Diyaliz sularının mikrobiyal kontaminasyon ve bakteriyel endotoksin testleri ile kontrolü.

Objective: The aim of this study was to evaluate the microbial contamination and bacterial endotoxin levels in dialysis water samples sent to the Water and Food Microbiology Laboratory of the Adana Hygiene Institute Refik Saydam Hygiene Center, and to assess factors that might influence the results of these tests. Method: Two hundred fourty five dialysis water samples sent to the laboratory between January 2009 and December 2010 were tested; all of them for microbial contamination and 198 of them for bacterial endotoxin levels. Microbial contamination was evaluated by using the Plate Count Agar (PCA) method while the Limulus Amoebocyte Lysate (LAL) assay was used for the detection of bacterial endotoxins. The results were evaluated according to the criteria of the "Directives on the Water Purification Systems" and "the European Pharmacopoeia". To compare the annual differences, the chi-square test was used for statistical evaluation and results with p<0.05 were considered statistically significant. Results: Total aerobic microorganism count (TAMC) found by microbial contamination test higher than 100 CFU/ml were 11.7% in 2009, while only 4.8% (p>0.05) in 2010. On the other hand, in 26.7% of the dialysis water samples the levels of bacterial endotoxins was higher than 0.25 İU/ml in 2009, this percentage dropped to 16.5% in 2010 (p>0.05). During 2009-2010, 245 microbial contamination tests were performed and in 20 (8.2%) of the samples the TAMC values were higher than 100 CFU/ml, while in 43 (21.7%) out of 198 of the samples the bacterial endotoxin levels were higher than 0.25 İU/ml. Out of 20 in 43 samples, a bacterial endotoxin levels were >0.25 İU/ml were also found as microbiologically contaminated ( >100 CFU/ml), while in remaining 23 samples the level was <100 CFU/ml. There were no statistically significant differences in the percentages of positives found in 2009 and 2010. Conclusion: The results of our study indicate that the detection of endotoxins is a complementary factor to microbial contamination in the bacteriological monitoring of dialysis waters. We recommend that level of endotoxin should be taken into account when the bacterial contamination test is used. It is important that periodic control of dialysis waters should be done by different reliable laboratory tests. [ABSTRACT FROM AUTHOR]