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Demissie R, Kabre P, Fung LWM. Nonactive-Site Mutations in S. aureus FabI That Induce Triclosan Resistance. ACS OMEGA 2020; 5:23175-23183. [PMID: 32954168 PMCID: PMC7495757 DOI: 10.1021/acsomega.0c02942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 08/13/2020] [Indexed: 06/11/2023]
Abstract
The wide use of the antimicrobial agent/biocide, triclosan, promotes triclosan-resistant bacterial strains, including Staphylococcus aureus, as well as leads to accumulation in the aquatic and terrestrial environments. Knowledge of the molecular actions of triclosan on S. aureus is needed to understand the consequence of triclosan resistance and environmental accumulation of triclosan on S. aureus resistant strains, as well as to develop biphenyl ether analogs as antibiotic candidates. Triclosan inhibits an essential enzyme in the fatty acid biosynthetic pathway, the reduced nicotinamide adenine dinucleotide (NADH)/reduced nicotinamide adenine dinucleotide phosphate (NADPH)-dependent enoyl-acyl carrier protein (enoyl-ACP) reductase, or FabI. In this study, we used error-prone polymerase chain reaction (epPCR) to generate mutations in the S. aureus FabI enzyme. Instead of using an elaborate FabI enzyme activity assay that involves ACP-linked substrates to determine whether triclosan inhibits the enzyme activities of individual FabI mutants, we used an efficient and economical assay that we developed, based on thermal shift principles, to screen for triclosan binding to FabI mutants in cells. We identified four active-site mutations. More interestingly, we also identified nine triclosan-resistant mutations distant from the active site (G113V, Y123H, S166N, N220I, G227C, A230T, V241I, F252I, and H253P) but located in disparate positions in the monomer-monomer and dimer-dimer interface regions in S. aureus FabI. We suggest that these sites may serve as potential allosteric sites for designing potential therapeutic inhibitors that offer advantages in selectivity since allosteric sites are less evolutionarily conserved.
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Affiliation(s)
- Robel Demissie
- Department of Chemistry, University of Illinois at Chicago, Chicago, Illinois 60607, United States
| | | | - Leslie W.-M. Fung
- Department of Chemistry, University of Illinois at Chicago, Chicago, Illinois 60607, United States
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Michalíková K, Linhartová L, Ezechiáš M, Cajthaml T. Assessment of agonistic and antagonistic properties of widely used oral care antimicrobial substances toward steroid estrogenic and androgenic receptors. CHEMOSPHERE 2019; 217:534-541. [PMID: 30445398 DOI: 10.1016/j.chemosphere.2018.11.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Revised: 10/31/2018] [Accepted: 11/01/2018] [Indexed: 06/09/2023]
Abstract
Personal care product consumption has increased in the last decades. A typical representative ingredient, i.e., triclosan, was identified in the scientific literature as an endocrine disruptor, and its use is restricted in several applications. Oral hygiene formulations contain various compounds, including synthetic phenol derivatives, quaternary ammonium compounds (QACs), various amides and amines, or natural essential oils containing terpenes. The aim of this paper was to explore possible endocrine-disrupting effects of these most-used compounds. For this purpose, two different assays based on recombinant yeast (BMAEREluc/ERα; BMAEREluc/AR) and human cell lines (T47D; AIZ-AR) were employed to investigate the agonistic and antagonistic properties of these compounds on human estrogen and androgen receptors. The results showed that none of the compounds were indicated as agonists of the steroid receptors. However, octenidine (OCT, QAC-like) and hexadecylpyridinium (HDP, QAC) were able to completely inhibit both androgenic (IC50 OCT = 0.84 μM; IC50 HDP = 1.66 μM) and estrogenic (IC50 OCT = 0.50 μM; IC50 HDP = 1.64 μM) signaling pathways in a dose-dependent manner. Additionally, chlorhexidine was found to inhibit the 17β-estradiol response, with a similar IC50 (2.9 μM). In contrast, the natural terpenes thymol and menthol were found to be competitive antagonists of the receptors; however, their IC50 values were higher (by orders of magnitude). We tried to estimate the risk associated with the presence of these compounds in environmental matrices by calculating hazard quotients (HQs), and the calculated HQs were found to be close to or greater than 1 only when predicted environmental concentrations were used for surface waters.
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Affiliation(s)
- Klára Michalíková
- Institute of Microbiology, Czech Academy of Sciences, v.v.i., Vídeňská 1083, CZ-142 20, Prague 4, Czech Republic; Institute for Environmental Studies, Faculty of Science, Charles University, Benátská 2, CZ-128 01, Prague 2, Czech Republic
| | - Lucie Linhartová
- Institute of Microbiology, Czech Academy of Sciences, v.v.i., Vídeňská 1083, CZ-142 20, Prague 4, Czech Republic; Institute for Environmental Studies, Faculty of Science, Charles University, Benátská 2, CZ-128 01, Prague 2, Czech Republic
| | - Martin Ezechiáš
- Institute of Microbiology, Czech Academy of Sciences, v.v.i., Vídeňská 1083, CZ-142 20, Prague 4, Czech Republic
| | - Tomáš Cajthaml
- Institute of Microbiology, Czech Academy of Sciences, v.v.i., Vídeňská 1083, CZ-142 20, Prague 4, Czech Republic; Institute for Environmental Studies, Faculty of Science, Charles University, Benátská 2, CZ-128 01, Prague 2, Czech Republic.
