Kev xav txog Hemodialysis Dej Microbiological Zoo hauv Brazil Ⅱ

PHEM HEEV RAU HEMODIALYSIS

Tsawg molecular hnyav cov kab mob muaj nyob rau hauvkev lim ntshavTej zaum yuav hla cov filtration membrane mus txog cov hlab ntsha thiab ua rau muaj teeb meem loj rau tus neeg mob, vim li no, cov tshuaj no yuav tsum yog tshuaj thiab microbiologically ntshiab rau lub sij hawm ntev, vim muaj ntau cov tshuaj uas tus neeg mob raug thaum lub sij hawm kho ( Pontoriero li al., 2003; Penne et al., 2009;

Nws yuav siv sij hawm ntev npaum li cas rau CISTANCHE ua haujlwm?

Vim nws yog ib qho khoom siv industrialized, lubdialysis concentrate, nyob rau hauv cov hmoov los yog tov, yuav tsum nruj zoo tswj thiab ceev faj ntawm cov koom haum tswj, whereas qhov zoo ntawm cov dej siv rauhemodialysisyog lub luag haujlwm ntawm chav lim ntshav (Daugirdas, Blake, Ing, 2016). Daim duab 3 qhia txog kev kho cov dej lim dej, uas qhia txog qhov muaj ntau ntawm cov dej kho dej. Txawm li cas los xij, qee lub chaw txais yuav cov tshuab nrog qee qhov kev hloov kho, xws li ob npaug rov qab osmosis. Nyob rau hauv ib qho kev kawm sib pivcov chaw lim ntshav, nws tau pom tias cov dej zoo hauv ib qho nrog ib qho rov qab osmosis tsis yog qhov qis dua rau ib qho uas muaj ob npaug rov qab osmosis (Penne li al., 2009)

Daim duab 3 - Dialysis dej kho lub tswv yim. Cov dej ua ntej dhau los ntawm cov lim membrane thiab ua raws li cov xuab zeb sediment lim. Tom qab ntawd nws dhau los ntawm ob lub tshuab lim dej lim dej, tom qab ntawd, cov dej dhau los ntawm ion txauv resin (softener lossis deionizer nyob ntawm lub hom phiaj). Tom qab ntawd cov dej dhau los ntawm lwm lub lim dej, thiab thaum kawg, nws dhau los ntawm kev rov qab osmosis (uas tuaj yeem ua ib zaug lossis ob zaug). Cov dej kho tau muab khaws cia rau hauv lub tank huv thiab muab faib rau qhov chaw siv.

Ua ntej, dej dhau los ntawm cov lim membrane thiab cov xuab zeb sediment lim, ob qho tib si tshem tawm cov khoom. Tom qab ntawd cov dej nkag mus los ntawm ob lub lim dej ua kom muaj cov pa roj carbon monoxide, uas muaj cov tshuaj chlorine thiab chloramine tuav thiab cov khoom paug organic raug txo. Tom qab ntawd, cov dej dhau los ntawm ion txauv resin, lub kaw lus uas tshem tawm ions, softener yog lub hom phiaj yog tshem tawm cations, los yog deionizer yog lub hom phiaj yog tshem tawm cations thiab anions. Lub sijhawm no, lwm lub lim dej yuav tsum tau tshem tawm cov khoom seem (Riella, 2018; Daugirdas, Blake, thiab Ing, 2016).

Thaum kawg, cov dej hla dhau rov qab osmosis, uas ua raws li kev tiv thaiv kab mob thiab endotoxins. Cov dej kho tau muab khaws cia rau hauv cov tso tsheb hlau luam huv thiab tom qab ntawd muab faib mus rau qhov chaw siv los ntawm kev faib dej (Pontoriero li al., 2003; Riella, 2018; Daugirdas, Blake, thiab Ing, 2016).

Cov kab mob sib txawv, thaum kawg pom nyob rau hauv cov dej kho rau kev lim ntshav, xws li cov kab mob heterotrophic, endotoxins, thiab tshuaj lom neeg tej zaum yuav ua rau muaj ntau yam teeb meem, tshwm sim los ntawm cov cim thiabcov tsos mob xws li txias txias, xeev siab, mob taub hau, kub taub hau, hemolysis, sepsis, thiab txawm tuag (Coulliette, Arduino, 2013).

