 amostras de água tratada para diálise. Os resultados demonstraram que o método alternativo permite a quantificação de bactérias heterotróficas após 40 horas de incubação, com exatidão e precisão para o range de 5 a 100 UFC/placa, resultando em uma redução de aproximadamente 67% do tempo atualmente empregado no método tradicional. Portanto, a técnica de detecção microbiana pelo uso de fluorescência se mostrou uma opção viável para a implementação de um método microbiológico rápido para a contagem de bactérias heterotróficas em amostras de água tratada para hemodiálise.Monitoring the quality of dialysis water is an important tool for decision-making when unsatisfactory results are available in a short period of time. The drawbacks related to waiting time for obtaining results have led to the search for alternative microbiological methods that allow accurate data to be obtained in less time than those obtained by classical methods. This project aimed to evaluate the alternative microbiological method performance for the heterotrophic bacteria counts in dialysis treated water through the microbial detection technique using fluorescence. Initially, the determination of the minimum incubation time to obtain reliable count values by the alternative method was performed, followed by the performance evaluation of the method, considering all the parameters established in national and international compendiums and demonstrating the equivalence of the alternative method to the traditional method, through the evaluation of 23 samples of dialysis treated water. The results demonstrated that the alternative method allows quantification of heterotrophic bacteria after 40 hours of incubation, with accuracy and precision for the range of 5 to 100 CFU/plate, resulting in a reduction of approximately 67% of the time currently used in the traditional method. Therefore, the microbial detection technique using fluorescence showed a viable option for the implementation of a rapid microbiological method for the heterotrophic bacteria counts in samples of treated water for hemodialysis

Is dialysis water a safe component for hemodialysis treatment in São Paulo State, Brazil?

Failure on the water treatment poses hemodialysis patients at risk of injury and death. Identifying if the patients are exposed to water quality related microbiological risks is an important objective to reduce the mortality for chronic renal patients and is the main issue of this study. We evaluated the microbiological water quality used by 205 dialysis services in São Paulo State, Brazil between 2010 to 2016. The study included heterotrophic bacteria count, total coliforms research, and bacterial endotoxin determination in 1366 dialysis water samples. The number of unsatisfactory clinics for at least one microbiological parameter decreased 16.0% between 2010 to 2015 but increased 57.2% in 2016. In 2010, the most frequent unsatisfactory parameter was related to heterotrophic bacteria count (54.8%) followed by endotoxin determination (45.2%). However, in 2013 an opposite situation was observed: endotoxin determination as the parameter of the higher incidence of nonconformities. Total coliform was verified at a lower frequency. We highlighted the importance of regular monitoring of dialysis water quality to prevent infections caused by dialytic procedures and to ensure that the water is a safe component of the treatment

Effectiveness of the monitoring program for ensuring the quality of water treated for dialysis in the state of São Paulo

ABSTRACT Introduction: Chronic kidney failure is a disease that affects the functions of the kidneys and can cause irreversible kidney failure over time. Among the main factors that cause this disease are hypertension and diabetes mellitus. The number of patients presenting this clinical condition has been increasing in Brazil, leading to an increase in renal replacement therapy, such as hemodialysis. Material and methods: In the state of São Paulo, a joint action between the Adolfo Lutz Institute, the Sanitary Surveillance Center, and the Sanitary Surveillance Groups have promoted the State Program for the Monitoring of Water Treated for Dialysis since 2007 to evaluate the chemical and microbiological quality of the water used in dialysis in compliance with the current legislation. Objective: This study aimed to evaluate the monitoring program developed between 2010 and 2016 as a tool for corrective action when unsatisfactory results are observed. Results: The level of satisfactory results during the period varied from 85.8 to 98.0%, indicating an increase in the adequacy of the dialysis services in producing water with adequate quality for patient health. Conclusion: The design adopted in the state monitoring program is highly effective based on new collections after the joint actions of the Sanitary Surveillance System and the State Dialysis Services

Effectiveness of the monitoring program for ensuring the quality of water treated for dialysis in the state of São Paulo

<div><p>ABSTRACT Introduction: Chronic kidney failure is a disease that affects the functions of the kidneys and can cause irreversible kidney failure over time. Among the main factors that cause this disease are hypertension and diabetes mellitus. The number of patients presenting this clinical condition has been increasing in Brazil, leading to an increase in renal replacement therapy, such as hemodialysis. Material and methods: In the state of São Paulo, a joint action between the Adolfo Lutz Institute, the Sanitary Surveillance Center, and the Sanitary Surveillance Groups have promoted the State Program for the Monitoring of Water Treated for Dialysis since 2007 to evaluate the chemical and microbiological quality of the water used in dialysis in compliance with the current legislation. Objective: This study aimed to evaluate the monitoring program developed between 2010 and 2016 as a tool for corrective action when unsatisfactory results are observed. Results: The level of satisfactory results during the period varied from 85.8 to 98.0%, indicating an increase in the adequacy of the dialysis services in producing water with adequate quality for patient health. Conclusion: The design adopted in the state monitoring program is highly effective based on new collections after the joint actions of the Sanitary Surveillance System and the State Dialysis Services.</p></div