THE SLOW GROWING GRAM NEGATIVE PIGMENTED WATER BACTERIA
Abstract
Bacteria, producing yellow to orange pigmented colonies on the surface of natural and artificial media, can be found in virtually every segment of the environment. They can be isolated from the soil, from fresh and salt water, from rain and snow, as well as from man, animals, birds, fish and plants. The majority of pigmented organisms are slow growing and can best be seen on the surface of agar plates and membrane filter pads, but usually only after extended incubation of 5-15 days at room temperatures, Some species appear to be chlorine tolerant and can be readily isolated from domestic water supply outlets such as taps, spigots and drinking fountain heads. They also grow readily in static water holding units such as tanks, water baths and special equipment, commonly noted in laboratories and hospitals. Although most of the yellow pigmented bacterial colonies can be classified as harmless microorganisms, occurring in most natural water supplies; infections can and do occur among infants, debilitated patients, surgical patients and patients on immunosupressive drug therapy, chiefly through careless handling of water supplies contaminated with these organisms, The use and abuse of our natural fresh water supplies is an ever increasing worldwide problem. Not only are the lakes and streams polluted by chemicals, fertilizers, and insecticides from surface waters, but the sewage disposal practices encourage the survival and growth of many undesirable species of microbes. Bayliss /2/ in 1930 foresaw the coming events when he stated, "It is easy to remove microorganisms and avoid other particles by filtration, but it is not easy to reduce the organic content of many waters to the point where it will not support microbial growth." The truth of this statement was verified many times over a period of twenty years of microbiological analyses of water samples in a hospital and research facility. The samples came from many sources such as dynamic and free flowing and static or stored water supplies especially in dead end or little used pipe lines, water baths, reservoirs, tank and storage units. Most samples at one time or another, contained viable mold spores, yeast cells, acid fast bacilli, aerobic and anaerobic spore formers, micrococci, streptococci and diptheroids in addition to many species of pigmented and nonpigmented gram negative rods /14/—some of which still remain to be classified as this symposium is attempting to demonstrate. Our attention was first drawn to this problem when four open heart surgery patients developed a bacteremia during their convalescent period /4/. Environmental studies demonstrated a similar organism in a water bath for tempering blood in the surgical area, and in the watér cooling system of the heart lung machine used on the four patients, as was isolated from blood cultures of these patients. Subsequent environmental studies showed that various species of pigmented gram negative bacteria could be readily isolated from the water from virtually every area, in varying numbers, of the research complex. Since water is the "almost universal" solvent, it is able to extract both beneficial and harmful components from the soil or surfaces over or through which it flows and percolates that give it flavor, odor, color, hardness, acidity, alkalinity, and the nutrients that support and encourage microbial growth before, during and after routine use and handling. Chambers and Clarke /7/ describe it clearly, "the extent to which water can serve as a bacterial growth medium is one of the least recognized facets of microbiology." The typical water bacteria, i.e., the pigmented gram-negative, non-fermenting, slow growing species require somewhat different conditions for optimum development. Pigment is most readily produced on the surface of agar plates incubated at room temperature for 5-15 days. The slow growth is not limited to artificial media, since samples of water held at room temperature show a slow but steady increase in numbers, while the levels of coliforms or other non-pigmented species usually decrease during similar holding periods.
Full text
THE
SLOW
GROWING
GRAM
NEGATIVE
PIGMENTED
WATER
BACTERIA
L.G.
He man,
BSA,
Ph.D.
Na ional
Ins i u es
o
Heal h
En i onmen al
Sa e y
B anch
Be hesda,
Ma yland
20205
Summa
Bac e ia,
p oducing
yellow
o
o ange
pigmen ed
colonies
on he
su ace
o
na u al
and
a i icial
media,
can
be
ound
in
i ually
e e y
segmen
o
he
en i onmen .
They
can
be
isola ed
om
he
soil,
om
esh
and sal
wa e ,
om
ain
and
snow,
as
well
as
om
man,
animals,
bi ds,
ish
and
plan s.
The
majo i y
o
pigmen ed
o -
ganisms
a e
slow
g owing
and
can
bes
be
seen
on
he
su ace
o
aga
pla es
and
mem-
b ane
il e
pads,
bu
usually
only
a e
ex ended
incuba ion
o
5-15
days
a
oom
empe a u es,
Some
species
appea
o
be
chlo ine
ole an
and
can
be
eadily
isola-
ed
om
domes ic
wa e
supply
ou le s
such
as
aps,
spigo s
and
d inking
oun ain
heads.
