Misuse of antibiotics is the leading cause of emerging antimicrobial resistance — a public health crisis in the making. Inappropriate prescribing practices by health care providers contributes greatly to this problem, but now there is evidence that everyday cleaning and hand-washing may also contribute to the growing trend of antimicrobial resistance.

Bacteria become resistant to antibiotics or antimicrobial products when they develop a way to keep the antibiotic from working. Bacteria are constantly evolving and, in the presence of inadequate or inappropriate antibiotics, they develop mechanisms to overcome the killing power of the antibiotic. The ever-increasing presence of resistant bacteria makes protecting the remaining effective antibiotics a public health priority.

Recently, the Journal of Antimicrobial Chemotherapy reported that the use of antibacterial consumer and household products might contribute to the development of antibiotic resistance. Many surface disinfectants contain quaternary ammonium compounds, such as benzalkonium chloride (BAC), as biocides. The study examined 238 households that used either antibacterial or non-antibacterial cleaning products. After one year of use, bacteria was isolated from the hands of the household members and tested for susceptibility to several biocides and antibiotics. The household bacteria did not show significant differences in susceptibility to BAC. However, bacteria that did show decreased susceptibility to BAC also showed decreased susceptibility to triclosan (a biocide in many personal hygiene products), as well as several antibiotics. This cross-resistance with antibiotics that are used clinically may prove significant as we explore ways to combat antimicrobial resistance.

While this study reports potential risks associated with common antibacterial products, several studies have explored their benefits. Surprisingly, no additional health benefit is seen with biocide-containing soaps and cleaners when compared to traditional non-antibacterial products. Antibacterial consumer health-care products, including soaps and oral products, as well as plastics and textiles, provide no additional protection against common infectious bacteria than traditional hand-hygiene with non-antibacterial soap. Data is needed to assess whether biocides in consumer products are beneficial to groups at high risk for infections, such as individuals with compromised immune systems.

Many factors contribute to antibiotic resistance, but this new information must be balanced with the need to protect our population from potentially serious infectious diseases. Hand hygiene alone is the most effective way to reduce the spread of infections. However, monitoring antimicrobial products and appropriate prescribing practices are paramount in the fight against antibiotic resistance.

References

A. E. Aiello, R. M. Coulborn, V. Perez, E. L. Larson (2008). Effect of Hand Hygiene on Infectious Disease Risk in the Community Setting: A Meta-Analysis American Journal of Public Health, 98 (8), 1372-1381 DOI: 10.2105/AJPH.2007.124610

Allison E. Aiello, Elaine L. Larson, Stuart B. Levy (2007). Consumer Antibacterial Soaps: Effective or Just Risky? Clinical Infectious Diseases, 45 (S2) DOI: 10.1086/519255

R. T. Carson, E. Larson, S. B. Levy, B. M. Marshall, A. E. Aiello (2008). Use of antibacterial consumer products containing quaternary ammonium compounds and drug resistance in the community Journal of Antimicrobial Chemotherapy, 62 (5), 1160-1162 DOI: 10.1093/jac/dkn332

L. Tan (2002). Use of Antimicrobial Agents in Consumer Products Archives of Dermatology, 138 (8), 1082-1086 DOI: 10.1001/archderm.138.8.1082

Siamak P. Yazdankhah, Anne A. Scheie, E. Arne Hoiby, Bjorn-Tore Lunestad, Even Heir, Tor Oystein Fotland, Kristine Naterstad, Hilde Kruse (2006). Triclosan and Antimicrobial Resistance in Bacteria: An Overview Microbial Drug Resistance, 12 (2), 83-90 DOI: 10.1089/mdr.2006.12.83

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