Fernandes ÂR, Rodrigues AG, Cobrado L. Effect of prolonged exposure to disinfectants in the antimicrobial resistance profile of relevant micro-organisms: a systematic review.
J Hosp Infect 2024;
151:45-59. [PMID:
38740303 DOI:
10.1016/j.jhin.2024.04.017]
[Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Revised: 04/08/2024] [Accepted: 04/27/2024] [Indexed: 05/16/2024]
Abstract
BACKGROUND
Antimicrobial resistance (AMR) constitutes a major global health threat, to a very large extent due to the inadequate use of antibiotics. Additionally, the misuse of disinfectants can also trigger the selection of resistant clones, where micro-organisms develop an adaptative response and progress to resistance mechanisms. Cross-resistance may occur when a biocide's selective pressure induces antimicrobial resistance.
AIM
To acknowledge the potential relationship between repeated and/or prolonged exposure to disinfectants and antimicrobial resistance profile adjustment.
METHODS
This systematic review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Studies published until December 2023 that were related to the interaction between disinfectants and antimicrobials were included. Further selection was based on the methodology of exposure.
FINDINGS
Selected studies included testing about 'exposure to sublethal concentrations' for seventeen disinfectants. The mechanism of action for the majority of the disinfectants involved interactions with the cell membrane. Chlorhexidine was the most studied disinfectant.
CONCLUSION
Adaptation phenomena related to disinfectant exposure were documented and development of cross-resistance to antimicrobials was verified for several species, including Streptococcus spp., Klebsiella pneumoniae, Acinetobacter baumannii, Staphylococcus aureus, Pseudomonas aeruginosa, and Candida spp. Changes associated with disinfectant exposure also influenced biofilm formation, colony morphology, and efflux pump activity - three relevant determinants of loss of antibiotic efficacy.
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