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...