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Datta S, He G, Tomilov A, Sahdeo S, Denison MS, Cortopassi G. In Vitro Evaluation of Mitochondrial Function and Estrogen Signaling in Cell Lines Exposed to the Antiseptic Cetylpyridinium Chloride. ENVIRONMENTAL HEALTH PERSPECTIVES 2017; 125:087015. [PMID: 28885978 PMCID: PMC5783672 DOI: 10.1289/ehp1404] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Revised: 05/04/2017] [Accepted: 05/09/2017] [Indexed: 05/15/2023]
Abstract
BACKGROUND Quaternary ammonium salts (QUATS), such as cetylpyridinium chloride (CPC) and benzalkonium chloride (BAK), are frequently used in antiseptic formulations, including toothpastes, mouthwashes, lozenges, throat and nasal sprays, and as biocides. Although in a recent ruling, the U.S. Food and Drug Administration (FDA) banned CPC from certain products and requested more data on BAK's efficacy and safety profile, QUATS, in general, and CPC and BAK, in particular, continue to be used in personal health care, food, and pharmaceutical and cleaning industries. OBJECTIVES We aimed to assess CPC's effects on mitochondrial toxicity and endocrine disruption in vitro. METHOD Mitochondrial O2 consumption and adenosine triphosphate (ATP) synthesis rates of osteosarcoma cybrid cells were measured before and after CPC and BAK treatment. Antiestrogenic effects of the compounds were measured by a luciferase-based assay using recombinant human breast carcinoma cells (VM7Luc4E2, ERalpha-positive). RESULTS CPC inhibited both mitochondrial O2 consumption [half maximal inhibitory concentration (IC50): 3.8μM] and ATP synthesis (IC50: 0.9μM), and additional findings supported inhibition of mitochondrial complex 1 as the underlying mechanism for these effects. In addition, CPC showed concentration-dependent antiestrogenic activity half maximal effective concentration [(EC50): 4.5μM)]. BAK, another antimicrobial QUATS that is structurally similar to CPC, and the pesticide rotenone, a known complex 1 inhibitor, also showed mitochondrial inhibitory and antiestrogenic effects. In all three cases, there was overlap of the antiestrogenic activity with the mitochondrial inhibitory activity. CONCLUSIONS Mitochondrial inhibition in vitro occurred at a CPC concentration that may be relevant to human exposures. The antiestrogenic activity of CPC, BAK, rotenone, and triclosan may be related to their mitochondrial inhibitory activity. Our findings support the need for additional research on the mitochondrial inhibitory and antiestrogenic effects of QUATS, including CPC and BAK. https://doi.org/10.1289/EHP1404.
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Affiliation(s)
- Sandipan Datta
- Department of Molecular Bioscience, School of Veterinary Medicine, University of California , Davis, Davis, California, USA
| | - Guochun He
- Department of Environmental Toxicology, University of California , Davis, Davis, California, USA
| | - Alexey Tomilov
- Department of Molecular Bioscience, School of Veterinary Medicine, University of California , Davis, Davis, California, USA
| | - Sunil Sahdeo
- Department of Molecular Bioscience, School of Veterinary Medicine, University of California , Davis, Davis, California, USA
| | - Michael S Denison
- Department of Environmental Toxicology, University of California , Davis, Davis, California, USA
| | - Gino Cortopassi
- Department of Molecular Bioscience, School of Veterinary Medicine, University of California , Davis, Davis, California, USA
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Liu S, Ono RJ, Wu H, Teo JY, Liang ZC, Xu K, Zhang M, Zhong G, Tan JP, Ng M, Yang C, Chan J, Ji Z, Bao C, Kumar K, Gao S, Lee A, Fevre M, Dong H, Ying JY, Li L, Fan W, Hedrick JL, Yang YY. Highly potent antimicrobial polyionenes with rapid killing kinetics, skin biocompatibility and in vivo bactericidal activity. Biomaterials 2017; 127:36-48. [DOI: 10.1016/j.biomaterials.2017.02.027] [Citation(s) in RCA: 65] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2016] [Revised: 02/07/2017] [Accepted: 02/26/2017] [Indexed: 10/20/2022]
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Smarr MM, Sundaram R, Honda M, Kannan K, Louis GMB. Urinary Concentrations of Parabens and Other Antimicrobial Chemicals and Their Association with Couples' Fecundity. ENVIRONMENTAL HEALTH PERSPECTIVES 2017; 125:730-736. [PMID: 27286252 PMCID: PMC5381974 DOI: 10.1289/ehp189] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/10/2015] [Revised: 03/22/2016] [Accepted: 05/23/2016] [Indexed: 05/18/2023]
Abstract
BACKGROUND Human exposure to parabens and other antimicrobial chemicals is continual and pervasive. The hormone-disrupting properties of these environmental chemicals may adversely affect human reproduction. OBJECTIVE We aimed to prospectively assess couples' urinary concentrations of antimicrobial chemicals in the context of fecundity, measured as time to pregnancy (TTP). METHODS In a prospective cohort of 501 couples, we examined preconception urinary chemical concentrations of parabens, triclosan and triclorcarban in relation to TTP; chemical concentrations were modeled both continuously and in quartiles. Cox's proportional odds models for discrete survival time were used to estimate fecundability odds ratios (FORs) and 95% confidence intervals (CIs) adjusting for a priori-defined confounders. In light of TTP being a couple-dependent outcome, both partner and couple-based exposure models were analyzed. In all models, FOR estimates < 1.0 denote diminished fecundity (longer TTP). RESULTS Overall, 347 (69%) couples became pregnant. The highest quartile of female urinary methyl paraben (MP) concentrations relative to the lowest reflected a 34% reduction in fecundity (aFOR = 0.66; 95% CI: 0.45, 0.97) and remained so when accounting for couples' concentrations (aFOR = 0.63; 95% CI: 0.41, 0.96). Similar associations were observed between ethyl paraben (EP) and couple fecundity for both partner and couple-based models (p-trend = 0.02 and p-trend = 0.05, respectively). No associations were observed with couple fecundity when chemicals were modeled continuously. CONCLUSIONS Higher quartiles of preconception urinary concentrations of MP and EP among female partners were associated with reduced couple fecundity in partner-specific and couple-based exposure models.