They
also
g ow
eadily
in
s a ic
wa e
holding
uni s
such
as
anks,
wa e
ba hs
and
special
equipmen ,
commonly
no ed
in
labo a o ies
and
hospi als.
Al hough
mos
o
he
yellow
pigmen ed
bac e ial
colonies
can
be
classi ied
as
ha mless
mic o-
o ganisms,
occu ing
in
mos
na u al
wa e
supplies;
in ec ions
can
and do
occu
among
in an s,
debili a ed
pa ien s,
su gical
pa ien s
and
pa ien s
on
immunosup es-
si e
d ug
he apy,
chie ly
h ough
ca eless
handling
o
wa e
supplies
con amina ed
wi h
hese
o ganisms,
The
use
and
abuse
o
ou
na u al
esh
wa e
supplies
is
an
e e
inc easing
wo ldwide p oblem.
No
only
a e
he
lakes
and
s eams
pollu ed
by
chemicals,
e i-
lize s,
and
insec icides
om
su ace
wa e s,
bu
he
sewage
disposal
p ac ices
en-
cou age
he
su i al
and
g ow h
o
many
undesi able
species
o
mic obes.
Bayliss
/2/
in
1930
o esaw
he
coming
e en s
when
he
s a ed,
"I
is
easy
o
emo e
mic o-
o ganisms
and
a oid
o he
pa icles
by
il a ion,
bu
i is
no
easy
o
educe
he
o ganic
con en
o
many
wa e s
o
he
poin
whe e
i
will
no
suppo
mic obial
g ow h."
The
u h
o
his
s a emen
was
e i ied
many
imes
o e
a
pe iod
o
wen y
yea s
o
mic obiological
analyses
o
wa e
samples
in
a
hospi al
and
esea ch
acili y.
170
L.
G.
He man
The
samples
came
om
many
sou ces
such
as
dynamic
and
ee
lowing
and
s a ic
o
s o ed
wa e
supplies
especially
in
dead
end
o
li le
used
pipe
lines,
wa e
ba hs,
ese oi s,
ank
and
s o age
uni s.
Mos
samples
a
one
ime
o
ano he ,
con ained
iable
mold
spo es,
yeas
cells,
acid
as
bacilli,
ae obic
and
anae obic
spo e
o me s,
mic ococci,
s ep ococci
and
dip he oids
in
addi ion
o
many
species
o
pigmen ed
and
nonpigmen ed
g am
nega i e
ods
/14/—some
o
which
s ill
emain
o
be
classi ied
as
his
symposium
is
a emp ing
o
demons a e.
Ou
a en ion
was
i s
d awn
o
his
p oblem
when
ou
open
hea
su ge y
pa ien s
de eloped
a
bac-
e emia
du ing
hei
con alescen
pe iod
/4/.
En i onmen al
s udies
demons a ed
a
simila
o ganism
in
a
wa e
ba h
o
empe ing
blood
in
he
su gical
a ea,
and
in
he
wa é
cooling
sys em
o
he
hea
lung
machine
used
on
he
ou
pa ien s,
as
was
isola ed
om
blood
cul u es
o
hese
pa ien s.
Subsequen
en i onmen al
s udies
showed
ha
a ious
species
o
pigmen ed
g am
nega i e bac e ia
could
be
eadily
isola ed
om
he
wa e
om
i ually
e e y
a ea,
in
a ying
numbe s,
o he
e-
sea ch
complex.
Since
wa e
is
he
"almos
uni e sal"
sol en ,
i is
able
o
ex ac
bo h
bene-
icial
and
ha m ul
componen s
om
he
soil o
su aces o e
o
h ough
which
i
lows
and
pe cola es
ha
gi e
i
la o ,
odo ,
colo ,
ha dness,
acidi y,
alkalini y,
and
he
nu ien s
ha
suppo
and
encou age
mic obial
g ow h
be o e,
du ing
and
a e
ou ine
use
and
handling.
Chambe s
and
Cla ke
/7/
desc ibe
i
clea ly,
" he
ex en
o
which
wa e
can
se e
as
a
bac e ial
g ow h
medium
is
one
o he
leas
ecognized
ace s
o
mic obiology."
The
ypical
wa e
bac e ia,
i.e.,
he
pigmen ed
g am-nega i e,
non- e men ing,
slow
g owing
species
equi e
somewha
di e en
condi ions
o
op imum
de elopmen .
Pigmen
is
mos
eadily
p oduced
on
he
su ace
o
aga
pla es
incuba ed
a
oom
empe a u e
o
5-15
days.
