An investigation of the bactericidal activity of chlorhexidine digluconateagainst multidrug-resistant hospital isolates

An investigation of the bactericidal activity of chlorhexidine digluconateagainst multidrug-resistant hospital isolates

Background/aim: Hospital infections are among the most prominent medical problems around the world. Using proper biocides in an appropriate way is critically important in overcoming this problem. Several reports have suggested that microorganisms may develop resistance or reduce their susceptibility to biocides, similar to the case with antibiotics. In this study we aimed to determine the antimicrobial activity of chlorhexidine digluconate against clinical isolates. Materials and methods: The susceptibility of 120 hospital isolated strains of 7 bacterial genera against chlorhexidine digluconate was determined by agar dilution test, using minimum inhibitory concentration (MIC) values and the EN 1040 Basic Bactericidal Activity Test to determine the bactericidal activity. According to MIC values, Pseudomonas aeruginosa and Stenotrophomonas maltophilia were found to be less susceptible to chlorhexidine digluconate. Results: Quantitative suspension test results showed that 4% chlorhexidine digluconate was effective against antibiotic resistant and susceptible bacteria after 5 min of contact time and can be safely used in our hospital. However, concentrations below 4% chlorhexidine digluconate caused a decrease in bactericidal activity, especially for Staphylococcus aureus and P. aeruginosa. Conclusion: It is crucial to use biocides at appropriate concentrations and to perform surveillance studies to trace resistance or low susceptibility patterns of S. aureus, P. aeruginosa, and other hospital isolates.

