The antimicrobial activity in vitro of chlorhexidine, a mixture of isothiazolinones ('Kathon' CG) and cetyl trimethyl ammonium bromide (CTAB)

Bacterial resistance and topical antimicrobial wash products

Current scientific evidence has not shown that a link exists between the use of topical antimicrobial formulations and antiseptic or antibiotic resistance. As a result of the extensive history and varied use of antiseptic products and ingredients, any selective pressure for antibiotic resistance that may be occurring or may be uncovered in the future because of antiseptic use would be expected to be insignificant compared with the selective pressure because of antibiotic use. This review illustrates the effectiveness of topical antimicrobial wash products against antibiotic-resistant and antiseptic-resistant bacteria in use settings as well as the studies performed (antiseptic, deodorant, and oral care) demonstrating the lack of development of resistance in long-term clinical studies. Although these studies illustrate that the use of topical antimicrobial products have not been shown to play a role in the fluctuations of the specific composition or resistance of the skin flora, changes in skin flora have been shown to occur. Based on current knowledge, the benefit from use of topical antimicrobial wash products in combination with standard infection control and personal hygiene practices far outweighs the risk of increased antibiotic resistance.

Development of resistance to chlorhexidine diacetate and cetylpyridinium chloride in Pseudomonas stutzeri and changes in antibiotic susceptibility

Strains of Pseudomonas stutzeri developed stable resistance to chlorhexidine diacetate (CHA) or cetylpyridinium chloride (CPC) when exposed to gradually increasing concentrations of either antibacterial agent. Such strains showed reduced sensitivity to other non-antibiotics, including triclosan, and to some antibiotics, although this varied from strain to strain. Resistant strains were inactivated less readily by CHA or CPC and were less sensitive to sodium dodecyl sulphate. Some CHA-resistant and some CPC-resistant strains were more hydrophobic than the parent strains. Alterations in the cell envelope are likely to be responsible for non-specific changes in sensitivity to several antibacterial agents. Attempts to transfer CHA or CPC resistance by conjugation were unsuccessful. DNA from some CHA- or CPC-resistant strains could transform Ps. stutzeri strain JM 302, a histidine auxotroph, to prototrophy.

Antiseptics and disinfectants: activity, action, and resistance

Antiseptics and disinfectants are extensively used in hospitals and other health care settings for a variety of topical and hard-surface applications. A wide variety of active chemical agents (biocides) are found in these products, many of which have been used for hundreds of years, including alcohols, phenols, iodine, and chlorine. Most of these active agents demonstrate broad-spectrum antimicrobial activity; however, little is known about the mode of action of these agents in comparison to antibiotics. This review considers what is known about the mode of action and spectrum of activity of antiseptics and disinfectants. The widespread use of these products has prompted some speculation on the development of microbial resistance, in particular whether antibiotic resistance is induced by antiseptics or disinfectants. Known mechanisms of microbial resistance (both intrinsic and acquired) to biocides are reviewed, with emphasis on the clinical implications of these reports.

The effect of N-duopropenide (a new disinfectant with quaternary ammonium iodides) and formaldehyde on survival of organisms of sanitary interest in pig slurry

The counts of different groups of organisms (mesophilic total aerobic and anaerobic bacteria, enterobacteriaceae, faecal coliform bacteria and faecal streptococci type D), as well as the presence or absence of Pseudomonas spp. and Salmonella spp., were recorded in both unfiltered and filtered pig slurry samples at 1, 8 and 29 days of storage, before and after applying N-duopropenide (a new disinfectant with a quaternary ammonium structure) at 1, 2 x 1, 5 and 2 x 5% concentrations of the commercial product (equivalent to 0.11, 2 x 0.11, 0.55 and 2 x 0.55%, respectively, of active ingredient) for 1 h, or 0.5% commercial formaldehyde for 6 days. Before disinfection, anaerobic and aerobic organisms resulted in the highest counts (between 6 and 7 log units/ml), followed by enterobacteriaceae, faecal coliforms and streptococci (4-5 log units/ml). The unfiltered slurry showed higher bacterial counts than the filtered slurry. The variation in counts was similar for all the groups studied, with the highest count on day 1 of storage with a continuous decrease over the 3 days studied. N-duopropenide efficacy depended on the dose used, but a 2 x 5% concentration resulted in total inactivation (100% reduction) of all the bacteria studied, except for the total aerobic and anaerobic organisms present in unfiltered slurry. Formaldehyde efficacy was much lower. In respect of Pseudomonas spp., more isolates were obtained after using N-duopropenide at lower concentrations (1 and 2 x 1%) than before treatment, thus suggesting its suitability for selective isolation of this genus. Finally, no Salmonella spp. strains were isolated in any of the cases considered in this study.

An in-vitro evaluation of the activity of povidone-iodine against nosocomial bacterial strains

Two povidone-iodine (PVP-I) preparations, one, an antiseptic handwash and one, a skin disinfectant, were tested against 504 bacterial strains isolated from nosocomial infections in 12 French hospitals. In vitro bactericidal activity was determined by a micromethod, using specific interfering substances over a range of dilutions, after 1, 3 and 5 min exposure times. A 5 log10 reduction of the challenge inoculum was considered as the criterion of efficacy. Any resistant strains were tested with the French Standard (T72300). When the micromethod was carried out at 20 degrees C, 10.7% (54/504) of the strains were resistant to the PVP-I skin disinfectant (dilution 1:10) and 1.6% (8/504) were resistant to the handwashing formulations (dilution 1:3) after 1 min exposure. By increasing the temperature to 32 degrees C, the resistance rate to the skin disinfectant fell to 1.9% (10/504). All of the 18 strains found resistant with the micromethod were sensitive using the French standard.

In vitro activity of commercially manufactured disinfectants against Pseudomonas aeruginosa

The in vitro activity of 17 commercially manufactured disinfectants routinely used in a large teaching hospital was tested against 128 strains of Pseudomonas aeruginosa isolated from hospitalized patients and the hospital environment. Except for quaternary ammonium salts, all the disinfectants at dilutions higher or equalling those recommended by the manufacturer were adequate to suppress P. aeruginosa. Chlorhexidine-, povidone-iodine- and glutaraldehyde-based disinfectants at dilutions 4 to 8-fold lower than the normal use dilution had a marked bactericidal effect ( > 3 log10 reduction of viable cells) within a short time (10 to 120 min). Similar formulations produced by different manufacturers exhibited comparable activity against P. aeruginosa.

Susceptibility of suspended and surface-attached Salmonella enteritidis to biocides and elevated temperatures

The differential resistance of substratum-attached, detached, and planktonic cells of Salmonella enteritidis phage type 4 was studied by using several inimical processes and in vivo bioluminescence as a nondestructive, real-time reporter of metabolic activity. Bioluminescence in this strain was mediated by a construction containing the entire lux operon from Photorhabdus luminescens. An excellent correlation between bioluminescence and classical plate count data was obtained when we compared attachment profiles, biocide concentration exponents, and thermal inactivation D values (D value was the time required for a 10-fold reduction in the number of survivors). Biocide challenge of surface-adherent S. enteritidis resulted in concentration exponents that were experimentally indistinguishable from those obtained with Luria-Bertani broth-grown planktonic cells. It appears that cleansing regimes developed by using planktonic cell data are effective against surface-attached cells of this bacterium. Both attached and detached cells exhibited an approximately twofold increase in D values at 52 degrees C compared with values calculated for planktonic cells, strongly indicating that the detached cells exhibited an attached phenotype during the heating process. A model of a physiological adaptive response induced in attached cells and also reflected in detached cells is presented.