title: Occurrence of fungi in dialysis water and dialysate from eight haemodialysis units in central Italy.
abstract: BACKGROUND
  Fungal contamination of dialysis fluids may be a serious problem in therapy, particularly due to the debilitated immune system of haemodialysis patients.
  
  
  OBJECTIVE
  To investigate the occurrence, distribution, and diversity of fungi in dialysis water and dialysis solution of eight haemodialysis units in a region of central Italy.
  
  
  METHODS
  Samples were collected over a one-year period from different points of the haemodialysis circuits in accordance with the guidelines of the Italian Society of Nephrology. Isolation and identification of fungi was performed according to the ISTISAN method Reports (2007/05 and 2008/10).
  
  
  RESULTS
  Of the 976 samples analysed, 96 grew filamentous fungi, 28 were positive for yeast, and six samples contained both mould and yeast. A wide variety of filamentous fungi (26 genera, of which 15 identified at species level, and 'mycelia sterilia') were recovered, many of which are known as opportunistic pathogens. Cladosporium spp. were most frequently found (39%), followed by Alternaria spp. and Tricophyton spp. Fungal counts in treated water and standard dialysate solution were always below the threshold (<10 cfu/mL), and thus are in agreement with the Italian guidelines for dialysis fluid quality, whereas 10.9% of the samples of ultrapure dialysate solution were contaminated by one or several fungi types, in contravention of the guidelines.
  
  
  CONCLUSIONS
  The large variety of opportunistic fungi recovered in the haemodialysis circuits proves the importance of including an analysis of fungi to check the microbial quality of dialysis water and dialysate.
authors.affiliation: Department of Biomolecular Science, Section of Hygiene, University of Urbino 'Carlo Bo' Urbino, Italy.
authors.forename: G F
authors.initials: GF
authors.lastname: Schiavano
authors.affiliation: Laboratory of Public Health and Hygiene, Department of Prevention, Area Vasta n. 1 - AZUR Marche, Italy.
authors.forename: L
authors.initials: L
authors.lastname: Parlani
authors.affiliation: Department of Biomolecular Science, Section of Hygiene, University of Urbino 'Carlo Bo' Urbino, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Sisti
authors.affiliation: Laboratory of Public Health and Hygiene, Department of Prevention, Area Vasta n. 1 - AZUR Marche, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Sebastianelli
authors.affiliation: Department of Biomolecular Science, Section of Hygiene, University of Urbino 'Carlo Bo' Urbino, Italy. Electronic address: giorgio.brandi@uniurb.it.
authors.forename: G
authors.initials: G
authors.lastname: Brandi
mesh_terms: D015169:Colony Count, Microbial; D015314:Dialysis Solutions; D005658:Fungi / Q000145:classification / Q000302:isolation & purification*; D015312:Hemodialysis Solutions; D006801:Humans; D007558:Italy; D015995:Prevalence
chemical_list: D015314:Dialysis Solutions; D015312:Hemodialysis Solutions
keywords: Dialysis solution; Dialysis water; Filamentous fungi; Fungal count; Haemodialysis