The
slow
g ow h
is
no
limi ed
o
a i icial
media,
since
samples
o
wa e
held
a
oom
empe a u e
show
a
slow
bu
s eady
inc ease
in
numbe s,
while
he
le els
o
coli o ms
o
o he
non-pigmen ed
species
usually
de-
c ease
du ing
simila
holding
pe iods.
Pigmen
and
Biochemical
Cha ac e is ics
While
i
is
easy
o
ecognize
pigmen ed
colonies
on
he
su aces
o
aga
pla es
o
memb ane
il e
pads,
Gila di
/11/
igh ly
commen s
ha ,
"using
pigmen
p oduc-
ion
as
a
axonomic
c i e ion
is
in
i sel
o
dubious
me i
because
o
he
e ec s
o
a ia ion
in
empe a u e
and
media
on
pigmen
p oduc ion."
Ciegle
/8/
no ed
ha
o e
hal
o
he
ma ine
bac e ia
isola ed
o
da e,
con ain
unsaponi iable
a
soluble
yellow
o
ed pigmen s.
Hayes
/12/
sepa a ed
pigmen ed
cul u es
isola ed
om
ish
in o
Fla obac e ia
and
Cy ophaga
species.
S a
and
S ephens
/32/
no ed
ha
many
phy opa hogenic
bac e ial
colonies
isola ed
om
plan s
we e
also
yellow
in
colo .
Bean
and
E e on
/3/
isola ed
172
cul u es
o
o ange-yellow
pigmen ed
The
Slow
G owing
G am-Nega i e
Pigmen ed
Wa e
Bac e ia
171
bac e ia
om
chlo ina ed
cooling
wa e s
and
classi ied
mos
o
hem
as
Fla obac-
e ia.
On
he
o he
hand,
Koyama
e .
al.
/19/
no ed
non-pigmen ed
Fla obac e ia
and
concluded
ha ,
"pigmen a ion
o
hese
bac e ia
is
so
a iable
ha
he
desc ip-
ion
is
no
igid
and
hey
mus
he e o e
be
conside ed
o
be
a
he e ogeneous
spe-
cies,"
Al hough
Hayes
/12/
and
Shewan
/28/
eel
ha
he
Fla obac e ia
should
be
classi ied
as
Cy ophaga
,
Weeks
/33/
s a es
ha
"Fla obac e ium
is
mo e
a
his o -
ic
concep
han
a
axonomic
eali y."
Howe e ,
Gila di
/11/
de ines
he
minimal
ea u es
equi ed
o
he
iden i ica ion
o
Fla obac e ium
as:
(1)
G am
nega i e
aspo ogenous
bacilli,
(2)
pola
lagella ed,
i
mo ile,
(3)
oxidize
ca bohyd a es
o
acid
wi hou
gas,
(4)
usually
indole
posi i e,
(5)
ca alase
posi i e,
and
(6)
indophenol
oxidase
posi i e
and
(7)
gela in
posi i e.
Isola ion
Me hods
O
he
many
p oblems
associa ed
wi h
he
slow
g owing,
pigmen ed,
g am
nega i e
wa e
bac e ia,
ha
o
o iginal
isola ion
is
p obably
he
mos
us a ing.
Al-
hough
a ious
species
o
Fla obac e ia
and
Cy ophaga,
Table
I,
can
g ow
o e
a
wide
ange,
4°c
-
44°c,
o
empe a u es,
mos
species
g ow
bes
a
oom
empe a u e,
18°C
-
32°C,
bu
equi e
ex ended
incuba ion
o
5-15
days
o
p oduce
isible
colo-
nies
and
measu able
pigmen a ion
/14/,
hence
he
pla es
should
be
kep
in
plas ic
bags
o
p e en
undue
loss
o
mois u e
om
he
aga
base.
Since
mos
species
a e
pigmen ed
and
ae obic,
swabbed
o
su ace
inocula ed
pla es
a e
p e e able
o
pou ed
pla es,
in
ha
he
pigmen s
can
be
mo e
eadily
no ed
and
colony
g ow h
is
mo e
Table
I
Slow
G owing
Pigmen ed
Wa e
Bac e ia
in
Flowing
and
S a ic
Wa e
Supplies
%
Maximum
Sou ce
No.
