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Mekontso Dessap A, Arrestier R, Billiet PA. Reply to: Gaudry et al.. Am J Respir Crit Care Med 2023; 208:640-641. [PMID: 37437525 PMCID: PMC10492258 DOI: 10.1164/rccm.202306-1015le] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 07/12/2023] [Indexed: 07/14/2023] Open
Affiliation(s)
- Armand Mekontso Dessap
- Service de Médecine Intensive Réanimation, AP-HP, Hôpitaux Universitaires Henri Mondor, Créteil, France
- Faculté de Santé de Créteil, Université Paris Est Créteil, IMRB, GRC CARMAS, Créteil, France; and
- INSERM U955, Créteil, France
| | - Romain Arrestier
- Service de Médecine Intensive Réanimation, AP-HP, Hôpitaux Universitaires Henri Mondor, Créteil, France
- Faculté de Santé de Créteil, Université Paris Est Créteil, IMRB, GRC CARMAS, Créteil, France; and
| | - Pierre-Antoine Billiet
- Service de Médecine Intensive Réanimation, AP-HP, Hôpitaux Universitaires Henri Mondor, Créteil, France
- Faculté de Santé de Créteil, Université Paris Est Créteil, IMRB, GRC CARMAS, Créteil, France; and
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Anversa L, Romani CD, Caria ES, Saeki EK, Nascentes GAN, Garbelotti M, Stancari RCA, Dantas STA, Rall VLM, Ruiz LS, Camargo CH, Richini-Pereira VB. Quality of dialysis water and dialysate in hemodialysis centers: highlight for occurrence of non-fermenting gram-negative bacilli. J Appl Microbiol 2022; 132:3416-3429. [PMID: 35108426 DOI: 10.1111/jam.15470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 01/28/2022] [Accepted: 01/31/2022] [Indexed: 11/30/2022]
Abstract
AIMS To evaluate the physicochemical and microbiological quality of dialysis water and dialysate samples from hemodialysis centers. METHODS AND RESULTS Samples were fortnightly collected from three hemodialysis centers in Bauru City, Brazil, between July/2017 and June/2018, at the stages of post-reverse osmosis, reuse and dialysate. Analyses included determination of conductivity, fluoride, nitrate and sulfate; test for total coliform bacteria; count of heterotrophic bacteria; count and identification of non-fermenting gram-negative bacilli (NFGNB); drug susceptibility test; biofilm formation capacity, and genetic similarity among some isolated NFGNB. Of the analyzed samples, only 4/72 (5.6%) had conductivity values ≥ 10 mS/cm, 4/216 (1.9%) presented total coliforms, and 1/216 (0.5%) had heterotrophic bacteria count > 100 CFU/mL. NFGNB were isolated from 99/216 (45.8%) samples, and the major identified microorganisms included Herbaspirillum aquaticum/huttiense, Brevundimonas aurantiaca, Cupriavidus metallidurans, Pseudomonas aeruginosa and Ralstonia insidiosa. Isolates of P. aeruginosa and Burkholderia cepacia complex were sensitive to most antimicrobials and, together with isolates of Ralstonia insidiosa and Ralstonia pickettii, showed strong biofilm formation capacity. Some isolates expressed the same electrophoretic profile on pulsed-field gel electrophoresis, indicating persistence of bacterial clones in the systems over time. CONCLUSIONS NFGNB were observed in several dialysis water and dialysate samples from all investigated centers, which may represent a risk to the health of patients. SIGNIFICANCE AND IMPACT OF THE STUDY Regular inclusion of actions for NFGNB control and monitoring in hemodialysis fluids are suggested for greater safety of the dialytic process.
