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Use of Germicides in the Home and the Healthcare Setting Is There a Relationship Between Germicide Use and Antibiotic Resistance?

Published online by Cambridge University Press:  21 June 2016

David J. Weber  and
William A. Rutala
David J. Weber
Affiliation:
Division of Infectious Disease, University of North Carolina (UNC) School of Medicine, and the Department of Hospital Epidemiology, UNC Health Care System, Chapel Hill, North Carolina
William A. Rutala*
Affiliation:
Division of Infectious Disease, University of North Carolina (UNC) School of Medicine, and the Department of Hospital Epidemiology, UNC Health Care System, Chapel Hill, North Carolina
*
CB #7030 Bioinformatics Building, 130 Mason Farm Road, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-7030, ([email protected])
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Extract

Background.

The spread of antibiotic-resistant pathogens represents an increasing threat in healthcare facilities. Concern has been expressed that the use of surface disinfectants and antiseptics may select for antibiotic-resistant pathogens.

Objective.

To review the scientific literature on whether there is a link between use of germicides (ie, disinfectants and antiseptics) and bacterial resistance to antibiotics. In addition, we will review whether antibiotic-resistant bacteria exhibit altered susceptibility to germicides that are recommended for use as disinfectants or antiseptics.

Design.

A review of the appropriate scientific literature.

Results.

In the laboratory, it has been possible to develop bacterial mutants with reduced susceptibility to disinfectants and antiseptics that also demonstrate decreased susceptibility to antibiotics. However, the antibiotic resistance described was not clinically relevant because the test organism was rarely a human pathogen, the altered level of antimicrobial susceptibility was within achievable serum levels for the antibiotic, or the antibiotic tested was not clinically used to treat the study pathogen. Similarly, wild-type strains with reduced susceptibility to disinfectants (principally, quaternary ammonium compounds) and antiseptics (principally, triclosan) have been reported. However, because the concentration of disinfectants used in the healthcare setting greatly exceeds the concentration required to kill strains with reduced susceptibility to disinfectants, the clinical relevance of these observations is questionable.

Conclusion.

To date, there is no evidence that using recommended antiseptics or disinfectants selects for antibiotic-resistant organisms in nature. Disinfectants and antiseptics should be used when there are scientific studies demonstrating benefit or when there is a strong theoretical rationale for using germicides.

Type
Review Articles
Information
Infection Control & Hospital Epidemiology , Volume 27 , Issue 10 , October 2006 , pp. 1107 - 1119
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2006

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