Sampled&
Posi i e
Colony
Coun /ml
D inking
Foun ains
1965
117/150
78
3
x
10°
D inking
Foun ains
1975
164/217
76
4x
10°
D inking
Foun ains
1978
334/440
75
Oe
10°
Sink
Fauce s
48/69
70
3
x
10°
Dead
End
Pipe
Lines
10/10
100
5
10*
Wa e
Ba hs
5/7
Ta
ik
10°
X- ay
and
Pho o
Wash
Tanks
10/20
50
Ding
10°
Humidi ying’
Uni e
36/55
65
eee
Den al
Chai
Sp ay
Uni s
7/7
100
Dx. 10°
Dis illed
Wa e
Lines
5/10
50
S x
10°
*Dilu ions
sp ead
on
su ace
o
T.S.A.
pla es
and
incuba ed
a
oom
empe a u e
5-15
days.
172
L.
G.
He man
easily
ans e ed
om
he
aga
su aces.
En ichmen
me hods
in
b o h
a e
no
e-
commended
because
he
slow
g owing
cells
a e
o en
"los "
in
he
hea y
and
mo e
apid
g ow h
o
o he
species
o
bac e ia,
Howe e ,
i
has
been
no ed
ha ,
in
many
ins ances,
when
lac ose
b o h
ubes om
M.P.N.
de e mina ions
o
d inking
wa e
a e
held
o
5-15
days
a
oom
empe a u e, pigmen ed
g ow h
is
eadily
isible
in
many
gas
ee
ubes
and
his,
when
s eaked
on
aga
pla es,
usually
also
p oduces
pigmen ed
colonies,
Since
pigmen ed
bac e ial
colonies
can
be
isola ed
om
wa e
om
i ually
e e y
co ne
o
he
globe,
a
a ie y
o
media
/27/
a e
ad isable
o
p o ide
he
p ope
condi ions
o
op imum
g ow h,
pigmen
p oduc ion
and
iden i ica-
ion
o
he
a ious
species.
Basic
nu ien
mea
o
soybean
ex ac
aga
can
be
en-
hanced
by
he
addi ion
o
yeas
ex ac ,
plan
p o eins
and
ca bohyd a es,
ish
meal,
milk
casein,
as
well
as
soil
ex ac
and
sea
sal s,
wi h
and
wi hou
he
addi ion
o
sheep
blood.
To
p e en
o e g ow h
by
g am
posi i e
cocci
and
spo e
o me s,
he
addi ion
o
an ibio ics
o
he
media
is
help ul,
since
mos
Fla obac e ia
a e
an i-
bio ic
insensi i e.
Whe e
he
mic obial
con amina ion
is
minimal,
i.e.
less
han
1
iable
o ganism
in
10,
50 o 100
ml,
as in
he
case
o
dis illed,
ap,
deionized
o
e e se
osmosis
ea ed
wa e ,
he
memb ane
il e
echnique
should
be
used
wi h
50-500
ml_
samples
so
ha
10-20
isible
colonies
can
de elop
pe
pad
on
ex ended
incuba ion
o
5-15
days
a
oom
empe a u es,
Table
II
Wa e
Samples
Memb ane
Fil e ed
Th ough
47
mm
x
0.45p
Pads”
Sou ce
Samples
Tes ed
Sample
Size
Colonies
Pe
Pad
Tap
wa e
h ough
clean
auce
15
250
ml <10
(5)
10-200
(10)
Tap
wa e
h ough
ubbe
hose
20
250
ml
<200
(6)
ınıcb
(14)
Dis illed
wa e
om
s ill
(di ec )
30
500 ml No
G ow h
Dis illed
wa e
a
end
o
sys em;
20
250 ml
<200
(5)
clean
auce
TNTC
(15)
Dis illed
wa e
h ough
ubbe
hose
20
50
ml
<200
(5)
TNTC
(15)
Deionized
wa e ,
cen al
uni
5
250
ml
TNTC
(5)
“pads
laid
on
T.S.A.
pla es,
incuba ion
a
oom
empe a u e
5-15
days.
bon c
- oo
nume ous
o
coun .
The
Slow
G owing
G am-Nega i e
Pigmen ed
Wa e
Bac e ia
173
Since
some
species
o
Fla obac e ia
a e
pho och omogenic,
incuba ion
should
be
con inued
in
subdued
ligh
a he
han
in
di ec
sunligh
o
o al
da kness
and
whe e
he
empe a u es
a e
no
likely
o
a y
g ea ly
/19/.
Dynamic
Wa e
Supplies
D inking
Foun ains
I is
amazing
ha
he
"d inking
oun ain
head"
s ill
emains
he
mos
igno ed
pa
o
he
en i e
wa e
deli e y
sys em
o
he
indi idual
in
he
a e age
communi y.
Table
I
illus a es
he
a ia ions
and
deg ee
o
con amina ion
and
le els
o
pig-
men ed
wa e
bac e ia
in
one
hospi al.
