Abstract
Some biocidal agents used for disinfection have been described to enhance antibiotic resistance in Gram-negative species. The aim of this review was therefore to evaluate the effect of 13 biocidal agents at sublethal concentrations on antibiotic resistance in Gram-positive species. A MEDLINE search was performed for each biocidal agent on antibiotic tolerance, antibiotic resistance, horizontal gene transfer, and efflux pump. Most data were reported with food-associated bacterial species. In cells adapted to benzalkonium chloride, a new resistance was most frequently found to ampicillin (seven species), cefotaxime and sulfamethoxazole (six species each), and ceftazidime (five species), some of them with relevance for healthcare-associated infections such as Enterococcus faecium and Enterococcus faecalis. With chlorhexidine, a new resistance was often found to imipenem (ten species) as well as cefotaxime, ceftazidime, and tetracycline (seven species each). Cross-resistance was also found with triclosan and ceftazidime (eight species), whereas it was very uncommon for didecyldimethylammonium chloride or hydrogen peroxide. No cross-resistance to antibiotics has been described after low level exposure to glutaraldehyde, ethanol, propanol, peracetic acid, octenidine, povidone iodine, sodium hypochlorite, and polyhexanide. Preference should be given to disinfectant formulations based on biocidal agents with a low or no selection pressure potential.
Highlights
In some parts of the world, the incidence of nosocomial infections caused by vancomycin-resistant enterococci (VRE) is increasing [1,2,3]
When Enterococcus faecalis and Staphylococcus aureus were exposed on agar over 14 passages of 4 days each to increasing concentrations of benzalkonium chloride, both increases and decreases in antibiotic susceptibility were found, but its effect was typically small relative to the differences observed among microbicides
A MIC value > 2 mg/L for benzalkonium chloride was associated with multidrug antibiotic resistance in Staphylococcus aureus, as demonstrated in 1632 human clinical Staphylococcus aureus isolates from different geographical regions [17]
Summary
In some parts of the world, the incidence of nosocomial infections caused by vancomycin-resistant enterococci (VRE) is increasing [1,2,3]. Prior antibiotic treatment has been described to be a relevant risk factor among patients in hematology and oncology [5]. It is currently unknown if other antimicrobial compounds such as specific biocidal agents used in the immediate patient environment for disinfection may have a similar effect on the microbial flora on inanimate surfaces or the skin of patients or healthcare workers. Most users of disinfectants do not expect that some of the biocidal agents in the disinfectants can cause antibiotic resistance themselves, it has been shown recently in various Gram-negative species, especially during low level exposure [6].
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