Microbiological thiab lom kab mob ntawm cov dej kho rau kev lim ntshav

Cov kab mob thiab lawv cov khoom degradation zoo li endotoxins feem ntau pom muaj cov kab mob hauv cov dej kho rau kev lim ntshav, thaum kawg, protozoa, kab mob, thiab fungi kuj tuaj yeem pom (Pontoriero li al., 2003). Cov kab mob Gram-negative thiab nontuberculous mycobacteria yog cov feem ntau pom muaj cov kab mob, kuj tseem muaj peev xwm ua rau lwm hom kab mob, xws li cyanobacteria, ua rau muaj feem cuam tshuam nrog kev kho hemodialytic (Silva li al., 1996; Lima li al., 2005; Gueguim et al., 2016).

Xyoo 1996, hauv Caruaru, Pernambuco State, qhov xwm txheej suav tias yog "Kev nyuaj siab ntawm Hemodialysis" tshwm sim, nrog rau kev tuag ntawm kwv yees li 60 tus neeg, thiab qhov zoo ntawm cov dej siv los lim cov neeg mob cov ntshav tau qhia tias ua rau cov neeg tuag. Tsis tas li ntawd, nws tau txiav txim siab tias tib neeg tau dialyzed los ntawm microcystin uas tau tso tawm los ntawm cyanobacteria thaum chlorine. tau ntxiv rau lub tsheb thauj khoom ntawm lub tsev kho mob hemodialysis, cov dej tau dhau los ntawm kev kho mob, uas tsis muaj qhov rov qab osmosis no tau ua ib qho cim tseem ceeb ntawm kev ua raws li kev cai huv huv thiab kev soj ntsuam hauv Brazil (Azevedo li al., 2002).

Tsis tas li ntawd, xyoo 1996, muaj qhov tshwm sim ntawm cov kab mob bacteriosis tshwm sim hauv Hemodialysis Center hauv Campinas, hauv xeev São Paulo. Tom qab qhov ntu no, cov qauv dej thiab cov dialysate tau sau los ntawm ntau qhov chaw ntawm lubhemodialysis system. Hauv kev sau thawj zaug, 80% ntawm cov qauv qhia suav nrog Pseudomonas aeruginosa thiab Burkholderia cepacia, ob qho tib si kab mob gram-tsis zoo, thaum nyob rau hauv qhov thib ob sau, 100% ntawm cov qauv qhia suav cov kab mob (Pisani li al., 2000). Hauv kev sau los ntawm Sanitary Surveillance of Piracicaba, São Paulo State, xyoo 2003, los ntawm ob lub tsev kho mob npe A thiab B, 200 cov qauv ntawm cov dej lim dej kho tau raug tshuaj xyuas. Chav A tau pom cov poov xab, Pseudomonas aeruginosa, thiab cov kab mob heterotrophic saum 200 colony-forming units (CFU) / mL hauv 5, 14, thiab 52 cov qauv, raws li txhua yam ntawm cov kab mob. Chav B tau pom cov poov xab, Pseudomonas aeruginosa, thiab cov kab mob heterotrophic saum toj 200 CFU / mL hauv 20, 5, thiab 36 ntawm cov qauv, raws li txhua yam ntawm cov kab mob (Simões, Pires, 2004).

Hauv lub nroog Recife, Xeev Pernambuco, peb hom Burkholderia cepacia raug cais tawm ntawm ob qho tib si.dialysis-khoCov qauv dej tau sau los ntawm ntau qhov chaw ntawm cov dej thiab los ntawm cov neeg mob cov ntshav, ob qho tib si tau sau thaum muaj kab mob bacteremia hauv xyoo 2001. Cov qauv sau tom qab rov qab osmosis pom cov kab mob ntau dua li cov qauv sau ua ntej dhau mus, qhia tau cov kab mob colonization ntawm rov qab osmosis membrane. Tom qab ntxuav cov dej thiab hloov daim nyias nyias, qhov tshwm sim tau nres (Magalhães li al., 2003).