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Affiliation(s)
- L Anversa
- Adolfo Lutz Institute, Regional Laboratories Center Bauru, Bauru, Brazil
| | - C D Romani
- Adolfo Lutz Institute, Regional Laboratories Center Bauru, Bauru, Brazil
| | - E S Caria
- Adolfo Lutz Institute, Regional Laboratories Center Bauru, Bauru, Brazil
| | - E K Saeki
- Adolfo Lutz Institute, Regional Laboratories Center Presidente Prudente, Presidente Prudente, Brazil
| | - G A N Nascentes
- Federal Institute of Education, Science and Technology of Triângulo Mineiro, Uberaba, Brazil
| | - M Garbelotti
- Adolfo Lutz Institute, Regional Laboratories Center Bauru, Bauru, Brazil
| | - R C A Stancari
- Adolfo Lutz Institute, Regional Laboratories Center Bauru, Bauru, Brazil
| | - S T A Dantas
- Institute of Biosciences, Department of Microbiology and Immunology, São Paulo State University (Unesp), Botucatu, Brazil
| | - V L M Rall
- Institute of Biosciences, Department of Microbiology and Immunology, São Paulo State University (Unesp), Botucatu, Brazil
| | - L S Ruiz
- Adolfo Lutz Institute, Regional Laboratories Center Bauru, Bauru, Brazil
| | - C H Camargo
- Adolfo Lutz Institute, Central Laboratory, São Paulo, Brazil
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Chaoui L, Chouati T, Zalegh I, Mhand RA, Mellouki F, Rhallabi N. Identification and assessment of antimicrobial resistance bacteria in a hemodialysis water treatment system. JOURNAL OF WATER AND HEALTH 2022; 20:441-449. [PMID: 36366996 DOI: 10.2166/wh.2022.267] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
The water treatment process is a vital factor for hemodialysis (HD) patients. This study aimed to assess the degree of contamination of HD water by bacteria at the HD center of Mohammedia, Morocco, in addition to evaluating the antimicrobial resistance of isolated bacteria. Fifty-four water samples were taken, the appropriate cultures were used to isolate the pathogenic bacteria, which were identified biochemically and molecularly by 16S RNA sequencing. Their susceptibility to antimicrobial drugs was determined by the disk diffusion method. Approximately 5.5% of water samples were above the norm. The isolated bacteria that colonized the HD systems were mostly Gram-negative bacilli, such as Stenotrophomonas maltophilia, Pseudomonas spp., and Burkholderia cepacian. Results of the antibiotics test showed remarkable resistance levels. Among Pseudomonas spp. and S. maltophilia, 10 strains were classified as multidrug-resistant (MDR), and 4 as extensively drug-resistant (XDR). The diversity of bacterial strains isolated in the water used for HD treatments, and their worrying resistance levels pose a significant risk to patients. For these reasons, an urgent need for periodic microbiological monitoring of water after each treatment step must be applied, and the treatment process should also be optimized.
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Affiliation(s)
- Laila Chaoui
- Provincial Diagnostic Laboratory Epidemiological and Environmental Health, Provincial Health Delegation, Mohammedia, Morocco E-mail: ; Laboratory of physical chemistry and biotechnologies of biomolecules and materials, University Hassan II Casablanca, FSTM, Mohammedia, Morocco
| | - Taha Chouati
- Laboratory of Microbiology and Molecular Biology, UATRS-PGF, National Center for Scientific and Technical Research, Rabat, Morocco
| | - Imane Zalegh
- Laboratory of physical chemistry and biotechnologies of biomolecules and materials, University Hassan II Casablanca, FSTM, Mohammedia, Morocco
| | - Rajaa Ait Mhand
- Laboratory of physical chemistry and biotechnologies of biomolecules and materials, University Hassan II Casablanca, FSTM, Mohammedia, Morocco
| | - Fouad Mellouki
- Laboratory of physical chemistry and biotechnologies of biomolecules and materials, University Hassan II Casablanca, FSTM, Mohammedia, Morocco
| | - Naima Rhallabi
- Laboratory of physical chemistry and biotechnologies of biomolecules and materials, University Hassan II Casablanca, FSTM, Mohammedia, Morocco
