It’s Possible to Predict a Decreased Bactericidal Effect of Biocides, through Antibiotic Resistance in ICU: Study Using a Large Sample of Bacteria and Multivariate Analysis


Objective: To determine whether there was any association between resistance to antibiotics and decreased susceptibility to antiseptics and disinfectants and their importance in clinical practice. Methods: We studied a large number of microorganisms isolated from ICU patients (high percentage of cases of antibiotic resistance). The antibiogram (Kirby-Bauer) was determined and, in parallel, the bactericidal effect was assessed by two methods, according to the product used: 1) Effect on rough material (endodontic files) in 10 min, using five disinfectants; 2) Effect on a skin equivalent (sterile cotton cloth) in 30 sec, for two alcohol solutions. A predictive equation of the bactericidal effects versus microorganisms’ antibiogram was obtained by multivariate methods. Results: Bactericidal efficacy was very similar for all the products with the exception of 1% povidone-iodine. Within each product there were no significant differences between the three groups of microorganisms: “Enterobacteria”, “Non Fermentative Gram Negative Bacteria” and “cocci”. Multivariate study only obtained one significant equation: 1% chlorhexidine resistance was directly correlated with aztreonam resistance (OR = 2.16), while resistance to imipenem and to phosphomycin acted as protection factors (OR < 1). Conclusion: There is no necessary to change the indications for antiseptics or disinfectants in ICUs, except if aztreonam resistance is high. In which caseis better to use greater concentration than 1% of Chlorhexidine.

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Herruzo, I. , Herruzo, R. and Vizcaino, M. (2015) It’s Possible to Predict a Decreased Bactericidal Effect of Biocides, through Antibiotic Resistance in ICU: Study Using a Large Sample of Bacteria and Multivariate Analysis. Advances in Infectious Diseases, 5, 73-80. doi: 10.4236/aid.2015.52008.

Conflicts of Interest

The authors declare no conflicts of interest.


