滤膜法与涂抹法检测血液透析相关用水微生物的效果

目的 探讨滤膜法和涂抹法检测血液透析相关用水微生物的效果，为选择合适的检测方法提供依据。方法 回顾性收集某三级甲等综合性医院2018年1-12月同时采用滤膜法和涂抹法检测血液透析相关用水微生物的结果，对比分析滤膜法和涂抹法检测细菌检出率、单位菌落数、超干预值检出率和微生物合格率。结果 共收集274份血液透析相关用水微生物检测结果，其中透析液131份，反渗水39份，B浓缩液（下简称B液）14份，置换液34份，其他透析用水56份。滤膜法细菌检出率均高于涂抹法，其中透析液、反渗水、置换液、其他透析用水标本使用两种方法的细菌检出率比较，差异有统计学意义（均P<0.05）。透析液、B液、其他透析用水标本单位菌落数滤膜法数值上低于涂抹法，但仅其他透析用水标本使用两种方法检测结果单位菌落数差异有统计学意义（t=-3.011，P=0.004）。超干预值检出率其他透析用水滤膜法低于涂抹法，差异有统计学意义（χ²=6.596，P=0.010）。置换液、反渗水标本微生物合格率滤膜法数值上低于涂抹法，但仅置换液标本微生物合格率差异有统计学意义（χ²=18.987，P<0.001）。结论 滤膜法检出细菌的能力高于涂抹法，但其在血液透析相关用水微生物检测中存在一定局限性，除用于置换液比较适合外，应用在其余血液透析相关用水微生物的检测效果并不优于涂抹法。

Effect of filtration membrane method and smear method on detection of microorganism in hemodialysis-related water

Objective To investigate the effect of filtration membrane method and smear method on detection of microorganism in hemodialysis-related water, and provide basis for selecting appropriate detection method. Methods A retrospective study was conducted to analyze the results of water microorganism in hemodialysis-related water detected by filtration membrane method and smear method from January to December, 2018. Bacterial isolation rate, colony forming unit(CFU), rate of intervention-exceeding value as well as qualified rate of microorganism detected by filtration membrane method and smear method were compared and analyzed. Results A total of 274 hemodialysis-related water microbial detection results were collected, including 131 dialysate, 39 reverse osmosis water, 14 concentrated solution B (liquid B), 34 replacement fluid and 56 other dialysis water. Bacterial isolation rates of filtration membrane method were all higher than those of smear method, bacterial isolation rates of dialysate, reverse osmosis water, replacement fluid, and other dialysis water specimens detected by two methods were all significantly different (all P<0.05). The CFU of dialysate, liquid B and other dialysis water specimens detected by filtration member method were all lower than that of smear method, CFU of other dialysis water specimens detected by two methods was significantly different (t=-3.011, P=0.004). Detection rate of intervention-exceeding value of other dialysis water detected by filtration membrane method was lower than that smear method, difference was significant (χ²=6.596,P=0.010). Microbial qualified rate of replacement fluid and reverse osmosis water specimens detected by filtration membrane method was less than that of smear method, qualified rate of microbial detection of replacement fluid was significantly different (χ²=18.987,P<0.001). Conclusion The detection ability of filtration membrane method is higher than that of the smear method, but it has certain limitations in the detection of microorganisms in hemodialysis-related water, except for the replacement fluid, effect of filtration membrane method on the microbial detection of other hemodialysis-related water is no better than that of smear method.