三种用于血液透析和相关治疗用水微生物学监测方法的评价  

Three methods for microbiological monitoring on dialysate and dialysis water for hemodialysis

作　　者：钱雪峰[1] 乔美珍[1] 金美娟[1] 马文霞[1] 杨波[2] QIAN Xue-feng QIAO Mei-zhen JIN Mei-juan MA Wen-xia YANG Bo(The First Affiliated Hospital of Soochow University, Suzhou 215006, China Suzhou Center for Disease Control and Prevention, Suzhou 215006, China)

机构地区：[1]苏州大学附属第一医院,江苏苏州215006 [2]苏州市疾病预防控制中心,江苏苏州215006

出　　处：《中国感染控制杂志》2017年第8期698-701,共4页Chinese Journal of Infection Control

基　　金：国家自然科学基金(81501425)

摘　　要：目的评价三种方法用于监测血液透析和相关治疗用水微生物检测的效果。方法在某次飞行检查中采集36所受检单位的血液透析液和透析用水72份,分别采用血琼脂平皿(35℃,72 h)、胰蛋白酶大豆琼脂(TSA)平皿(35℃,72 h)、R2A营养琼脂(23℃,168 h)三种方法进行培养,比较三种方法菌落计数、菌落和超干预值(≥50 CFU/mL)检出率的差异。结果采用三种方法对透析液和透析用水进行检测,血琼脂平皿、TSA平皿、R2A营养琼脂菌落检出率分别为40.28%、63.89%和69.44%,差异有统计学意义(χ~2=14.16,P<0.05);两两比较结果显示,R2A营养琼脂和TSA平皿检出率高于血琼脂平皿。血琼脂平皿与R2A营养琼脂、TSA与R2A营养琼脂检出菌落计数比较,差异有统计学意义(Z值分别为-4.515、-6.970,均P<0.05)。血琼脂平皿、TSA平皿、R2A营养琼脂法检测透析液和透析用水菌落数,超干预值检出率分别为1.39%、4.17%和20.83%,差异有统计学意义(χ~2=19.83,P<0.05),R2A营养琼脂检出率高于其他两种方法。结论 R2A营养琼脂和TSA平皿检出率优于血琼脂平皿,R2A营养琼脂超干预值检出率高于TSA平皿和血琼脂平皿,R2A营养琼脂(23℃,168 h)用于血液透析和相关治疗用水微生物监测优于其他两种方法。Objective To evaluate detection effect of three methods on monitoring microbes in dialysate and dialysis water for hemodialysis. Methods Seventy-two dialysate and dialysis water specimens were collected from 36 medical institutions, specimens were cultured with three methods： blood agar plate incubated at 35℃ for 72 hours, Tryptic soy agar（TSA）plate incubated at 35 ℃ for 72 hours, and Reasoner＇s 2A agar （R2A agar） plate incubated at 23℃ for 168 hours, colony counts, isolation of colony, and detection rate of colony exceeding action level（≥50 CFU/mL） were compared among three methods. Results The colony isolation rates of microbes in dialysate and dialysis water detected by blood agar plate, TSA plate and R2A plate were 40.28%, 63.89%, and 69. 44% respectively, difference was significant（x2 = 14. 16, P〈0.05） ; pairwise comparison showed that isolation rates of colony on R2A agar plate and TSA plate were higher than blood agar plate. There was significant difference in isolated col- ony count between blood agar plate and R2A agar plate, TSA plate and R2A agar plate respeetively（Z = - 4. 515, -6. 970 respectively,both P〈0.05）. The rates of isolated colony exceeding action level in dialysate and dialysis water detected by blood agar plate, TSA plate, and R2A agar plate were 1. 39%, 4.17%, and 20.83% respectively, difference was significant（x2 = 19.83 ,P〈0.05） ,detection rate of R2A agar plate was higher than the other two methods. Conclusion The detection rate of colony by R2A agar plate and TSA plate are better than blood agar plate, detection rate of colony exceeding action level by R2A agar plate is higher than TSA plate and blood agar plate, R2A agar plate for microbial monitoring（23 ℃, 168 h） on dialysate and dialysis water is superior to the other two methods.

关 键 词：血液透析 透析液 透析用水 微生物学监测 

分 类 号：R459.5[医药卫生—治疗学]