Introdução:No estado de São Paulo, a concentração de flúor na água de abastecimento público deve ser mantida na faixa de 0,6 a 0,8 mg/L, a fim de prevenir a cárie e evitar o risco de fluorose. Objetivo: Avaliar a concentração de fluoretos na água de abastecimento público dos municípios de abrangência do Grupo de Vigilância Sanitária de Bauru. Método: Os dados foram extraídos da rotina do Instituto Adolfo Lutz -Bauru e oriundos de 38 municípios monitorados pelo Programa de Vigilância da Qualidade da Água para Consumo Humano (Proágua), no período de 2007-2016. As análises laboratoriais foram realizadas utilizando-se o método potenciométrico com eletrodo íon-seletivo e a interpretação dos resultados baseou-se na Resolução SS nº 250/95 e na classificação proposta pelo Centro Colaborador do Ministério da Saúde em Vigilância da Saúde Bucal (CECOL). Resultados: Das 8.887 amostras analisadas, 31,1% apresentaram teores inadequados de íons fluoretos, sendo que 22,7% estavam abaixo e 8,4% acima do limite estabelecido pela legislação. De acordo com a proposta do CECOL, 59,4% das amostras exibiram benefício máximo para prevenção de cárie e 0,6% revelaram risco muito alto para produção de fluorose dentária. Conclusões: Tais dados apontam a necessidade de aprimorar o controle operacional do processo de fluoretação e enfatiza a importância da vigilância da qualidade da água.

Aims To evaluate the physicochemical and microbiological quality of dialysis water and dialysate samples from haemodialysis centres. Methods and Results Samples were fortnightly collected from three haemodialysis centres 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 sulphate; 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 analysed 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 micro‐organisms 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 the persistence of bacterial clones in the systems over time. Conclusions NFGNB were observed in several dialysis water and dialysate samples from all investigated centres, 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 haemodialysis fluids are suggested for greater safety of the dialytic process.

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.