The Soaring Increase of Resistant Microorganisms Demands Immediate Action Solutions are Available

Abstract

Clinical environments provide an ideal reservoir for the growth, proliferation, and transmission of pathogenic organisms. Surfaces in hospitals e.g. hospital furniture, ECG lead wires and other cables, push buttons of infusion pumps, control knobs of ventilation machines, textiles as well as implantable biomaterials like central venous catheters, urologic catheters, endotracheal tubes are contaminated increasingly frequent with multiresistant microorganisms. These microorganisms are distributed by the hands of the nursing personnel throughout the hospital with serious, life threatening consequences. 1.8 million patients suffer from a nosocomial infection per year in Europe; approximately 180,000 deaths are attributed to these infections. The Centers for Disease Control (CDC) estimates that 2 million U.S. patients per year acquire a hospital-related infection. These infections cause 90,000 deaths each year and cost an average of $47,000 per patient to treat. The added cost to hospitals is $4.8 billion anually for extended care treatment. Microorganisms show an increasing rate of resistance against the majority of antibiotics including carbapenems as last available antibiotic. 700,000 deaths have been rеρorted worldwide, 30 000 deaths alone in Europe during the last year due to infections where no effective antimicrobial substance was available. The use of disinfectants is ostensibly intended to remove/kill pathogens on surfaces. However studies have shown that more than one-half the time, surfaces are not adequately cleaned or are re-contaminated within minutes. Much emphasis has been put therefore on hand disinfection. However there are also rеρorts of the emergence of alcohol tolerant/insensitive microorganisms e.g., vancomycin resistant enterococci. This phenomenon has the potential to undermine the effectiveness of alcohol based disinfectant standard precautions. The reason for this dramatic development of resistant microorganisms is still in debate. The indiscriminate use of antibiotics for prevention of a bacterial superinfections e.g. sinusitis, otitis media after a viral infections is frequently incriminated, however this seems to have little impact on the occurrence of multi-resistant hospital pathogens in general. However individual patients are seriously affected by the selection of multi-resistant pathogens. In contrast there is increasing evidence that the widespread use of disinfectants is responsible: disinfectants - analogous to antibiotics - must be incorporated into the metabolism of microorganisms. This is inevitably associated with induction of resistance by transfer of resistance plasmids e.g. induction of efflux pumps. 10 167 рublications (PUBMed Jan. 2023) are available in the international literature which document the resistance of microorganisms against disinfectants; 649 рublications describe the cross resistance with antibiotics, at the same time there are 11 237 publications on the toxicity of disinfectants.