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Affiliation(s)
| | - Rajeshwari Sundaram
- Biostatistics and Bioinformatics Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Department of Health and Human Services, Rockville, Maryland, USA
| | - Masato Honda
- Wadsworth Center, New York State Department of Health, Albany, New York, USA
- Department of Environmental Health Sciences, School of Public Health, State University of New York at Albany, Albany, New York, USA
| | - Kurunthachalam Kannan
- Wadsworth Center, New York State Department of Health, Albany, New York, USA
- Department of Environmental Health Sciences, School of Public Health, State University of New York at Albany, Albany, New York, USA
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Zhang M, Teo JJ, Liu S, Liang ZC, Ding X, Ono RJ, Breyta G, Engler AC, Coady DJ, Garcia J, Nelson A, Yang YY, Hedrick JL. Simple and cost-effective polycondensation routes to antimicrobial consumer products. Polym Chem 2016. [DOI: 10.1039/c6py00592f] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Cost-effective macromolecular antimicrobials were synthesized to explore a variety of chemical functional groups that target antimicrobial performance and reduce cytotoxicity.
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Affiliation(s)
| | - Jye Jyn Teo
- Institute of Bioengineering and Nanotechnology
- Singapore 138669
- Singapore
| | - Shaoqiong Liu
- Institute of Bioengineering and Nanotechnology
- Singapore 138669
- Singapore
| | - Zhen Chang Liang
- Institute of Bioengineering and Nanotechnology
- Singapore 138669
- Singapore
| | - Xin Ding
- Institute of Bioengineering and Nanotechnology
- Singapore 138669
- Singapore
| | | | | | | | | | | | | | - Yi Yan Yang
- Institute of Bioengineering and Nanotechnology
- Singapore 138669
- Singapore
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Tohidi F, Cai Z. GC/MS analysis of triclosan and its degradation by-products in wastewater and sludge samples from different treatments. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2015; 22:11387-400. [PMID: 25810102 DOI: 10.1007/s11356-015-4289-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/29/2014] [Accepted: 02/26/2015] [Indexed: 05/05/2023]
Abstract
A gas chromatography/mass spectrometry (GC/MS)-based method was developed for simultaneous determination of triclosan (TCS) and its degradation products including 2,4-dichlorophenol (2,4-DCP), 2,8-dichlorodibenzo-p-dioxin (2,8-DCDD), and methyl triclosan (MTCS) in wastewater and sludge samples. The method provides satisfactory detection limit, accuracy, precision and recovery especially for samples with complicated matrix such as sewage sludge. Liquid-liquid extraction and accelerated solvent extraction (ASE) methods were applied for the extraction, and column chromatography was employed for the sample cleanup. Analysis was performed by GC/MS in the selected ion monitoring (SIM) mode. The method was successfully applied to wastewater and sludge samples from three different municipal wastewater treatment plants (WWTPs). Satisfactory mean recoveries were obtained as 91(±4)-106(±7)%, 82(±3)-87(±4)%, 86(±6)-87(±8)%, and 88(±4)-105(±3)% in wastewater and 88(±5)-96(±8)%, 84(±2)-87(±3)%, 84(±7)-89(±4)%, and 88(±3)-97(±5)% in sludge samples for TCS, 2,4-DCP, 2,8-DCDD, and MTCS, respectively. TCS degradation products were detected based on the type of the wastewater and sludge treatment. 2,8-DCDD was detected in the plant utilizing UV disinfection at the mean level of 20.3(±4.8) ng/L. 2,4-DCP was identified in chemically enhanced primary treatment (CEPT) applying chlorine disinfection at the mean level of 16.8(±4.5) ng/L). Besides, methyl triclosan (MTCS) was detected in the wastewater collected after biological treatment (10.7 ± 3.3 ng/L) as well as in sludge samples that have undergone aerobic digestion at the mean level of 129.3(±17.2) ng/g dry weight (dw).
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Affiliation(s)
- Fatemeh Tohidi
- State Key Laboratory of Environmental and Biological Analysis, Department of Chemistry, Hong Kong Baptist University, Kowloon Tong, Hong Kong SAR, China,
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Dhillon GS, Kaur S, Pulicharla R, Brar SK, Cledón M, Verma M, Surampalli RY. Triclosan: current status, occurrence, environmental risks and bioaccumulation potential. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2015; 12:5657-84. [PMID: 26006133 PMCID: PMC4454990 DOI: 10.3390/ijerph120505657] [Citation(s) in RCA: 268] [Impact Index Per Article: 29.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/29/2014] [Revised: 05/18/2015] [Accepted: 05/18/2015] [Indexed: 01/14/2023]
Abstract
Triclosan (TCS) is a multi-purpose antimicrobial agent used as a common ingredient in everyday household personal care and consumer products. The expanded use of TCS provides a number of pathways for the compound to enter the environment and it has been detected in sewage treatment plant effluents; surface; ground and drinking water. The physico-chemical properties indicate the bioaccumulation and persistence potential of TCS in the environment. Hence, there is an increasing concern about the presence of TCS in the environment and its potential negative effects on human and animal health. Nevertheless, scarce monitoring data could be one reason for not prioritizing TCS as emerging contaminant. Conventional water and wastewater treatment processes are unable to completely remove the TCS and even form toxic intermediates. Considering the worldwide application of personal care products containing TCS and inefficient removal and its toxic effects on aquatic organisms, the compound should be considered on the priority list of emerging contaminants and its utilization in all products should be regulated.