[1] Barbee, S.L., Weber, D.J., Sobsey, M.D. and Rutala, W.A. (1999) Inactivation of Cryptosporidium parvum Oocyst Infectivity by Disinfection and Sterilization Processes. Gastrointestinal Endoscopy, 49, 605-611.
[2] Cookson, B.D., Bolton, M.C. and Platt, J.H. (1991) Chlorhexidine Resistance in Methicillin-Resistant Sthaphylococcus aureus or Just an Elevated MIC? An in Vitro and in Vivo Assessment. Antimicrobial Agents and Chemotherapy, 35, 1997-2002.
[3] Fayer, R., Graczyk, T.K., Cranfield, M.R. and Trout, J.M. (1996) Gaseous Disinfection of Cryptosporidium parvum Oocysts. Applied and Environmental Microbiology, 62, 3908-3909.
[4] Herruzo-Cabrera, R., Vizcaíno-Alcaide, M.J. and Fernández-Ace?ero, M.J. (2004) The Influence of Laboratory Adaptation on Test Strains, Such as Pseudomonas aeruginosa, in the Evaluation of the Antimicrobial Efficacy of Ortho-Phthalaldehyde. The Journal of Hospital Infection, 57, 217-222.
[5] Herruzo, R., Vizcaino, M.J., Herruzo, I. and de la Cruz, J.J. (2009) Can the Antibiotic Resistance of a Microorganism Predict Decreased Bactericidal Efficacy of Disinfectants? Application to OPA and Other Products. European Journal of Clinical Microbiology & Infectious Diseases, 28, 539-541.
[6] Moken, M.C., McMurry, L.M. and Levy, S.B. (1997) Selection of Multiple-Antibiotic-Resistant (mar) Mutants of Escherichia coli by Using the Disinfectant Pine Oil: Roles of the Mar and acrAB loci. Antimicrobial Agents and Chemotherapy, 41, 2770-2772.
[7] Rutala, W.A. and Weber, D.J. (2001) Surface Disinfection: Should We Do It? The Journal of Hospital Infection, 48, S64-S68.
[8] Stickler, D.J. (2002) Susceptibility of Antibiotic-Resistant Gram-Negative Bacteria to Biocides: A Perspective from the Study of Catheter Biofilms. Journal of Applied Microbiology, 92, 163S-170S.
[9] Scott, E., Bloomfield, S.F. and Barlow, C.G. (1982) An Investigation of Microbial Contamination in the Home. Journal of Hygien, 89, 279-293.
[10] Rutala, W.A. (1993) Sporicidal Activity of Chemical Sterilants Used in Hospitals. Infection Control and Hospital Epidemiology, 14, 713-718.
[11] McMurry, L.M., Oethinger, M. and Levy, S.B. (1988) Triclosan Targets Lipid Synthesis. Nature, 394, 531-532.
[12] Rusin, P., Orosz-Coughlin, P. and Gerba, C. (1998) Reduction of Faecal Coliform, Coliform and Heterotrophic Plate Count Bacteria in the Household Kitchen and Bathroom by Disinfection with Hypochlorite Cleaners. Journal of Applied Microbiology, 85, 819-828.
[13] Bueumer, R., Bloomfield, S.F., Exner, M., Fara, G. and Scott, E.A. (1999) The Need for a Home Hygiene Policy and Guidelines on Home Hygiene. Annali di Igiene, 11, 11-26.
[14] Gilbert, P. and McBain, A.J. (2003) Potential Impact of Increased Use of Biocides in Consumer Products on Prevalence of Antibiotic Resistance. Clinical Microbiology Reviews, 16, 189-208.
[15] Sheldon Jr., A.T. (2005) Antiseptic “Resistance”: Real or Perceived Threat? Clinical Infectious Diseases, 40, 1650-1656.
[16] Maillard, J.Y. (2007) Bacterial Resistance to Biocides in the Healthcare Environment: Should It Be of Genuine Concern? Journal of Hospital Infection, 65, 60-72.
[17] Levy, S.B. (2000) Antibiotic and Antiseptic Resistance: Impact on Public Health. The Pediatric Infectious Disease Journal, 19, S120-S122.
[18] McDonnell, G. and Russell, A.D. (1999) Antiseptics and Disinfectants: Activity, Action, and Resistance. Clinical Microbiology Reviews, 12, 147-179.
[19] Gerba, C.P. and Rusin, P. (2001) Relationship between the Use of Antiseptics/Disinfectants and the Development of Antimicrobial Resistance. In: Rutala, W.A., Ed., Disinfection, Sterilization and Antisepsis: Principles and Practices in Healthcare Facilities, Association for Professional in Infection Control and Epidemiology, Washington DC, 187-194.
[20] Russell, A.D. (2001) Principles of Antimicrobial Activity and Resistance. In: Block, S.S., Ed., Disinfection, Sterilization, and Preservation, Lippincott Williams & Wilkins, Philadelphia, 31-55.
[21] Syverson, E.A. (2006) Reduction of Hand Bacteria: A Comparative Study among Common Antiseptics. Saint Martin’s University Biology Journal, 1, 75-84.
[22] Oteo, J., Hernandez, J.M., Espasa, M., Fleites, A., Saez, D., Bautista, V., et al. (2013) Emergence of OXA-48-Producing Klebsiella pneumoniae and the Novel Carbapenemases OXA-244 and OXA-245 in Spain. Journal of Antimicrobial Chemotherapy, 68, 317-321.
[23] Herruzo-Cabrera, R., Vizcaino-Alcaide, M.J., Mayer, F. and Rey-Calero, J. (1992) A New in Vitro Model to Test the Effectiveness of Topical Antimicrobial Agents. Use of an Artificial Eschar. Burns, 18, 35-38.
[24] Herruzo, R., Vizcaino, M.J. and Herruzo, I. (2010) In Vitro—In Vivo Sequence Studies as a Method of Selecting the Most Efficacious Alcohol-Based Solution for Hygienic Hand Disinfection. Clinical Microbiology and Infection, 16, 518-523.
[25] Estudio Nacional de Vigilancia de la Infeccion Nosocomial en Servicios de Medicina Intensiva. ENVIN-HELICS, 2013.
[26] Moureau, N. (2009) Preventing Peripheral Intravenous Life Infections: Recommendations for Healthcare Facilities. Journal of the Association for Vascular Access, 14, 187-190.
[27] O’Grady, N.P., Alexander, M., Burns, L.A., Dellinger, E.P., Garland, J., Heard, S.O., et al. (2011) Guidelines for the Prevention of Intravascular Catheter-Related Infections. CDC.
[28] CDC (2014) Carbapenem-Resistant Enterobacteriaceae (CRE) Control and Prevention Toolkit.

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