Bacterial contamination of Haemodialysis Water and Dialysis Fluid in Turkish Teaching Hospital- Khartoum State – Sudan

Abstract

The study was conducted during the period of October to December 2018 in Khartoum State in Turkish Teaching Hospital. During the course of this study a total of 100 samples, 50 samples of them were water haemodialysis and 50 sample were dialysis fluid were collected from haemodialysis center in Turkish Hospital. The Water samples were collected just before the water enters the dialysis machine or centeal proportioner. And the dialysate samples were collected following dialysis from the effluent dialysate port on the dialyzer. Bacterial detected as contaminated with a rate of 58% for dialysis fluid and 46% with water haemodialysis. The positive samples were 52% from whole collected samples during the study. and 6 types of bacteria were isolated. The samples were cultured directly onto trypton soya agar media, incubated aerobically overnight at 35ºC for 48 hours. After growth standard methods of identification were used. The isolated bacteria in water haemodialysis fluid were Pseudomonas aeruginosa 10 (20%), Staphylococcus epidermidis 3 (6%), Klebsiella pneumoniae 5 (10%), Streptococcus viridans 2(4%), Gram positive bacillus 3(6%). Only 27(54%) of the samples showed negative growth. The isolated bacteria from dialysis fluid were Pseudomonas aeruginosa 9 (18%), Klebsiella pneumoniae 6(12%), E.coli 3(6%), Gram positive bacillus 7(14%), Staphylococcus epidermidis 4 (8%), the samples showed negative growth were 21 (40%) respectively. Results are reported as mean ± standard deviation and correlation. The p > 0.05 statisticall insignificant. This were showed that the mean of haemodialysis water and dialysis fluid were 3.83 and 4.83.the standard deviation were 3.43 and 3.18 respectively. The PV was 0.076 which is >0.05 and no correlation. Susceptibility results for dialysis fluid samples showed that 18% of Pseudomonas aeruginosa were sensitive to Piperacillin Tazobactum and Ceftazidime and resistance to Ampicillin and Nalidixic acid. 14% sensitive to Gentamicin, were 4% showed intermediate resistance to Gentamicin. While 10% of Klebsiella penumoniae sensitive to Nitrofurantoin, 12% of isolated K.pneumoniae sensitive to Trimethoprim and Amoxicillin, and 2% resistant to Nitrofurantoin. 6% of E.coli were sensitive to Nitrofurantoin, Trimethoprim and 4% sensitive to Amoxicillin, and 2% resistance to Amoxicillin. 8% of Staphylococcus epidermidis were resistant to Penicillin, and sensitive to Methicillin, Fusidic acid and Gentamicin. 6% of it sensitive to Amoxycillin clavulanate, Erythromycin, and 2% resistance to Amoxycillin clavulanate, Erythromycin. 14% of Bacillus species were sensitive to Penicillin, Ciprofloxacin, Tetracycline and Streptomycin. Antibiotic Susceptibility results for Water Samples showed that 20% of Pseudomonas aeurginosa were sensitive to Piperacillin-tazobactum and Ceftazidime and resistance to Ampicillin. 12% of it were sensitive to Gentamicin and 8% intermediate resistant to Gentamicin. 16% of isolated Pseudomonas aeruginosa were showed resistance to Nalidixic acid and 4% were intermediate resistance. 10% of Klebsiella pneumonia were sensitive to Nitrofurantoin, Amoxicillin. 6% sensitive to Trimethoprim, and 4% resistance to Trimethoprim. 6% of Staphylococcus epidermidis were sensitive to Methicillin, Erythromycin, Gentamicin, Fusidic acid, Amoxycillin and resistance to Penicillin. While 4% of Streptococcus viridans sensitive to Ampicillin, Penicillin and resistant to Gentamicin, 2% of isolated Streptococcus viridans sensitive and resistance to Ceftazidime. 6% of isolated Bacillus species was sensitive to Penicillin, Streptomycin. 4% sensitive to Tetracycline, Ciprofloxacin. 2% of isolated Bacillus species were resistance to Tetracycline and Ciprofloxacin. It is concluded from this study the water used in haemodialysis center are of targeted for contamination with different bacterial species of Gram negative and Gram positive. The contamination also in dialysis fluid this may be from water or other sources like vascular access.