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Anversa L, Lara BR, Romani CD, Saeki EK, Nogueira Nascentes GA, Bonfietti LX, Melhem MDSC, da Silva Ruiz L, Camargo CH, Pereira VBR. Fungi in dialysis water and dialysate: occurrence, susceptibility to antifungal agents and biofilm production capacity. JOURNAL OF WATER AND HEALTH 2021; 19:724-735. [PMID: 34665766 DOI: 10.2166/wh.2021.204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
The aim of this study was to investigate the occurrence of fungi in dialysis water and dialysate, in addition to evaluating the susceptibility to antifungals and the biofilm production capacity of isolated microorganisms. The samples were collected in three hemodialysis units in Bauru (Brazil), every 15 days (July 2017-June 2018) at post-reverse osmosis, reuse, and dialysate points. The fungi were isolated by spread plate on Sabouraud dextrose agar. Filamentous fungi were phenotypically identified and yeasts were subjected to molecular evaluation of the ITS region. Susceptibility test to antifungals was carried out by the broth microdilution method and biofilm production capacity was evaluated in microtiter plates using crystal violet staining. Fungi were isolated in 52/216 (24.1%) samples, with an average count of 16.3 (10-40) CFU/mL. Overall, 61 microorganisms were identified, with 54 (88.5%) filamentous fungi and 7 (11.5%) yeasts. The main genera included were Penicillium, Cladosporium, Scedosporium, Rhinocladiella, Fusarium, and Emmonsia. Most isolates showed high values of minimum inhibitory concentration for 5-flucytosine and fluconazole and 35/45 (77.8%) isolates were classified as strong producers of biofilm. In order to increase the safety of the dialysis process, the adoption of control measures and monitoring of fungi in hemodialysis fluids is suggested.
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Affiliation(s)
- Laís Anversa
- Regional Laboratories Center Bauru, Adolfo Lutz Institute, Bauru, Brazil E-mail:
| | - Bruna Rossini Lara
- Regional Laboratories Center Bauru, Adolfo Lutz Institute, Bauru, Brazil E-mail:
| | | | - Erika Kushikawa Saeki
- Regional Laboratories Center Presidente Prudente, Adolfo Lutz Institute, Presidente Prudente, Brazil
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Ghomimaghsad N, Yaslianifard S, Mohammadzadeh M, Dadashi M, Noorisepehr M. Contamination of Water Sources of Karaj Hospitals with Legionella pneumophila and Campylobacter jejuni. INTERNATIONAL JOURNAL OF ENTERIC PATHOGENS 2020. [DOI: 10.34172/ijep.2020.29] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Background: One of the most common routes of infection development in humans is contaminated water. Legionella pneumophila and Campylobacter jejuni are the important causes of community- and hospital-acquired pneumonia and gastroenteritis that are transmitted to humans via the inhalation of contaminated water droplets and consumption of contaminated water, respectively. Thus, continuous monitoring of the water supply systems for these pathogens has great importance in public health. Objective: This study aimed to evaluate the water contamination of Karaj hospitals with these two bacterial species. Materials and Methods: In this study, 62 water samples were obtained from different parts of the hospitals of Karaj from April to September 2019, including air conditioning systems, dialysis equipment, ventilation tanks, and different wards of a hospital such as infectious diseases, pediatrics, gastroenterology, dialysis, and intensive and neonatal intensive care units. The samples were collected in sterile containers and immediately transferred to the laboratory for further analysis. The culture on specific media, staining, and biochemical tests were performed to identify the L. pneumophila and C. jejuni. Results: Out of 62 water samples, 25.8% (16 samples) were positive for L. pneumophila; 68.75% were observed in hot water samples, and 31.25% were attributed to cold water samples. Among 62 samples, 4.84% (3 samples) were positive for C. jejuni, which were all detected in hot water samples. Conclusion: Considering that the methods of water refinery of municipal water have no high efficiency, the quality improvement of the water sources of hospitals seems to be necessary.