Yav dhau los, cov dej xa dej rau cov ntsiab lus siv tau ua los ntawm cov kav dej ntev, qhov loj ntawm polyvinyl chloride (PVC) cov kav dej, yog li txo cov dej ntws, thiab ua rau muaj kab mob ntau ntxiv. Niaj hnub no, cov raj uas muaj cov kab me me thiab ua los ntawm lwm cov ntaub ntawv xws li stainless hlau, polyvinylidene fluoride (PVDF), thiab cross-linked polyethylene (PEX) yog qhov zoo dua vim tias lawv yog cov ntaub ntawv smoother, uas tiv thaiv microbial adhesion thiab pab tua kab mob. Qhov muag tsis pom kev, thaj chaw ntawm stagnation, thiab lub tank cia yuav tsum raug zam, vim tias lawv yog qhov muaj peev xwm ntawm kev sib kis (Pontoriero li al., 2003; Silva li al., 1996).

Txhawm rau tiv thaiv kom tsis txhob muaj kab mob hauv qhov system no, ib txwm siv tshuaj tua kab mob ntawm cov kav dej, tso tsheb hlau luam, thiabcov tshuab lim ntshavyog qhov tseem ceeb (Silva li al., 1996). Cov tshuaj lom neeg xws li peracetic acid thiab hypochlorite, tshav kub, thiab ozone yog dav siv rau cov tshuaj tua kab mob rau cov kab mob lim ntshav. Kev tua kab mob uas suav nrog tag nrho cov kab ke, ua tsawg kawg ib hlis ib zaug, tuaj yeem tiv thaiv kev tsim cov biofilms, tab sis ib zaug tam sim no nyob rau hauv lub cev nws tshem tawm yog qhov nyuaj heev los ua ib qho chaw tsis tu ncua (Pontoriero li al., 2003; Montanari li al. , 2009).

Cov kab mob tuaj yeem pom nyob rau hauv ob txoj hauv kev, cais raws li cov hlwb ywj pheej uas ntab hauv cov kua (planktonic) lossis hauv cov zej zog agglomerated (benthic) adhering rau cov khoom nto hu ua biofilms, yog tias 99% ntawm cov kab mob tam sim no nyob rau hauv daim ntawv ntawm biofilms. . Los ntawm kev txhais, cov no yog cov polymer matrices uas muaj cov kab mob agglomerates thiab txawm tias ntau cov kab mob fungi txuas ua ke los ntawm exopolysaccharides (EPS), tsim los ntawm cov kab mob. EPS tseem muab cov adhesion ntawm biofilm rau saum npoo ntawm cov khoom, feem ntau yog raus rau hauv cov kua dej (Norf, Arndt, Weitere, 2009; Tortora, Funke, Case, 2016).

Cov dej lim dej tau sau tseg hauv lub nroog São Luís, Maranhão State, xyoo 2005, hauv peb lub tsev kho mob, npe A, B, thiab C, nthuav tawm cov tshuaj endotoxins hauv 100% ntawm cov qauv ua ntej kho, thiab 33.33% ntawm cov neeg sau tom qab kho. Hais txog kev txheeb xyuas kab mob hauv tsev kho mob B hom Pseudomonas aeruginosa, Burkholderia cepacia, Alcaligenes xylosoxidans, thiab Stenotrophomonas maltophilia, tag nrho cov kab mob gram-negative, raug cais tawm. Hauv tsev kho mob C, cov kab mob Burkholderia cepacia, Ralstonia pickettii, thiab Flavimonas oryzihabitans, tag nrho cov kab mob Gram-negative raug txheeb xyuas (Lima li al., 2005)

Muaj ntau yam teeb meem tshwm sim los ntawm biofilms, lawv muaj nyob rau hauv qhov chaw tsis tsim nyog tuaj yeem ua rau muaj kev puas tsuaj loj xws li cov yeeb nkab txhaws vim lawv qhov sib txuam (Tortora, Funke, Case, 2016). Biofilms yog qhov ua rau muaj kev txwv ntawm kev kuaj dej qhov twg cov kab mob uas tau khaws tau yog benthic es tsis yog planktonic (Sandle, 2015).