In
1965
a
o al
o
78%
o
he
d inking
oun ains
we e
con amina ed,
ye
hi een
yea s
la e
he e
was
li le
(75%)
signi—
ican
di e ence
in
he
numbe
o
con amina ed
uni s.
Ano he
ac o
o en
o e looked
when
wa e
om
d inking
oun ains
is
compa ed
wi h
wa e
om
sink
auce s,
is
he
absence
o
chlo ine
in
he
oun ain
wa e .
Many
public
buildings
such
as
schools,
hospi als,
o ices,
e c.,
ha e
a
sepa a e
wa e
deli e y
sys em
o
d inking
oun ains
which
is
cooled
o
chilled,
especially
in
he
summe ime,
and
cons an ly
ci cula ed
so
ha
he
chlo ine
con en
usually
alls
below
he
e ec i e
le el
o
0.6
ppm,
he eby
pe mi ing
mic obial
g ow h
and
mul iplica ion
in
he
sys em
and
especially
a
he
ai -wa e
in e ace
on
he
oun-
ain
head,
Close
examina ion
o
many
oun ains
lea es
much
o
be
desi ed
in
he
way
o
aes he ics.
Many
ha e
easily
isible
accumula ions
o
deposi ed
scales,
o he s
a e
hea ily
us ed,
occasional
heads
ha e
a
deposi
o
slimy
g ow h,
o en
yellowish
o
b own
in
colo
/13/
/14/.
Ne e heless,
he
d inking
oun ain
head,
unless
ou inely
b ushed
and
polished,
is
o en
li le
be e
han
he
"common
cup"
ha
is
seldom
cleaned
o
sani ized.
Dis illed,
Deionized
and
Re e se
Osmosis
Uni s
The
con inuing
demand
o
wa e
o
high
pu i y
in
pha macy,
biochemical,
mic o-
biological
and
issue
cul u e
esea ch
has
been
de eloped
o
a
poin
whe e
dis illed
wa e
is
now
a ailable
wi hou
demons able
py ogens
and
ee
om
iable
bac e ia
/16/.
Howe e ,
he
usual
cen al
dis illed
wa e
supply
ank
wi h
ex ended
pipe
lines
and
ubbe
hoses,
will
always
be
con amina ed wi h
a
wide
a ie y
o
pigmen ed
and
non-pigmen ed
o ganisms
/6,
9,
14,
17/.
Deionizing
uni s
o
a ious
sizes
a e
also
able
o
p o ide
wa e
wi h
e y
low
le els
o
anions
and
ca ions,
bu
mic obial
con amina ion
emains
a
p oblem,
S amm
e .al.,
/31/
ound
Fla obac e ium
in
e e y
deionized
and
so ened
wa e
uni
and
ou le
in
hei
labo a o ies
and
no ed
g ow h
in
he
esin
columns
o
up
o
10°
cells
pe
ml.
DeRoos
e .
al.,
/9/
no ed
ha
when
bo h
deionized
wa e
and
dis-
illed
wa e
was
a ailable
in
he
labo a o y,
he
dis illed
wa e
had
a
lowe
bac-
e ial
and
py ogen
con en
han
he
deionized
supply.
174
L.
G.
He man
A
wa e
supply,
low
in
sodium
and
calcium
sal s
and
i ually
ee
om
Py ogens
and
iable
bac e ia
o
use
in
hemodialysis,
seems
o
be
possible
wi h
a
e e se
osmosis
wa e
p oduc ion
sys em
/15/.
Howe e ,
i
was
no ed
ha
c i ical
main e-
nance
and
s ic
sani a ion
is
necessa y
o
p e en
ecu ing
con amina ion
wi h
bo h
py ogens
and
iable
o ganisms
/25/.
S a ic
Wa e
Supplies
Wa e
Ba hs
and
Wash
Tanks
The
wa e
in
his
equipmen ,
s a ic,
open,
seldom
changed,
and
held
a
a ying
empe a u es
om
ambien
oom
o
45°C
p o ides
an
ideal
medium
o
mic o lo a
o
all
species
(Table
III)
bu
e en
he e,
Fla obac e ium
seem
o
be
he
p edominan
o ganism
-
up
o
35%
o
he
ecognizable
ypes.
Table
III
P edominan
Mic obial
Species
Isola ed
F om
100
Labo a o y
Wa e
Ba hs,
(0°c-45°c)
No.
Con amina ed
Fla obac e ium
sp.
21%
Fla obac e ium
wi h
mixed
lo a
14
Klebsiella
sp.
