Incidence of pyrexia in patients undergoing haemodialysis

Four patients on maintenance haemodialysis at the Lagos University Teaching developed pyrogenic reactions during treatment. Blood cultures were negative but the haemodialysates were grossly contaminated, mostly with Gram-negative bacilli, implicating their endotoxin as the cause of the observed pyrogenicity. The water reservoirs supplying the dialysis centre were grossly contaminated (counts 2.0 x 10(2) cfuml-1) with Gram-negative bacteria such as Pseudomonas aeruginosa, Ps. fluorescens, Alcaligenes faecalis, Achromobacter spp. and a Gram-positive organism, Micrococcus spp. These were the organisms isolated from the haemodialysates. At each sampling time, though fewer bacterial species were isolated from the haemodialysates, contrast the water reservoirs, the population of each bacterial type recovered from both samples was higher in the haemodialysates indicating a build up of the organisms within the haemodialysis machines. These findings therefore call for regular monitoring of the level of contamination of water use for mixing haemodialysis fluid in order to know when critical level is being exceeded.