title: Endotoxin concentration in treated water of all hemodialysis units in Greece and inquisition of influencing factors.
abstract: Mains and purified water samples from all hemodialysis centers in Greece were surveyed to assess hemodialysis water quality and the potential consequences on the dialysis population of any microbial and endotoxin contamination. Total heterotrophic bacteria counts were estimated employing the pour-plate method, the membrane filter technique, for total coliforms, fecal coliforms, enterococci and Pseudomonas spp., and the most probable number method for sulfite-reducing clostridia. Overall 170 paired samples were tested. Endotoxin concentrations were assayed in treated water samples, by the Limulus Amebocyte Lysate method, employing a chromogenic substrate. Endotoxin concentration varied from 0-30 EU/ml and exceeded 5 EU/ml in 30.6% of the centers. Endotoxin contaminated samples showed higher counts of total heterotrophic bacteria, fecal coliforms, enterococci and Pseudomonas spp. than the rest of the samples, though the difference was significant only for total heterotrophic bacteria and enterococci. Additionally, samples with endotoxin contamination derived from the mains water had significantly higher counts of fecal coliforms, enterococci and Pseudomonas spp. Endotoxin concentration was correlated with the presence of a deionization system, counts of fecal coliforms in supply water and counts of total coliforms, fecal coliforms and enterococci in treated water. These results demonstrate that hemodialysis centers in Greece need to monitor and preventively maintain the entire hemodialysis system, in order to ensure renal replacement therapy of good quality.
authors: Laboratory of Hygiene, Medical School, University of Thessaloniki, Greece. vayona@med.auth.gr
authors: M
authors: M
authors: Arvanitidou
authors: S
authors: S
authors: Spaia
authors: N
authors: N
authors: Askepidis
authors: D
authors: D
authors: Kanetidis
authors: M
authors: M
authors: Pazarloglou
authors: V
authors: V
authors: Katsouyannopoulos
authors: G
authors: G
authors: Vayonas
mesh_terms: D004731:Endotoxins / Q000032:analysis*; D006115:Greece; D006436:Hemodialysis Units, Hospital; D006801:Humans; D014871:Water Microbiology; D018508:Water Purification
chemical_list: D004731:Endotoxins