Antiseptic Resistance: What Do We Know and What Does It Mean?

Extract

Biocides (antiseptics, disinfectants, preservatives, sterilants) are used in clinical medicine as intervention strategies that prevent the dissemination of nosocomial pathogens. Biocides are also used for personal hygiene and to prevent cross-contamination of food-borne pathogens in homes, restaurants, day care centers, and nursing homes. However, laboratory evidence has emerged suggesting that the mechanism of nonsusceptibility to biocides may counter-select for resistance to antibiotics. Nature conserves successful survival strategies. Using existing mechanisms of resistance to antibiotics and their means of dissemination, microorganisms have adopted this same survival strategy for biocide nonsusceptibility. These mechanisms are intrinsic in nature or are acquired. The consequences to biocide efficacy in the clinical setting are probably not significant from the biocide perspective. But, the selective pressure biocides exert on bacterial populations that have mechanisms of resistance similar to those to antibiotics or that are also substrates for antibiotic resistance is of concern.

Semmelweis's mandate that physicians wash examining fingers with chlorine to prevent puerperal (childbed) fever provided the scientific evidence to justify the use of biocides in the practice of medicine.¹ Biocides (antiseptics, disinfectants, preservatives, and sterilants) are now an integral component in the practice of clinical medicine and serve primarily to prevent the dissemination of nosocomial pathogens in the hospital environment.² Antiseptics are used as surgical hand scrubs, healthcare personnel hand washes, preoperative skin preparations, and total body washes. Biocides are also used in vascular catheter-care site preparation and are impregnated into catheters to prevent catheter related blood stream infections.^3-5 Disinfectants are used to decontaminate or…

ABBREVIATIONS: CM = cytoplasmic membrane; LPS = lipopolysaccharides; MRSA = methicillin-resistant Staphylococcus aureus; OM = outer membrane; PG = peptidoglycan; PMF = proton motive force; RND = resistance-nodulation-division.