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Affiliation(s)
| | - Somayeh Yaslianifard
- Department of Microbiology, School of Medicine, Dietary Supplements and Probiotic Research Center, Alborz University of Medical Sciences, Karaj, Iran
| | - Mohammad Mohammadzadeh
- Department of Microbiology, School of Medicine, Dietary Supplements and Probiotic Research Center, Alborz University of Medical Sciences, Karaj, Iran
| | - Masoud Dadashi
- Department of Microbiology, School of Medicine, Dietary Supplements and Probiotic Research Center, Alborz University of Medical Sciences, Karaj, Iran
| | - Mohammad Noorisepehr
- Department of Environmental Health Engineering, Faculty of Health, Alborz University of Medical Sciences, Karaj, Iran
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Characterization of the Bacterial Biofilm Communities Present in Reverse-Osmosis Water Systems for Haemodialysis. Microorganisms 2020; 8:microorganisms8091418. [PMID: 32942620 PMCID: PMC7564833 DOI: 10.3390/microorganisms8091418] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 08/14/2020] [Accepted: 08/19/2020] [Indexed: 02/03/2023] Open
Abstract
Biofilm in reverse osmosis (RO) membranes is a common problem in water treatment at haemodialysis facilities. Bacteria adhere and proliferate on RO membranes, forming biofilms, obstructing and damaging the membranes and allowing the transfer of bacteria and/or cellular components potentially harmful to the health of haemodialysis patients. Our aim was to characterize the bacterial community associated to biofilm of RO membranes and to identify potentially pathogenic bacteria present in the haemodialysis systems of two dialysis centres in Chile. The diversity of the bacterial communities present on RO membranes and potable and osmosed water samples was evaluated using Illumina sequencing. Additionally, bacteria from potable water, osmosed water and RO membrane samples were isolated, characterized and identified by Sanger’s sequencing. The molecular analyses of metagenomics showed that the phyla having a greater relative abundance in both dialysis centres were Proteobacteria and Planctomycetes. Pseudomonas, Stenotrophomonas, Agrobacterium, Pigmentiphaga, Ralstonia, Arthrobacter, Bacteroides and Staphylococcus were bacterial genera isolated from the different samples obtained at both haemodialysis centres. Pseudomonas spp. was a bacterial genus with greater frequency in all samples. Pseudomonas and Staphylococcus showed higher levels of resistance to the antibiotics tested. Results demonstrated the presence of potentially pathogenic bacteria, showing resistance to antimicrobials on RO membranes and in osmosed water in both dialysis centres studied.
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Varied functions of immune checkpoints during cancer metastasis. Cancer Immunol Immunother 2020; 70:569-588. [PMID: 32902664 PMCID: PMC7907026 DOI: 10.1007/s00262-020-02717-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 08/31/2020] [Indexed: 12/14/2022]
Abstract
Immune checkpoints comprise diverse receptors and ligands including costimulatory and inhibitory molecules, which play monumental roles in regulating the immune system. Immune checkpoints retain key potentials in maintaining the immune system homeostasis and hindering the malignancy development and autoimmunity. The expression of inhibitory immune checkpoints delineates an increase in a plethora of metastatic tumors and the inhibition of these immune checkpoints can be followed by promising results. On the other hand, the stimulation of costimulatory immune checkpoints can restrain the metastasis originating from diverse tumors. From the review above, key findings emerged regarding potential functions of inhibitory and costimulatory immune checkpoints targeting the metastatic cascade and point towards novel potential Achilles’ heels of cancer that might be exploited therapeutically in the future.