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Affiliation(s)
| | - Surinder Kaur
- INRS-ETE, Université du Québec, 490, Rue de la Couronne, Québec, QC G1K 9A9, Canada.
- Department of Mycology & Plant Pathology, Institute of Agricultural Sciences, Banaras Hindu University (BHU), Varanasi-221005, India.
| | - Rama Pulicharla
- INRS-ETE, Université du Québec, 490, Rue de la Couronne, Québec, QC G1K 9A9, Canada.
| | - Satinder Kaur Brar
- INRS-ETE, Université du Québec, 490, Rue de la Couronne, Québec, QC G1K 9A9, Canada.
| | - Maximiliano Cledón
- INRS-ETE, Université du Québec, 490, Rue de la Couronne, Québec, QC G1K 9A9, Canada.
- CONICET-IIMyC, National Council of Scientific and Technical Research, C1033AAJ Buenos Aires, Argentina.
| | - Mausam Verma
- CO2 Solutions Inc., 2300, Rue Jean-Perrin, Québec, QC G2C 1T9, Canada.
| | - Rao Y Surampalli
- Department of Civil Engineering, University of Nebraska-Lincoln, N104 SEC P.O. Box 886105, Lincoln, NE 68588, USA.
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Anderson SE, Meade BJ, Long CM, Lukomska E, Marshall NB. Investigations of immunotoxicity and allergic potential induced by topical application of triclosan in mice. J Immunotoxicol 2015; 13:165-72. [PMID: 25812624 PMCID: PMC4720145 DOI: 10.3109/1547691x.2015.1029146] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2015] [Accepted: 03/10/2015] [Indexed: 01/22/2023] Open
Abstract
Triclosan is an antimicrobial chemical commonly used occupationally and by the general public. Using select immune function assays, the purpose of these studies was to evaluate the immunotoxicity of triclosan following dermal exposure using a murine model. Triclosan was not identified to be a sensitizer in the murine local lymph node assay (LLNA) when tested at concentrations ranging from 0.75-3.0%. Following a 28-day exposure, triclosan produced a significant increase in liver weight at concentrations of ≥ 1.5%. Exposure to the high dose (3.0%) also produced a significant increase in spleen weights and number of platelets. The absolute number of B-cells, T-cells, dendritic cells and NK cells were significantly increased in the skin draining lymph node, but not the spleen. An increase in the frequency of dendritic cells was also observed in the lymph node following exposure to 3.0% triclosan. The IgM antibody response to sheep red blood cells (SRBC) was significantly increased at 0.75% - but not at the higher concentrations - in the spleen and serum. These results demonstrate that dermal exposure to triclosan induces stimulation of the immune system in a murine model and raise concerns about potential human exposure.
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Affiliation(s)
- Stacey E Anderson
- a National Institute for Occupational Safety and Health (NIOSH) , Morgantown , WV , USA
| | - B Jean Meade
- a National Institute for Occupational Safety and Health (NIOSH) , Morgantown , WV , USA
| | - Carrie M Long
- a National Institute for Occupational Safety and Health (NIOSH) , Morgantown , WV , USA
| | - Ewa Lukomska
- a National Institute for Occupational Safety and Health (NIOSH) , Morgantown , WV , USA
| | - Nikki B Marshall
- a National Institute for Occupational Safety and Health (NIOSH) , Morgantown , WV , USA
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Yang YS, Kwon JT, Shim I, Kim HM, Kim P, Kim JC, Lee K. Evaluation of toxicity to triclosan in rats following 28 days of exposure to aerosol inhalation. Regul Toxicol Pharmacol 2015; 71:259-68. [PMID: 25591546 DOI: 10.1016/j.yrtph.2015.01.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2014] [Revised: 01/07/2015] [Accepted: 01/07/2015] [Indexed: 11/18/2022]
Abstract
The present study was conducted to investigate the potential subchronic toxicity of triclosan (TCS) in rats following 28 days of exposure by repeated inhalation. Four groups of six rats of each sex were exposed to TCS-containing aerosols by nose-only inhalation of 0, 0.04, 0.13, or 0.40 mg/L for 6 h/day, 5 days/week over a 28-day period. During the study period, clinical signs, mortality, body weight, food consumption, ophthalmoscopy, hematology, serum biochemistry, gross pathology, organ weights, and histopathology were examined. At 0.40 mg/L, rats of both sexes exhibited an increase in the incidence of postdosing salivation and a decrease in body weight. Histopathological alterations were found in the nasal septum and larynx. There were no treatment-related effects in rats of either sex at ⩽0.13 mg/L. Under the present experimental conditions, the target organs in rats were determined to be the nasal cavity and larynx. The no-observed-adverse-effect concentration in rats was determined to be 0.13 mg/L.
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Affiliation(s)
- Young-Su Yang
- Jeonbuk Department of Inhalation Research, Korea Institute of Toxicology, Jeonbuk 580-185, Republic of Korea
| | - Jung-Taek Kwon
- Environmental Health Research Department, National Institute of Environmental Research, Incheon 404-708, Republic of Korea
| | - Ilseob Shim
- Environmental Health Research Department, National Institute of Environmental Research, Incheon 404-708, Republic of Korea
| | - Hyun-Mi Kim
- Environmental Health Research Department, National Institute of Environmental Research, Incheon 404-708, Republic of Korea
| | - Pilje Kim
- Environmental Health Research Department, National Institute of Environmental Research, Incheon 404-708, Republic of Korea
| | - Jong-Choon Kim
- College of Veterinary Medicine, Chonnam National University, Gwangju 500-757, Republic of Korea.
| | - Kyuhong Lee
- Jeonbuk Department of Inhalation Research, Korea Institute of Toxicology, Jeonbuk 580-185, Republic of Korea.