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  • 1. European Union Biocidal Products Regulation. EU Biocides Regulation 528/2012. Health and Safety Executive. Biocides. Brussels, Belgium: EU; 2012.
  • 2. McDonnell G, Russell AD. Antiseptics and disinfectants: activity, action, and resistance. Clin Microbiol Rev 1999; 12: 147–179.
  • 3. Russell AD. Biocide usage and antibiotic resistance: the relevance of laboratory findings to clinical and environmental situations. Lancet Infect Dis 2003; 3:794–803.
  • 4. Horner C, Mawer D, Wilcox M. Reduced susceptibility to chlorhexidine in staphylocci: is it increasing and does it matter? J Antimicrob Chemother 2012; 67: 2547–2559.
  • 5. Maillard JY. Bacterial resistance to biocides in the healthcare environment: should it be of genuine concern? J Hosp Infect 2007; 65: 60–72.
  • 6. Russell AD. Bacterial resistance to disinfectants: present knowledge and future problems. J Hosp Infect 1998; 43 (Suppl.): S57–S68.
  • 7. Harbarth S, Soh Tuan S, Horner C, Wilcox MH. Is reduced susceptibility to disinfectants and antiseptics a risk in healthcare settings? A point/counterpoint review. J Hosp Infect 2014; 87: 194–202.
  • 8. McBain AJ, Gilbert P. Biocide tolerance and harbingers of doom. Int Biodeter Biodegr 2001; 47: 55–61.
  • 9. Shiraishi T, Nakagawa Y. Review of disinfectant susceptibility of bacteria isolated in hospital to commonly used disinfectants. Postgrad Med J 1993; 69 (Suppl. 3): S70–77.
  • 10. Vali L, Davies SE, Lai LLG, Dave J, Amyes SGB. Frequency of biocide resistance genes, antibiotic resistance and the effect of chlorhexidine exposure on clinical methicillin-resistant Staphylococcus aureus isolates. J Antimicrob Chemother 2008; 61: 524–532.
  • 11. Clinical and Laboratory Standards Institute. Methods for Dilution Antimicrobial Susceptibility Tests for Bacteria that Grow Aerobically: Approved Standard. M07-A8. 8th ed. Wayne, PA, USA: Clinical and Laboratory Standards Institute; 2008.
  • 12. European Committee for Standardization. EN 1040, Chemical Disinfectants and Antiseptics - Quantitative Suspension Test for the Evaluation of Basic Bactericidal Activity of Chemical Disinfectants and Antiseptics - Test Method and Requirements. (Phase 1). Brussels, Belgium: European Committee for Standardization; 2005.
  • 13. Ekizoğlu MT, Özalp M, Sultan N, Gür D. An investigation of the bactericidal effect of certain antiseptic/disinfectants against isolates of gram-negative bacteria. Infect Cont Hosp Epidemiol 2003; 24: 225–227.
  • 14. Reybrouck G. Efficacy of inactivators against 14 disinfectant substances. Zbl Bakt Hyg I Abt Orig B 1979; 168: 480–492.
  • 15. Kung HC, Hoyert DL, Xu J, Murphy SL. Deaths: final data for 2005. Natl Vital Stat Rep 2008; 56: 1–120.
  • 16. Metintas S, Akgun Y, Durmaz G, Kalyoncu C. Prevalence and characteristics of nosocomial infections in a Turkish university hospital. Am J Infect Control 2004; 32: 409–413.
  • 17. Coates D, Hutchinson DN. How to produce a hospital disinfection policy. J Hosp Infect 1994; 26: 57–68.
  • 18. Dance DA, Pearson AD, Seal DV, Lowes JA. A hospital outbreak caused by a chlorhexidine and antibiotic-resistant Proteus mirabilis. J Hosp Infect 1987; 10: 10–16.
  • 19. Weber DJ, Rutala WA, Sickbert-Bennett EE. Antiseptics and disinfectants outbreaks associated with contaminated antiseptics and disinfectants. Antimicrob Agents Chemother 2007; 51: 4217–4224.
  • 20. Meyer B, Cookson B. Does microbial resistance or adaptation to biocides create a hazard in infection prevention and control? J Hosp Infect 2010; 76: 200–205.
  • 21. Fıçıcı SE, Durmaz G, İlhan S, Akgün Y, Köşgeroğlu N. Bactericidal effects of commonly used antiseptics/disinfectans against nosocomial pathogens and relationship between antibacterial and biocide resistance. Mikrobiyol Bul 2002; 36: 259–269 (in Turkish with abstract in English).
  • 22. Eryılmaz M, Akın A, Akan ÖA. Bazı dezenfektanların nozokomiyal enfeksiyon etkeni Staphylococcus aureus ve Enterococcus spp. izolatları üzerine olan etkilerinin araştırılması. Mikrobiyol Bul 2011; 45: 454–460 (in Turkish).
  • 23. Chapman JS. Disinfectant resistance mechanisms, crossresistance, and co-resistance. Int Biodeter Biodegr 2003; 51: 271–276.
  • 24. Martró E, Hernández A, Ariza J, Dominguez MA, Matas, L, Argerich, MJ, Martin, R, Ausina V. Assessment of Acinetobacter baumannii susceptibility to antiseptics and disinfectants. J Hosp Infect 2003; 55: 39–46.
  • 25. Wang JT, Sheng WH, Wang JL,  Chen D, Chen ML, Chen YC, Chang SC. Longitudinal analysis of chlorhexidine susceptibilities of nosocomial methicillin-resistant Staphylococcus aureus isolates at a teaching hospital in Taiwan. J Antimicrob Chemother 2008; 62: 514–517.
  • 26. Kõljalg S, Naaber P, Mikelsaar M. Antibiotic resistance as an indicator of bacterial chlorhexidine susceptibility. J Hosp Infect 2002; 51: 106–113.
  • 27. Rutala WA, Weber DJ. Bacterial resistance to disinfectants: present and future problems. J Hosp Infect 1999; 43: 57S–68S.
  • 28. Kastbjerg VG, Larsen MH, Lone G, Ingmer H. Influence of sublethal concentrations of common disinfectants on expression of virulence genes in Listeria monocytogenes. Appl Environ Microbiol 2010; 76: 303–309.
  • 29. Irizzary L, Merlin T, Rupp J and Griffith J. Reduced susceptibility of methicillin resistant Staphylococcus aureus to cetylpyridinium chloride and chlorhexidine. Chemotherapy 1996; 42: 248–252.
  • 30. Thomas L, Maillard JY, Lambert RJW, Russell AD. Development of resistance to chlorhexidine diacetate in Pseudomonas aeruginosa and the effect of a ‘residual’ concentration. J Hosp Infect 2000; 46: 297–303.