J.M. Boyce Consulting, LLC, 5123 Town Place, Middletown, CT, Connecticut, USA.
Antimicrob Resist Infect Control. 2023 Apr 13;12(1):32. doi: 10.1186/s13756-023-01241-z.
Due to the substantial increase in the use of disinfectants containing quaternary ammonion compounds (QACs) in healthcare and community settings during the COVID-19 pandemic, there is increased concern that heavy use might cause bacteria to develop resistance to QACs or contribute to antibiotic resistance. The purpose of this review is to briefly discuss the mechanisms of QAC tolerance and resistance, laboratory-based evidence of tolerance and resistance, their occurrence in healthcare and other real-world settings, and the possible impact of QAC use on antibiotic resistance.
A literature search was conducted using the PubMed database. The search was limited to English language articles dealing with tolerance or resistance to QACs present in disinfectants or antiseptics, and potential impact on antibiotic resistance. The review covered the period from 2000 to mid-Jan 2023.
Mechanisms of QAC tolerance or resistance include innate bacterial cell wall structure, changes in cell membrane structure and function, efflux pumps, biofilm formation, and QAC degradation. In vitro studies have helped elucidate how bacteria can develop tolerance or resistance to QACs and antibiotics. While relatively uncommon, multiple episodes of contaminated in-use disinfectants and antiseptics, which are often due to inappropriate use of products, have caused outbreaks of healthcare-associated infections. Several studies have identified a correlation between benzalkonium chloride (BAC) tolerance and clinically-defined antibiotic resistance. The occurrence of mobile genetic determinants carrying multiple genes that encode for QAC or antibiotic tolerance raises the concern that widespread QAC use might facilitate the emergence of antibiotic resistance. Despite some evidence from laboratory-based studies, there is insufficient evidence in real-world settings to conclude that frequent use of QAC disinfectants and antiseptics has promoted widespread emergence of antibiotic resistance.
Laboratory studies have identified multiple mechanisms by which bacteria can develop tolerance or resistance to QACs and antibiotics. De novo development of tolerance or resistance in real-world settings is uncommon. Increased attention to proper use of disinfectants is needed to prevent contamination of QAC disinfectants. Additional research is needed to answer many questions and concerns related to use of QAC disinfectants and their potential impact on antibiotic resistance.
在 COVID-19 大流行期间，由于医疗保健和社区环境中含季铵化合物（QAC）消毒剂的大量使用，人们越来越担心大量使用可能导致细菌对 QAC 产生耐药性或导致抗生素耐药性。本综述的目的是简要讨论 QAC 耐受和耐药的机制、基于实验室的耐受和耐药证据、它们在医疗保健和其他实际环境中的发生情况，以及 QAC 使用对抗生素耐药性的可能影响。
使用 PubMed 数据库进行文献检索。检索仅限于涉及消毒剂或防腐剂中存在的 QAC 耐受或耐药性及其对抗生素耐药性潜在影响的英文文章。综述涵盖了 2000 年至 2023 年 1 月中旬的时间段。
QAC 耐受或耐药的机制包括细菌固有细胞壁结构、细胞膜结构和功能的变化、外排泵、生物膜形成和 QAC 降解。体外研究有助于阐明细菌如何对 QAC 和抗生素产生耐受或耐药性。虽然相对少见，但由于产品使用不当导致多次污染的即用型消毒剂和防腐剂引发了医疗保健相关感染的爆发。多项研究已确定了苯扎氯铵（BAC）耐受与临床定义的抗生素耐药之间的相关性。携带多个编码 QAC 或抗生素耐受基因的移动遗传决定因素的出现引起了人们的关注，即广泛使用 QAC 可能会促进抗生素耐药性的出现。尽管实验室研究提供了一些证据，但在实际环境中没有足够的证据可以得出结论，即频繁使用 QAC 消毒剂和防腐剂促进了抗生素耐药性的广泛出现。
实验室研究已经确定了细菌对 QAC 和抗生素产生耐受或耐药性的多种机制。在实际环境中，新出现的耐受或耐药情况并不常见。需要更加关注消毒剂的正确使用，以防止 QAC 消毒剂受到污染。需要进一步研究来回答与 QAC 消毒剂的使用及其对抗生素耐药性的潜在影响相关的许多问题和关注。
