Does Microbicide Use in Consumer Products Promote Antimicrobial Resistance? A Critical Review and Recommendations for a Cohesive Approach to Risk Assessment

Maillard, Jean‐Yves; Bloomfield, Sally F.; Coelho, Joana Rosado; Collier, Phillip J.; Cookson, B.; Fanning, Séamus; Hill, Andrew; Hartemann, Philippe; McBain, Andrew J.; Oggioni, Marco R.; Sattar, Syed A.; Schweizer, Herbert P.; Threlfall, John

doi:10.1089/mdr.2013.0039

Cited by 63 publications

(75 citation statements)

References 27 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…This has encouraged disinfectant use, which kills pathogens but can be expensive and environmentally unfriendly [23,24]. Products may also incite tolerance among habitually exposed pathogens, itself linked with antimicrobial resistance [25,26]. Most formulations persist unchanged in the environment and exert long-term effects on other biological systems.…”

Section: Novel Disinfectantsmentioning

confidence: 99%

Dos and don’ts for hospital cleaning

Dancer

2016

Current Opinion in Infectious Diseases

View full text Add to dashboard Cite

Purpose of review More evidence is emerging on the role of cleaning and decontamination for reducing hospital-acquired infection. Timely and adequate removal of environmental pathogens leads to measurable clinical benefits for patients. This article considers studies published from 2013 examining hospital decontamination technologies and evidence for cost-effectiveness. Recent findings Novel biocides and cleaning products, antimicrobial coatings, monitoring practices and automated equipment are widely accessible. They do not necessarily remove all environmental pathogens, however, and most have yet to be comprehensively assessed against patient outcome. Some studies are confounded by concurrent infection control and/or antimicrobial stewardship initiatives. Few contain data on costs. Summary As automated dirt removal is assumed to be superior to human effort, there is a danger that traditional cleaning methods are devalued or ignored. Fear of infection encourages use of powerful disinfectants for eliminating real or imagined pathogens in hospitals without appreciating toxicity or cost benefit. Furthermore, efficacy of these agents is compromised without prior removal of organic soil. Microbiocidal activity should be compared and contrasted against physical removal of soil in standardized and controlled studies to understand how best to manage contaminated healthcare environments.

show abstract

Section: Novel Disinfectantsmentioning

confidence: 99%

Dos and don’ts for hospital cleaning

Dancer

2016

Current Opinion in Infectious Diseases

View full text Add to dashboard Cite

show abstract

“…While there have been reports documenting the laboratory selection of bacteria with decreased microbicide sensitivity following repeated exposure to microbicides in highly selective conditions, it remains unclear whether this commonly occurs in the environment (19)(20)(21)(22)(23)(24).…”

mentioning

confidence: 99%

Effects of Formulation on Microbicide Potency and Mitigation of the Development of Bacterial Insusceptibility