20
O he
G am
nega i e
species
20
Pseudomonas
ae uginosa
4
G am
posi i e
spo e
o me s
Yeas
species
3
S e ile
-
No
g ow h
LZ
aswabs
on
T.S.
aga
pla es
held
5-15
days
a
oom
empe a u e.
Con amina ed
wa e
ba hs
a e
especial
haza ds
in
su gical
sui es
whe e
blood
packs
a e
empe ed
/4/
o
in
d essing
ooms
whe e
saline
ans usions
a e
wa med,
and
especially
in
mic obiological
labo a o ies
when
ae osols
c ea ed
by
splashing,
e c.,
end
o
elease
con aminan s
in o
media,
able
ops,
equipmen ,
e c.
The
mos
e -
ec i e
and
leas
haza dous
o
co osi e
inhibi o
no ed
o
da e
is
he
addi ion
o
0.1%
-
0.6% o
glu a aldehyde
o
he
wa e
ba h.
The
wa e
should hen
emain
in-
hibi o y
o
ex ended
pe iods
o
ime
depending
on
he
addi ion
o
o ganic
ma e
h ough
spills,
e c,
Regula
cleaning
and
he
use
o
dis illed
wa e
is
also
ecommended,
The
Slow
G owing
G am-Nega i e
Pigmen ed
Wa e
Bac e ia
175
Nebulize s
and
Humidi ie s
A
c i ical
s udy
o
mic o
o ganisms
/29/
in
hea ed
nebulize s
showed
almos
com-
ple e
con ol
o
g ow h
o
all
ypes
o
g am
nega i e
ods,
bu
chie ly
Pseudomonas,
Mo axella,
Acine obac e ,
and
Fla obac e ium
species
when
he
wa e
empe a u e
was
held
a
46°C
o
abo e
while
hose
uni s
held
a
41°C
o
below,
showed
38%
-
52%
con-
amina ion
when held
o
5
days
o
mo e
be o e
cleaning.
I
was
also
no ed
ha
ap
wa e ,
when
used
in
humidi ying
uni s,
was
he
sou ce
o
in ec ion
o
5
o
8
in-
an s
exposed
o
hese
con amina ed
mis s
/21/.
Den al
Chai
Uni s
S udies
o
he
wa e
sp ay
om
a
den al
hand
piece
/1,
20/
(Table
I),
showed
a
high
le el o
con amina ion
by
pigmen ed
g am nega i e
o ganisms
in
e e y
uni
checked,
which could
be
a
haza d
o
bo h
pa ien
and
den is ,
especially
since
some
coun s
exceeded
5,000,000
o ganisms
pe ml.
This
con amina ion
p oblem
is
u he
complica ed
by
he
ac
ha
den al
ese oi s
a e
usually
hea ed
o
35-37°C
o
p o-
ide
a
wa m
sp ay.
The
possibili y
ha
he
pigmen ed
colonies
o en
no ed
in
spu-
um
specimens
/26/
may
in
some
cases
o igina e
om
den al
sp ays,
should
no
be
o e
looked,
Hemodialysis
Sys ems
Fa e o
e ,
al./10/
no ed
ha
wa e
p oduced
by
deioniza ion,
dis illa ion,
e-
e se
osmosis
o
so ening,
suppo ed
many
species
o
g am
nega i e
bac e ia
espe-
cially
when
s o ed
o
used
in
he
dialysa e
o
a i icial
(hemodialysis)
kidney
machines.
In
many
ins ances,
he
p oli e a ing
o ganisms we e
o en
he
cause
o
py ogenic
and
sep ic
eac ions
in
he
ea ed
pa ien .
They
emphasized
he
haza ds
o
"na u ally
occu ing"
bac e ia—in
which o ganisms
p esen
in
dis illed
wa e
and
dilu ed
in
he
same
"memb ane
il e ed"
wa e
g ew
mo e
apidly,
showed
highe
disin ec an
esis ance
and longe
su i al
imes
han
did
hose
o ganisms
ha
we e
passed
h ough
con en ional
labo a o y
media
and
hen
ein oduced
in o
he
same
wa e s,
Among
he
nine g am nega i e o ganisms
usually
isola ed
om
dialysis
luids,
Fla obac e ium,
Pseudomonas
and
Acine obac e
a e
he
mos
common
and
oublesome
con aminan s.
