联合培养在血液透析用水和透析液细菌菌落检测中的作用  

Effect of combined culture methods on bacterial colony count in hemodialysis water and dialysate

作　　者：蔡宏[1] 张伟明[1] 杨海慧[2] 王咏梅[1] 张斌[1] 蒋蓉[1] 应春妹[2] 严玉澄[1] 倪兆慧[1] 钱家麒[1] 

机构地区：[1]上海交通大学医学院附属仁济医院肾脏科分子细胞(肾病)实验室,200127 [2]上海交通大学医学院附属仁济医院检验科,200127

出　　处：《中华肾脏病杂志》2015年第3期193-197,共5页Chinese Journal of Nephrology

基　　金：上海市卫生局项目（2010120）

摘　　要：目的 比较不同培养基在不同培养温度和时间条件下对血液透析用水和透析液以及原水细菌检出率的影响,探索临床上理想的透析用水和透析液细菌菌落检测方法.方法 2012年1～12月随机采集上海交通大学医学院附属仁济医院血液净化中心透析用水样本176份,透析液样本176份,原水样本88份.采用血培养基、Rresoner＇ 2A琼脂（R2A）和胰蛋白胨葡萄糖浸膏琼脂（tryptone glucose extract agar,TGEA）3种培养基,分别在相应的温度和时间条件下进行培养.培养结束时对每个培养皿进行细菌菌落计数.结果 原水、透析用水和透析液血培养基组细菌菌落计数最低,与TGEA和R2A培养基组相比,差异有统计学意义（P＜0.01）.透析用水和透析液在R2A培养基20℃168 h培养条件下,细菌检出率为61.9％,显著高于其余不同培养条件下细菌检出率（P＜0.05）.根据美国医疗器械促进协会（AAMI）标准细菌计数大于100 CFU/ml为阳性,3种培养基在不同条件下细菌阳性率差异无统计学意义.20℃168 h条件下R2A联合TGEA培养基细菌检出率为77.6％,较相同条件下单纯R2A培养基以及单纯TGEA培养基细菌检出率显著增加（77.6％比61.9％、50.6％,P=0.003、P=0.001）.结论 R2A或TGEA较血培养显著提高透析用水和透析液细菌检出率.临床上采用R2A联合TGEA培养基20℃ 168 h培养条件下可以进一步提高透析用水和透析液细菌检出率.Objective To compare the detection ratio of bacterial colony count in dialysis water,dialysate and raw water with different media and different incubation conditions,searching for suitable methods to detect bacteria from dialysis water.Methods Between Jan 2012 and Dec 2012,176 samples of hemodialysis water and dialysate,88 samples of raw water were collected by hemodialysis unit,Renji hospital.Samples were inoculated in duplicate on spread plates with blood agar,Reasoner＇s 2A（R2A）,tryptone glucose extract agar（TGEA） respectively,at different temperature and time.After incubation,the numbers of colonies were quantified.Results The bacterial colony counts in dialysis water,dialysate and raw water were the lowest in blood agar and the difference had statistical significance with R2A or TGEA culture media （P 〈 0.01）.The detection rate of dialysis water and dialysate were 61.9% in R2A at 20℃ for 168 hours.According to the standard of the association for the advancement of medical instrumentation（AAMI）,the detection rate had no difference among these media with different conditions.Combined with medium of R2A and TGEA,the detection rate of bacteria was 77.6% at 20℃ for 168 hours and the bacteria detection rate was significantly increased than that in culture R2A and TGEA under the same conditions （77.6% vs 61.9%,50.6%,P value was 0.003 and 0.001）.Conclusions The method of R2A or TGEA agar culture can improve the detection rate of bacterial colony count compared with the method of blood agar.The method of R2A combined with TGEA at 20℃ for 168 hours can improve the detection rate of bacteria in dialysis water and dialysate.

关 键 词：血液透析 透析液 培养技术 细菌培养 透析用水 培养基 

分 类 号：R692[医药卫生—泌尿科学]