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11
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Hong S, Kwon HJ, Choi WJ, Lim WR, Kim J, Kim K. Association between exposure to antimicrobial household products and allergic symptoms. ENVIRONMENTAL HEALTH AND TOXICOLOGY 2014; 29:e2014017. [PMID: 25420879 PMCID: PMC4243727 DOI: 10.5620/eht.e2014017] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/09/2014] [Accepted: 10/02/2014] [Indexed: 05/24/2023]
Abstract
OBJECTIVES Antimicrobial chemicals are used in a variety of household and personal care products. Exposure to antimicrobial household products has been hypothesized to lead to allergic diseases in children. METHODS We investigated antimicrobial household product exposure and allergic symptoms in Korean children. An antimicrobial exposure (AE) score was derived. To examine the symptoms of allergic diseases (current wheeze, current rhinitis, and current eczema) in the past 12 months, we used a questionnaire based on the core module of the International Study of Asthma and Allergies in Children. Complete data for the analysis were available for 25,805 of the 35,590 (72.5%) children. RESULTS The prevalence of current allergic diseases was as follows: wheeze, 5.6%; allergic rhinitis, 32.6%; and eczema, 17.7%. The mean (standard deviation) AE score was 14.3 (9.3) (range: 0-40). Compared with subjects with a low AE score (reference), subjects with a high AE score (fourth quartile) were more likely to have symptoms of wheezing and allergic rhinitis (adjusted odds ratio [aOR] for wheezing 1.24, 95% confidence interval [CI], 1.05-1.45, p for trend=0.24; aOR for allergic rhinitis 1.30, 95% CI, 1.20-1.40, p<0.01). CONCLUSIONS These findings suggest that frequent use of antimicrobial household products was associated with current wheeze and current allergic rhinitis.
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Affiliation(s)
- Soyoung Hong
- Department of Environmental Health Research, Seoul Medical Center, Seoul, Korea
- Graduate School of Public Health, Seoul National University, Seoul, Korea
| | - Ho-Jang Kwon
- Department of Preventive Medicine, Dankook University College of Medicine, Cheonan, Korea
| | - Won-Jun Choi
- Department of Occupational & Environmental Medicine, Gachon University Gil Medical Center, Incheon, Korea
| | - Wan Ryung Lim
- Department of Environmental Health Research, Seoul Medical Center, Seoul, Korea
| | - Jeonghoon Kim
- Department of Environmental Health Research, Seoul Medical Center, Seoul, Korea
- Graduate School of Public Health, Seoul National University, Seoul, Korea
| | - KyooSang Kim
- Department of Environmental Health Research, Seoul Medical Center, Seoul, Korea
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Filippini M, Ortiz LGG, Masiero G. Assessing the impact of national antibiotic campaigns in Europe. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2013; 14:587-599. [PMID: 22706960 DOI: 10.1007/s10198-012-0404-9] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/12/2011] [Accepted: 05/14/2012] [Indexed: 06/01/2023]
Abstract
Because of evidence of causal association between antibiotic use and bacterial resistance, the implementation of national policies has emerged as a interesting tool for controlling and reversing bacterial resistance. The aim of this study was to assess the impact of public policies on antibiotic use in Europe using a differences-in-differences approach. Comparable data on systemic antibiotics administered in 21 European countries are available for a 11-year period between 1997 and 2007. Data on national campaigns are drawn from the public health literature. We estimate an econometric model of antibiotic consumption with country fixed effects and control for the main socioeconomic and epidemiological factors. Lagged values and the instrumental variables approach are applied to address endogeneity aspects of the prevalence of infections and the adoption of national campaigns. We find evidence that public campaigns significantly reduce the use of antimicrobials in the community by 1.3-5.6 defined daily doses per 1,000 inhabitants yearly. This represents an impact of roughly 6.5-28.3 % on the mean level of antibiotic use in Europe between 1997 and 2007. The effect is robust across different measurement methods. Further research is needed to investigate the effectiveness of policy interventions targeting different social groups such as general practitioners or patients.
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Affiliation(s)
- M Filippini
- Department of Economics, University of Lugano, Switzerland
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13
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Anderson SE, Franko J, Kashon ML, Anderson KL, Hubbs AF, Lukomska E, Meade BJ. Exposure to triclosan augments the allergic response to ovalbumin in a mouse model of asthma. Toxicol Sci 2012. [PMID: 23192912 DOI: 10.1093/toxsci/kfs328] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
During the last decade, there has been a remarkable and unexplained increase in the prevalence of asthma. These studies were conducted to investigate the role of dermal exposure to triclosan, an endocrine-disrupting compound, on the hypersensitivity response to ovalbumin (OVA) in a murine model of asthma. Triclosan has had widespread use in the general population as an antibacterial and antifungal agent and is commonly found in consumer products such as soaps, deodorants, toothpastes, shaving creams, mouthwashes, and cleaning supplies. For these studies, BALB/c mice were exposed dermally to concentrations of triclosan ranging from 0.75 to 3% (0.375-1.5mg/mouse/day) for 28 consecutive days. Concordantly, mice were ip injected with OVA (0.9 µg) and aluminum hydroxide (0.5mg) on days 1 and 10 and challenged with OVA (125 µg) by pharyngeal aspiration on days 19 and 27. Compared with the animals exposed to OVA alone, increased spleen weights, OVA-specific IgE, interleukin-13 cytokine levels, and numbers of lung eosinophils were demonstrated when mice were coexposed to OVA and triclosan. Statistically significant increases in OVA-specific and nonspecific airway hyperreactivity were observed for all triclosan coexposed groups compared with the vehicle and OVA controls. In these studies, exposure to triclosan alone was not demonstrated to be allergenic; however, coexposure with a known allergen resulted in enhancement of the hypersensitivity response to that allergen, suggesting that triclosan exposure may augment the allergic responses to other environmental allergens.