In ec ion
Haza ds
wi h
Pigmen ed
Wa e
Bac e ia
P ema u e
and
Newbo n
In an s
Wi h
he
ad en
o
an ibio ics,
mo e
a en ion
is
being
paid
o
he
g am
nega i e
bac e ia
capable
o
su i ing
in
he
p esence
o
many
an ibio ics
a
highe
han
a e age
le els
equi ed
o
inhibi
he
g am
posi i e
species.
The
eme gence
o
a
sligh ly
pigmen ed
g am
nega i e
non-mo ile,
oxidase
posi i e
bacillus
ha
p oduced
indole
bu
had
li le
eac ion
on
suga s
and
was
sensi i e
only
o
e y h omycin
and
176
.
L.
G.
He man
ca benomycin,
was
he
appa en
cause
o
spinal
meningi is
in 19
newbo n
in an s
o
which
i een
died
/5/.
King
/18/
s udied
hese
o ganisms
u he
and
in
1959
sepa-
a ed
hem
in o
h ee
se ological
g oups,
and
because
o
i s
ligh
yellow
pigmen
and
associa ion
wi h
meningi is, en a i ely
classi ied
i
as
a
new
species—
Fla-
obac e ium
meningosep icum.
Following
his
publica ion,
spo adic
cases
ha e
been
no ed
in
he
in e na ional
li e a u e
annually
/14,
22,
34/.
Ma u e
Pa ien s
In ec ed
Following
Su ge y
Olsen
/22/
isola ed
E
meningosep icum
om
en
cases
o
pos
ope a i e
in ec ion
ollowing
ho acic
su ge y
in
Denma k,
all
pa ien s
su i ed.
To
de e mine
he
sou ce
o
hese
in ec ions,
he
was
able
o
isola e
F.
meningosep icum
om
b ook
wa-
e ,
ga den
soil
and
om
he
blood,
u ine,
spu um
and spinal
luid
o
a ious
pa-
ien s—all
simila
o
he
1959
King
isola es.
The
haza ds
o
indwelling
a e ial
ca he e s
a e
well
desc ibed
by
S amm
e .
al.,
/30/
in
which
hey
no ed
14
pa ien s
wi h
posi i e
blood
cul u es
due
o
a
Fla obac-
e ium.
The
o ganisms
we e
isola ed
om
he
ca he e s,
s op
cocks
and
ice
supply
used
o
cool
he
sy inges.
Thei
ecommenda ions
a e
simple—s e ile
echniques,
handwashing
and
esh
ca he e s
e e y
24
hou s.
Discussion
Since
he
slow
g owing
pigmen ed
wa e
bac e ia
a e
usually
ound
in
ci cula ing
and
s a ic
wa e
supplies
e en
in
he
p esence
o
de ec able
le els
o
chlo ine
/13/,
i
may
mean
ha
many
a e
chlo ine
ole an
and
su i e
o
g ow
and
mul iply
when
"na u ally
occu -
he
chlo ine
has
been
dissipa ed.
Al hough
hese
o ganisms
may
be
ing"
in
wa e
supplies,
/10,
23/
hey
g ow
so
slowly
and
be e
on
he
su ace
o
aga
pla es,
ha
hey
can
easily
be
missed
because
mos
wa e
analyses
ubes
and
pou ed
pla es
a e
disca ded
a e
48
hou s
incuba ion.
While
a ious
species
o
Fla obac e ium
ha e
been
isola ed om
pa ien s
ollow-
ing
use
o
p oduc s
con amina ed
by
hem,
iz
/11,
23,
24,
30/
hence, one
should
no
o e look
he
hospi al
wa e
supplies
as
a
possible
sou ce
o
hose
in ec ions,
e en
hough
hey
a e
di icul
o
iden i y
and
ace
/1,
4,
10/.
Al hough
he
a e age
labo a o y
may
no
ha e
he
pe sonnel
o
expe ience
a ail-
able
o
iden i y
each
and
e e y
wa e bo ne
o ganism,
as
has
been
shown
many
imes
du ing
his
symposium,
hey
can
easily
demons a e
he
p esence
o
o he
han
coli-
o m
species
by:
(1)
swabbing
he
su ace
o
a ious
ypes
o aga
pla e
media
di -
ec ly,
o
by
(2)
using
la ge
amoun s,
e.g.,
50-500
ml o
ea ed
wa e
o
mem-
b ane
il a ion,
bo h
wi h
ex ended
incuba ion.
The
abili y
o
ecognize
mic obial
g ow h
in
any
kind
o
po able,
dis illed
o
deionized
wa e
supplies
when
used
o
domes ic,
medical
o
esea ch
uses,
hus
be-
comes
a
esponsibili y
o
he
mic obiologis
associa ed
wi h
he
consuming
uni .