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Single-species (bacterial, fungal, or mycobacterial) biofilms or dual-species (mycobacterial-fungal) biofilms formed in dialysis fluids. Diagn Microbiol Infect Dis 2020; 96:114870. [PMID: 31955953 DOI: 10.1016/j.diagmicrobio.2019.114870] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Revised: 07/15/2019] [Accepted: 07/17/2019] [Indexed: 11/21/2022]
Abstract
Continuous hemodialysis system monitoring is necessary to prevent microorganism growth and health problems. This study evaluates single- and dual-species biofilm formation in microtiter plates by using dialysis solutions under aerobiosis or 5% CO2 atmosphere. Escherichia coli, Pseudomonas aeruginosa, Staphylococcus epidermidis, Candida parapsilosis sensu lato, and Mycobacterium smegmatis produce single-species biofilms in all dialysis solutions in both oxygenation conditions. Dual-species biofilm cultures grown at 5% CO2 atmosphere and in dialysate containing glucose reveal that M. smegmatis benefits from its association with C. parapsilosis. The dialysate and its constituent solutions support the growth of all the mono-species and the inter-kingdom mycobacterial/yeast biofilms in both aerobiosis and microaerophilic conditions.
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Moradi S, Nasiri MJ, Pourahmad F, Darban-Sarokhalil D. Molecular characterization of nontuberculous mycobacteria in hospital waters: a two-year surveillance study in Tehran, Iran. JOURNAL OF WATER AND HEALTH 2019; 17:350-356. [PMID: 30942784 DOI: 10.2166/wh.2019.294] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Microbiological control of hospital waters as one of the main sources of nontuberculous mycobacteria (NTM) is important for the prevention of NTM-associated illness. This study aimed to investigate the prevalence of NTM in the hospital water systems of Tehran, Iran. A total of 218 samples from different hospital waters (i.e., tap water and medical devices such as humidifying cup of oxygen manometer, dialysis devices, nebulizers, and dental units) were included in this study. Phenotypic and molecular tests were used to identify the isolated organisms to species level. Of 218, 85 (39.0%) samples at 37 °C and 87 (40.0%) samples at 25 °C were identified as NTM. Using hsp65-sequencing method, Mycobacterium lentiflavum was the most frequently encountered, followed by M. gordonae and M. paragordonae. No significant difference was seen in frequency and species in mycobacteria isolated at 37 °C and 25 °C temperatures. Humidifying cup of oxygen manometer had the most contaminated water among the investigated water distribution systems in hospitals. Isolation of NTM from hospital water sources is a serious public health problem in Iran and merits further attention by health authorities. Establishment of microbiological monitoring systems for hospital waters and expanding the number of facilitated laboratories are strongly recommended.
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Affiliation(s)
- Somayeh Moradi
- Department of Microbiology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran E-mail:
| | - Mohammad Javad Nasiri
- Department of Microbiology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | - Davood Darban-Sarokhalil
- Department of Microbiology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran E-mail:
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Hashemi Shahraki A, Trovato A, Droz S, Haidarieh P, Borroni E, Mirsaeidi M, Mannino R, Hashemzadeh M, Mariottini A, Cirillo DM, Tortoli E. Mycobacterium aquaticum sp. nov., a rapidly growing species isolated from haemodialysis water. Int J Syst Evol Microbiol 2017; 67:3279-3282. [PMID: 28829035 DOI: 10.1099/ijsem.0.002103] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
The characterization of five Iranian isolates, four from hospital haemodialysis water and one from the sputum of a patient, led to the detection of a novel mycobacterium species. The strains were characterized by mucoid colonies developing in 3-5 days at temperatures ranging from 25 to 37 °C. The biochemical test pattern was unremarkable while the HPLC profile of mycolic acids resembled that of Mycobacterium fortuitum. The sequences of three major housekeeping genes (16S rRNA, hsp65 and rpoB) were unique and differed from those of any other mycobacterium. Mycobacterium brisbanense, which is the species that shared the highest 16S rRNA gene sequence similarity (99.03 %), was distinct, as shown by the average nucleotide identity and by the genome to genome distance values (91.05 and 43.10 %, respectively). The strains are thus considered to represent a novel species of the genus Mycobacterium, for which the name Mycobacterium aquaticum sp. nov. is proposed. The type strain is RW6T (=DSM 104277T=CIP111198T).