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Affiliation(s)
- Stacey E Anderson
- National Institute for Occupational Safety and Health, Morgantown, WV, USA.
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Ilkit M, Durdu M, Karakaş M. Majocchi's granuloma: a symptom complex caused by fungal pathogens. Med Mycol 2012; 50:449-57. [PMID: 22435879 DOI: 10.3109/13693786.2012.669503] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Majocchi's granuloma (MG) is a well-recognized but uncommon infection of dermal and subcutaneous tissues that is caused by mold fungi. Although primarily caused by keratinophilic dermatophytes such as anthropophilic Trichophyton rubrum, species from the Aspergillus and Phoma genera have been occasionally detected as etiologic agents of MG. In both healthy individuals and immunocompromised hosts, MG often presents as nodules, plaques, and papules on areas that are prone to trauma. Although MG generally appears on the upper and lower extremities (forearms, hands, legs, or ankles), it occasionally appears on the scalp and face. The clinical, mycologic, and/or cytologic diagnosis should be confirmed by the demonstration of perifollicular granulomatous inflammation by histologic examination. This review focuses on the clinical presentation, pathogenesis, laboratory diagnostic methods (including the Tzanck smear test), etiologic agents, histopathologic characteristics, and therapeutic approaches to the treatment of MG.
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Affiliation(s)
- Macit Ilkit
- Division of Mycology, Department of Microbiology, Baş kent University Adana Hospital, Adana, Turkey.
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15
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Emergence of resistance to antibacterial agents: the role of quaternary ammonium compounds--a critical review. Int J Antimicrob Agents 2012; 39:381-9. [PMID: 22421329 DOI: 10.1016/j.ijantimicag.2012.01.011] [Citation(s) in RCA: 343] [Impact Index Per Article: 28.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2012] [Accepted: 01/12/2012] [Indexed: 12/11/2022]
Abstract
Quaternary ammonium compounds (QACs) are widely distributed in hospitals, industry and cosmetics. Little attention has been focused on the potential impact of QACs on the emergence of antibiotic resistance in patients and the environment. To assess this issue, we conducted a literature review on QAC chemical structure, fields of application, mechanism of action, susceptibility testing, prevalence, and co- or cross-resistance to antibiotics. Special attention was paid to the effects of QACs on microflora; in particular, the issue of the potential of QACs for applying selective pressure on multiple-antibiotic-resistant organisms was raised. It was found that there is a lack of standardised procedures for interpreting susceptibility test results. QACs have different impacts on the minimum inhibitory concentrations of antibacterials depending on the antibacterial compound investigated, the resistance genes involved, the measuring methodology and the interpretative criteria. The unmet needs for adequate detection of reduced susceptibility to QACs and antibiotics include (i) a consensus definition for resistance, (ii) epidemiological cut-off values and (iii) clinical resistance breakpoints. This review advocates the design of international guidelines for QAC use.
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16
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Jung EM, An BS, Choi KC, Jeung EB. Potential estrogenic activity of triclosan in the uterus of immature rats and rat pituitary GH3 cells. Toxicol Lett 2012; 208:142-8. [DOI: 10.1016/j.toxlet.2011.10.017] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2011] [Revised: 10/24/2011] [Accepted: 10/24/2011] [Indexed: 12/31/2022]
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17
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Affiliation(s)
- Catherine Firanek
- Baxter Healthcare Corporation, Renal Division, McGaw Park, Illinois, USA
| | - Steven Guest
- Baxter Healthcare Corporation, Renal Division, McGaw Park, Illinois, USA
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Fang JL, Stingley RL, Beland FA, Harrouk W, Lumpkins DL, Howard P. Occurrence, efficacy, metabolism, and toxicity of triclosan. JOURNAL OF ENVIRONMENTAL SCIENCE AND HEALTH. PART C, ENVIRONMENTAL CARCINOGENESIS & ECOTOXICOLOGY REVIEWS 2010; 28:147-71. [PMID: 20859822 DOI: 10.1080/10590501.2010.504978] [Citation(s) in RCA: 130] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
Triclosan has broad-spectrum anti-microbial activity against most gram-negative and gram-positive bacteria. It is widely used in personal care products, household items, medical devices, and clinical settings. Due to its extensive use, there is potential for humans in all age groups to receive life-time exposures to triclosan, and, indeed, triclosan has been detected in human tissues and the environment. Data gaps exist regarding the chronic dermal toxicity and carcinogenicity of triclosan, which is needed for the risk assessment of triclosan. The US Food and Drug Administration (FDA) nominated triclosan to the National Toxicology Program (NTP) for toxicological evaluations. Currently, the NTP is conducting several dermal toxicological studies to determine the carcinogenic potential of triclosan, evaluate its endocrine and developmental-reproductive effects, and investigate the potential UV-induced dermal formation of chlorinated phenols and dioxins of triclosan. This paper reviews data on the human exposure, environmental fate, efficacy of anti-microbial activity, absorption, distribution, metabolism and elimination, endocrine disrupting effects, and toxicity of triclosan.
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Affiliation(s)
- Jia-Long Fang
- National Center for Toxicological Research, Food and Drug Administration, Jefferson, AR 72079, USA.