The
Slow
G owing
G am-Nega i e
Pigmen ed
Wa e
Bac e ia
177
The e o e,
depending
on
he
inal
use
o
any
gi en
wa e
supply,
he
p esence
o
slow
g owing,
pigmen ed
wa e
bac e ia
can
be
(1)
ha mless
indica o s
o
an
uns e -
ile
condi ion,
o
(2)
hey
can
be
a
haza d
o
he
sys em,
he
use
and
he
end
p o-
duc .
The
deg ee
o
which
his
occu s,
depends
on
he
p essu es
c ea ed
by
ou
changing
socie y
on
he
o al
en i onmen
and
e en ually
on
he
mic o lo a
wi hin
i .
Then
as
some
species
a e
s imula ed
o
al e ed
by
he
e ec
o
acids,
an i-
bio ics,
an ibodies,
an isep ics,
chemicals,
disin ec an s,
gases,
pe oleum
p o-
duc s,
e c.,
hei
adap a ion
becomes
mo e
easily
ecognizable
as
"su i o s"
in
a
complex
popula ion,
which
is
ce ainly
ue
o
he
yellow
pigmen ed
g am
nega i e
bac e ia
o
he
Fla obac e ium
-
Cy ophaga
g oup
o
mic oo ganisms.
Bibliog aphy
/1/
Abel,
L.C.,
Mille ,
R.L.,
Micik,
R.E.,
and
Ryge
G.:
J.
Den .
Res.
50,
1567-1569
(1971)
/2/
Baylis,
J.R.:
Wa e Wo ks
and
Sewe age,
77,
335-338
(1930)
/3/
Bean,
PlG.
,
(and.
E e oniaeR
:)
JnpApplis
Bac s
503251
51259)
(L969)
/4/
Be y,
W.
B.,
Mo ow,
A.G.,
Ha ison,
D.C.,
Hochs ein,
H.D.,
and
Himmelsbach,
C.K.:
J.
Tho ac.
and
Ca dio as.
Su g.
45,
476-480
(1963)
/5/
B ody,
J.A.,
Moo e,
H.,
King, E.0.:
Am.
J.
Dis.
Child.
96,
1-5
(1958)
/6/
Ca son,
L.A.,
Fa e o,
M.S.,
Bond,
W.W., and
Pe e son,
N.J.:
Appl.
Mic obiol,
23,
863-869
(1972)
/7/
Chambe s,
C.W.,
and
Cla ke,
N.A.:
Ad .
Appl.
Mic obiol.
8,
105-143
(1966)
/8/
Ciegle ,
A.:
Ad .
Appl.
Mic obiol.
7,
1-34
(1965)
/9/
DeRoos,
R.,
Vesley,
D.,
DuChene,
A.G., and
Ha ,
L.J.:
Heal h
Lab
Science,
13,
11-19
(1976)
/10/
Fa e o,
M.S.,
Pe e sen,
N.J.,
Ca son,
L.A., Bond, W.W.,
and
Hyndman,
S.H.:
Heal h
Lab
Science,
12,
321-334
(1975)
/11/
Gila di,
G.L.,
Hi schl,
$.,
and
Mandel,
M.:
J.
Clin.
Mic obiol.
1,
384-389
(1975)
/12/
Hayes,
P.R.:
J.
Gen.
Mic obiol,
30,
1-9
(1963)
/13/
He man,
L.G.
and
Himmelsbach,
C.K.:
Hospi als
39,
72-76
(1965)
/14/
He man,
L.G.:
Ad ance
in
Appl.
Mic obiol.,
23,
155-171
(1978)
/15/
Bu wick,
B.J.:
Is ael
J.
Med.
Sci.
8,
602-605
(1972)
/16/
Ka amian,
N.A.:
Am.
Lab.
8,
24-28
(1976)
/17/
Kelsey,
J.D.,
and
Beeby,
M.D.:
The
Lance ,
July
11,
82-84
(1964)
/18/
King,
E.D.:
Am.
J.
Clin.
Pa h.
31,
241-247
(1959)
/19/
Koyama
U.,
Yazawa,
Y.,
Yamogishi,
S.,
and
A ai
T,:
Jap.
J.
Mic obiol.
18,
49-56
(1974)
/20/
McEn ega ,
M.C.,
and
Cla k,
A.S.:
B .
Den .
J.
134,
140-142
(1973)
/21/
Mo e ,
H.L.,
Allan
D.,
and
Williams,
T.: Am.
J.
Dis.
Child.
114,
13-20
(1967)