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Affiliation(s)
| | - Alberto Trovato
- Emerging Bacterial Pathogens Unit, IRCCS San Raffaele Scientific Institute, Milano, Italy
| | - Sara Droz
- Institute for Infectious Diseases, University of Berne, Berne, Switzerland
| | - Parvin Haidarieh
- Department of Microbiology, School of Medicine, Alborz University, Karaj, Iran
| | - Emanuele Borroni
- Emerging Bacterial Pathogens Unit, IRCCS San Raffaele Scientific Institute, Milano, Italy
| | - Mehdi Mirsaeidi
- Division of Pulmonary and Critical Care, University Miami, Miami, FL, USA
| | - Roberta Mannino
- Microbiology and Virology Laboratory, Careggi University Hospital, Firenze, Italy
| | - Mohamad Hashemzadeh
- Health Research Institute, Infectious and Tropical Diseases Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | | | - Daniela Maria Cirillo
- Emerging Bacterial Pathogens Unit, IRCCS San Raffaele Scientific Institute, Milano, Italy
| | - Enrico Tortoli
- Emerging Bacterial Pathogens Unit, IRCCS San Raffaele Scientific Institute, Milano, Italy
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Khosravi AD, Hashemi Shahraki A, Hashemzadeh M, Sheini Mehrabzadeh R, Teimoori A. Prevalence of Non-Tuberculous Mycobacteria in Hospital Waters of Major Cities of Khuzestan Province, Iran. Front Cell Infect Microbiol 2016; 6:42. [PMID: 27148491 PMCID: PMC4829604 DOI: 10.3389/fcimb.2016.00042] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Accepted: 03/26/2016] [Indexed: 11/13/2022] Open
Abstract
Non-tuberculous mycobacteria (NTM) are among the emerging pathogens in immunocompromised individuals including hospitalized patients. So, it is important to consider hospitals water supplies as a source for infection. The aim of this study was to determine the prevalence of NTM in the hospital aquatic systems of Khuzestan, South west of Iran. In total, 258 hospital water samples were collected and examined. After initial sample processing, sediment of each sample were inoculated into two Lowenstein-Jensen medium. The positive cultures were studied with phenotypic tests including growth rate, colony morphology, and pigmentation, with subsequent PCR- restriction enzyme analysis (PRA) and rpoB gene sequence analysis. Mycobacterial strains were isolated from 77 samples (29.8%), comprising 52 (70.1%) rapid growing, and 25 (32.4%) slow growing mycobacteria. Based on the overall results, M. fortuitum (44.1%) was the most common mycobacterial species in hospital water samples, followed by M. gordonae (n = 13, 16.8%) and M. senegalense (n = 5, 7.7%). In conclusion, current study demonstrated the NTM strains as one of the major parts of hospital water supplies with probable potential source for nosocomial infections. This finding also help to shed light on to the dynamics of the distribution and diversity of NTM in the water system of hospitals in the region of study.
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Affiliation(s)
- Azar Dokht Khosravi
- Health Research Institute, Infectious and Tropical Diseases Research Center, Ahvaz Jundishapur University of Medical SciencesAhvaz, Iran
- Department of Microbiology, School of Medicine, Ahvaz Jundishapur University of Medical SciencesAhvaz, Iran
| | - Abdolrazagh Hashemi Shahraki
- Health Research Institute, Infectious and Tropical Diseases Research Center, Ahvaz Jundishapur University of Medical SciencesAhvaz, Iran
- Department of Epidemiology, Pasteur Institute of IranTehran, Iran
| | - Mohammad Hashemzadeh
- Department of Microbiology, School of Medicine, Ahvaz Jundishapur University of Medical SciencesAhvaz, Iran
- Student Research Committee, Ahvaz Jundishapur University of Medical SciencesAhvaz, Iran
| | - Rasa Sheini Mehrabzadeh
- Health Research Institute, Infectious and Tropical Diseases Research Center, Ahvaz Jundishapur University of Medical SciencesAhvaz, Iran
| | - Ali Teimoori
- Department of Virology, School of Medicine, Ahvaz Jundishapur University of Medical ScienceAhvaz, Iran
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