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Stoker TE, Gibson EK, Zorrilla LM. Triclosan Exposure Modulates Estrogen-Dependent Responses in the Female Wistar Rat. Toxicol Sci 2010; 117:45-53. [DOI: 10.1093/toxsci/kfq180] [Citation(s) in RCA: 163] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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20
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Efremenko E, Peregudov A, Kildeeva N, Perminov P, Varfolomeyev S. New enzymatic immobilized biocatalysts for detoxification of organophosphorus compounds. BIOCATAL BIOTRANSFOR 2009. [DOI: 10.1080/10242420500132474] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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21
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Orzech KM, Nichter M. From Resilience to Resistance: Political Ecological Lessons from Antibiotic and Pesticide Resistance. ANNUAL REVIEW OF ANTHROPOLOGY 2008. [DOI: 10.1146/annurev.anthro.37.081407.085205] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Kathryn M. Orzech
- Department of Anthropology, University of Arizona, Tucson, Arizona 85721; ,
| | - Mark Nichter
- Department of Anthropology, University of Arizona, Tucson, Arizona 85721; ,
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22
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JOHNSON J, McMULLEN L, HASSELBACK P, LOUIE M, JHANGRI G, SAUNDERS L. Risk factors for ciprofloxacin resistance in reported Campylobacter infections in southern Alberta. Epidemiol Infect 2007; 136:903-12. [PMID: 17678560 PMCID: PMC2870889 DOI: 10.1017/s0950268807009296] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
We conducted a case-control study examining risk factors for ciprofloxacin resistance in Campylobacter infections that were reported in 2004 and 2005 in two health regions in southern Alberta. The study questionnaire included questions about recent travel and antibiotic use, food consumption frequency, use of household and personal hygiene products with antibacterial agents, contact with animals, and potential misuse of antibiotics. Of the 210 patients who participated, 31.0% had ciprofloxacin-resistant Campylobacter infections. Foreign travel was the strongest predictor of resistance. Surprisingly, possession of antibiotics for future use was identified as a risk factor for resistance. We also examined the potential for participation bias and resistance misclassification to affect the resulting multivariable models. Participation bias appears to have had a substantial effect on the model results, but the estimated misclassification effect due to the use of different ciprofloxacin susceptibility testing methods was only slight.
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Affiliation(s)
- J. Y. M. JOHNSON
- Department of Public Health Sciences, University of Alberta, Edmonton, Alberta, Canada
- Department of Agriculture, Food, and Nutritional Science, University of Alberta, Edmonton, Alberta, Canada
| | - L. M. McMULLEN
- Department of Agriculture, Food, and Nutritional Science, University of Alberta, Edmonton, Alberta, Canada
| | - P. HASSELBACK
- Interior Health Authority, Kelowna, British Columbia, Canada
| | - M. LOUIE
- Provincial Laboratory for Public Health (Microbiology), Calgary, Alberta, Canada
| | - G. JHANGRI
- Department of Public Health Sciences, University of Alberta, Edmonton, Alberta, Canada
| | - L. D. SAUNDERS
- Department of Public Health Sciences, University of Alberta, Edmonton, Alberta, Canada
- Address for correspondence: Dr L. D. Saunders, Department of Public Health Sciences, 13-103 Clinical Sciences Building, University of Alberta, Edmonton, Alberta, T6G 2G3, Canada. ()
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Abstract
Antimicrobial use presents a dilemma, say Foster and Grundmann. Appropriate use can benefit individual patients but carries a cost to society by selecting for resistant strains that are difficult to treat.
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Affiliation(s)
- Kevin R Foster
- Wissenschaftskolleg zu Berlin, Institute for Advanced Study, Berlin, Germany.
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Abstract
Triphenyl-methan dyes, traditionally used in dermatology should be reevaluated with caution. Their use should be limited due to the uncertain pharmacological-toxicological risk-benefit ratio and the lack of pharmacological quality of the raw substances. Sometimes antimicrobial activity is insufficient and the cytotoxic effects, along with the inhibition of wound healing, make these dyes less suitable for topical treatment in dermatology. Chinolinolsulfat (Chinosol) and Clioquinol should be used in low concentrations and only on small areas. Due to their negative benefit-risk profile ethracidinlactate-monohydrate (Rivanol) and phenylmercuri-borate (Mercuchrom) should not be used as topical antimicrobial substances. The present publication is intended to give practical recommendations on compounded medications for topical antimicrobial use. Even though some of the cited compounds must be considered critically, we recommend the topical use of chlorhexidine salts, polihexanide, triclosan, polyvidone iodide and silver compounds. Useful standardised compounded formulations containing these four groups are listed in the NRF (Neues Rezeptur Formularium: New German Pharmacopoeia for compounded medication).
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Affiliation(s)
- R Eifler-Bollen
- Pharmazeutisches Laboratorium des Neuen Rezeptur Formulariums, Eschborn
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Faergemann J, Hedner T, Larsson P. The in vitro activity of pentane-1,5-diol against aerobic bacteria. A new antimicrobial agent for topical usage? Acta Derm Venereol 2005; 85:203-5. [PMID: 16040402 DOI: 10.1080/00015550410026128] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
Multi-resistance to antibiotic therapy and to biocides is becoming increasingly common, which has led to mounting concern worldwide regarding the future use of traditional antimicrobials. Diols or glycols also have antimicrobial effects. Pentane-1,5-diol has low oral toxicity, is essentially non-irritating to the skin and has high antimicrobial activities against bacteria, fungi and viruses. The effect of pentane-1,5-diol against both sensitive and multi-resistant Gram-positive and Gram-negative bacteria was tested in vitro against 85 bacterial strains showing minimal inhibitory concentrations in the range of 2.5 to 15.0% (vol/vol) against both antibiotic-susceptible and multi-resistant aerobic bacteria. The exact mechanism of action is unknown but probably pentane-1,5-diol sucks water out of the bacterial cells which then collapse, a mechanism to which it is probably very difficult to develop resistance. The high activity against multi-resistant bacteria makes pentane-1,5-diol an interesting new compound for topical antimicrobial therapy in humans.