Biofilm yog cov kab mob virulence yam vim nws muaj peev xwm ua raws li qhov chaw. Virulence factor yog ib lub tswv yim ua kom cov kab mob muaj peev xwm txhawb kev kis kab mob. Tsis tas li ntawd, nyob rau hauv biofilm, cov kab mob muaj kev tiv thaiv los ntawm cov tshuaj tua kab mob, tiv thaiv lub cev, thiab tshuaj tua kab mob los ntawm kev qhia txog cov noob caj noob ces (Pontoriero li al., 2003; Trabulsi, and Alterthum, 2015; Singh et al., 2017).

Cov txheej txheem kis tau tuaj yeem suav tias yog qhov ua rau muaj kev mob tshwm sim thiab kev tuag hauv cov neeg mob lim ntshav, nrog rau cov tshuaj tiv thaiv pyrogenic, vim muaj cov endotoxins tam sim no thaum kho dej tsis txaus (Roth, Jarvis, 2000).

Endotoxins muaj nyob rau hauv cov kab mob gram-tsis zoo, uas muaj cov txheej txheem txheej txheej ntawm lipoprotein, phospholipid, thiab lipopolysaccharide (LPS). Cov lipid feem ntawm LPS, hu ua lipid A, muab tshuaj toxicity rau nws thaum tso tawm thaum lub sij hawm lysis ntawm cov kab mob tom qab nws tuag, nws kuj yuav raug tso tawm thaum lub sij hawm cov kab mob (Trabulsi, Alterthum, 2015; Tortora, Funke, Case, 2016).

Hauv tib neeg lub cev, endotoxins txhawb cytokines tso tawm los ntawm macrophages, lawv yog IL-1, IL-6, thiab TNF-, uas ua rau kub taub hau hauv hypothalamus. Cov tshuaj uas ua rau kub taub hau yog hu ua pyrogens. Muaj ob hom pyrogens: endogenous thiab exogenous. Exogenous pyrogens yog cov khoom uas txawv teb chaws rau lub cev, xws li endotoxins, uas, thaum nkag mus rau hauv lub cev, qhib endogenous pyrogens xws li IL-1, IL-6, thiab TNF- (Carvalho, 2002; Trabulsi , Alterthum, 2015).

Ib txoj kev tshawb fawb tau ua nyob rau hauv lub xeev Mato Grosso do Sul tshuaj xyuas cov dej tshuaj ntsuam xyuas los ntawm cov kev pab cuam hemodialysis rau lub sij hawm ntawm 2012 - 2013, thiab, 1% mus rau 3% ntawm cov qauv muaj tag nrho cov coliforms, 1% mus rau 7% yog saum toj no qhov tso cai los ntawm txoj cai rau cov kab mob heterotrophic thiab 6% yog siab tshaj qhov tso cai rau endotoxins. Kev soj ntsuam kuj tau pom tias 1% ntawm cov qauv tau kis los ntawm Escherichia coli thiab 1% los ntawm Pseudomonas aeruginosa. Raws li cov khoom sau tau paub txog 15 hnub tom qab kev ntxuav thiab tshuaj tua kab mob ntawm cov dej kho, qhov no qhia tau tias cov txheej txheem ntxuav tsis zoo (Tristão, 2014).

Cov qauv dej tau sau txhua hli hauv kev tshawb fawb ntawm 2015 thiab 2016 hauv cuaj lub tsev kho mob hauv tsev kho mob hauv tebchaws Ltalis, uas cov kav dej tau tshuaj tua kab mob txhua hli nrog peracetic acid (0.5%). Tag nrho cov qauv muaj cov tshuaj endotoxin tsawg dua 0.03 endotoxin chav tsev (EU) / mL, ib qib qis dua qhov siab tshaj plaws tau tso cai, thiab tsis muaj fungi, tab sis ob ntawm cuaj lub tsev kho mob ntshav qab zib muaj cov kab mob suav. Nws yuav tsum tau muab sau tseg tias nyob rau hauv ib tug ntawm cov pawg ntseeg, lub Burkholderia cepacia strain raug cais, thiab nyob rau hauv lwm yam pawg ntseeg hom Pseudomonas aeruginosa. Txhawm rau kom tsis txhob muaj kev sib kis, cov txheej txheem tshuaj tua kab mob tau ua nrog peracetic acid (2%), thiab sodium hypochlorite (2%) tom qab ntxuav nrog dej (Totaro li al., 2017).