Cowley

Forbes

Amézquita

et al. 2015

Appl Environ Microbiol

Self Cite

View full text Add to dashboard Cite

bRisk assessments of the potential for microbicides to select for reduced bacterial susceptibility have been based largely on data generated through the exposure of bacteria to microbicides in aqueous solution. Since microbicides are normally formulated with multiple excipients, we have investigated the effect of formulation on antimicrobial activity and the induction of bacterial insusceptibility. We tested 8 species of bacteria (7 genera) before and after repeated exposure (14 passages), using a previously validated gradient plating system, for their susceptibilities to the microbicides benzalkonium chloride, benzisothiozolinone, chlorhexidine, didecyldimethyl ammonium chloride, DMDM-hydantoin, polyhexamethylene biguanide, thymol, and triclosan in aqueous solution (nonformulated) and in formulation with excipients often deployed in consumer products. Susceptibilities were also assessed following an additional 14 passages without microbicide to determine the stability of any susceptibility changes. MICs and minimum bactericidal concentrations (MBC) were on average 11-fold lower for formulated microbicides than for nonformulated microbicides. After exposure to the antimicrobial compounds, of 72 combinations of microbicide and bacterium there were 19 >4-fold (mean, 8-fold) increases in MIC for nonformulated and 8 >4-fold (mean, 2-fold) increases in MIC for formulated microbicides. Furthermore, there were 20 >4-fold increases in MBC (mean, 8-fold) for nonformulated and 10 >4-fold (mean, 2-fold) increases in MBC for formulated microbicides. Susceptibility decreases fully or partially reverted back to preexposure values for 49% of MICs and 72% of MBCs after further passage. In summary, formulated microbicides exhibited greater antibacterial potency than unformulated actives and susceptibility decreases after repeated exposure were lower in frequency and extent. Microbicides are broad-spectrum chemical agents that inactivate microorganisms (1-3). They are widely deployed throughout health care (4-6), domestic (7,8), and industrial (9-11) environments, where their application includes antisepsis (12), hard surface disinfection (13), and pharmaceutical product preservation (14). They may also be incorporated into medical device coatings, for instance in sutures (15), wound dressings (16), and urinary catheters (17) to inhibit bacterial adhesion and subsequent biofilm formation.It has been hypothesized that the use of microbicides could select for bacterial adaptation, resulting in reduced efficacy of the primary agent, as well as potentially decreasing bacterial susceptibility to chemically unrelated agents such as other microbicides and antibiotics (18). While there have been reports documenting the laboratory selection of bacteria with decreased microbicide sensitivity following repeated exposure to microbicides in highly selective conditions, it remains unclear whether this commonly occurs in the environment (19-24).The majority of studies reporting reductions in microbicide susceptibility have used the active compo...

show abstract

“…UVC light is a physical approach that exerts a germicidal effect by breaking the molecular bond in DNA [18]. It represents a possible solution to the emerging problem of microbial resistance to disinfectants commonly used in healthcare settings [19,20,21] and it is already used for disinfecting patient rooms [22,23,24]. …”

Section: Discussionmentioning

confidence: 99%

Time Effectiveness of Ultraviolet C Light (UVC) Emitted by Light Emitting Diodes (LEDs) in Reducing Stethoscope Contamination

Messina

Fattorini

Nante

et al. 2016

IJERPH

View full text Add to dashboard Cite

Today it is well demonstrated that stethoscopes can be as contaminated as hands, which are a recognized source of Health-Care Associated Infections (HCAIs). Ultraviolet C (UVC) light has proven disinfection capacity and the innovative UVC technology of Light Emitting Diode (LED) shows several potential benefits. To verify whether the use of UVC LEDs is effective and reliable in stethoscope membrane disinfection after prolonged use, a pre-post intervention study was conducted. A total of 1668 five-minute cycles were performed on two UVC LEDs to simulate their use; thereafter, their disinfection capacity was tested on stethoscope membranes used on a previously auscultated volunteer. Then, a further 1249 cycles were run and finally the LEDs were tested to assess performance in reducing experimental contamination by Staphylococcus aureus, Pseudomonas aeruginosa and Escherichia coli on the stethoscope membrane. Baseline volunteer contamination identified 104 Colony Forming Units (CFUs) while treated Petri dishes had 12 and 15 CFUs (p < 0.001). Statistically significant differences (p < 0.001) were also found relating to the reduction of specific bacteria: in particular, after treatment no CFU were observed for S. aureus and E. coli. UVC LEDs demonstrated the capacity to maintain high levels of disinfection after more than 240 h of use and they were effective against common microorganisms that are causative agents of HCAIs.

show abstract

Does Microbicide Use in Consumer Products Promote Antimicrobial Resistance? A Critical Review and Recommendations for a Cohesive Approach to Risk Assessment

Cited by 63 publications

References 27 publications

Dos and don’ts for hospital cleaning

Dos and don’ts for hospital cleaning

Effects of Formulation on Microbicide Potency and Mitigation of the Development of Bacterial Insusceptibility

Time Effectiveness of Ultraviolet C Light (UVC) Emitted by Light Emitting Diodes (LEDs) in Reducing Stethoscope Contamination

Contact Info

Product

Resources

About