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Affiliation(s)
- Jan Faergemann
- Department of Dermatology, Sahlgrenska University Hospital, SE-413 45 Gothenburg, Sweden.
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27
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Locke LJ. Bactericidal household products and antibiotic resistance: issues for parents. J SPEC PEDIATR NURS 2005; 10:139-42. [PMID: 16083433 DOI: 10.1111/j.1744-6155.2005.00025.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Luana J Locke
- University of Colorado, School of Nursing, Denver, CO, USA.
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28
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Sheldon AT. Antiseptic "Resistance": Real or Perceived Threat? Clin Infect Dis 2005; 40:1650-6. [PMID: 15889364 DOI: 10.1086/430063] [Citation(s) in RCA: 89] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2004] [Accepted: 02/19/2005] [Indexed: 11/03/2022] Open
Abstract
Biocides (antiseptics, disinfectants, preservatives, and sterilants) are critical components of intervention strategies used in clinical medicine for preventing the dissemination of nosocomial diseases. Biocides are also used in community environments for personal hygiene and to prevent cross-contamination with foodborne pathogens. In vitro studies suggest that exposure to biocides results in reduced susceptibility to antibiotics and biocides by intrinsic or acquired mechanisms of resistance. In addition, microorganisms have adapted to biocide exposure by acquiring plasmids and transposons that confer biocide resistance, the same survival strategies to disseminate acquired mechanisms of resistance to biocides as they have for resistance to antibiotics. The scientific community must weigh the risks and benefits of using biocides in clinical and community environments, to determine whether additional precautions are needed to guide biocide development and use. At present, insufficient scientific evidence exists to weigh these risks, and additional research is needed to allow appropriate characterization of risks in clinical and community environments.
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Affiliation(s)
- Albert T Sheldon
- Antibiotic and Antiseptic Consultants, Silver Spring, MD 20910, USA.
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29
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Russell AD. Bacterial adaptation and resistance to antiseptics, disinfectants and preservatives is not a new phenomenon. J Hosp Infect 2004; 57:97-104. [PMID: 15183238 DOI: 10.1016/j.jhin.2004.01.004] [Citation(s) in RCA: 89] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- A D Russell
- Welsh School of Pharmacy, Cardiff University, Cardiff CF10 3XF, UK.
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30
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Byarugaba DK. A view on antimicrobial resistance in developing countries and responsible risk factors. Int J Antimicrob Agents 2004; 24:105-10. [PMID: 15288307 DOI: 10.1016/j.ijantimicag.2004.02.015] [Citation(s) in RCA: 206] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Antimicrobial resistance is one of the biggest challenges facing global public health. Although antimicrobial drugs have saved many lives and eased the suffering of many millions, poverty, ignorance, poor sanitation, hunger and malnutrition, inadequate access to drugs, poor and inadequate health care systems, civil conflicts and bad governance in developing countries have tremendously limited the benefits of these drugs in controlling infectious diseases. The development of resistance in the responsible pathogens has worsened the situation often with very little resource to investigate and provide reliable susceptibility data on which rational treatments can be based as well as means to optimise the use of antimicrobial agents. The emergence of multi-drug-resistant isolates in tuberculosis, acute respiratory infections and diarrhoea, often referred to as diseases of poverty, has had its greatest toll in developing countries. The epidemic of HIV/AIDS, with over 30 million cases in developing countries, has greatly enlarged the population of immunocompromised patients. The disease has left these patients at great risk of numerous infections and even greater risks of acquiring highly resistant organisms during long periods of hospitalisation. This review discusses antimicrobial resistance in developing countries and the risk factors responsible.
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Affiliation(s)
- D K Byarugaba
- Department of Veterinary Microbiology and Parasitology, Faculty of Veterinary Medicine, Makerere University, P.O. Box 7062, Kampala, Uganda.
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31
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Kampf G, Kramer A. Epidemiologic background of hand hygiene and evaluation of the most important agents for scrubs and rubs. Clin Microbiol Rev 2004; 17:863-93, table of contents. [PMID: 15489352 PMCID: PMC523567 DOI: 10.1128/cmr.17.4.863-893.2004] [Citation(s) in RCA: 415] [Impact Index Per Article: 20.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
The etiology of nosocomial infections, the frequency of contaminated hands with the different nosocomial pathogens, and the role of health care workers' hands during outbreaks suggest that a hand hygiene preparation should at least have activity against bacteria, yeasts, and coated viruses. The importance of efficacy in choosing the right hand hygiene product is reflected in the new Centers for Disease Control and Prevention guideline on hand hygiene (J. M. Boyce and D. Pittet, Morb. Mortal. Wkly. Rep. 51:1-45, 2002). The best antimicrobial efficacy can be achieved with ethanol (60 to 85%), isopropanol (60 to 80%), and n-propanol (60 to 80%). The activity is broad and immediate. Ethanol at high concentrations (e.g., 95%) is the most effective treatment against naked viruses, whereas n-propanol seems to be more effective against the resident bacterial flora. The combination of alcohols may have a synergistic effect. The antimicrobial efficacy of chlorhexidine (2 to 4%) and triclosan (1 to 2%) is both lower and slower. Additionally, both agents have a risk of bacterial resistance, which is higher for chlorhexidine than triclosan. Their activity is often supported by the mechanical removal of pathogens during hand washing. Taking the antimicrobial efficacy and the mechanical removal together, they are still less effective than the alcohols. Plain soap and water has the lowest efficacy of all. In the new Centers for Disease Control and Prevention guideline, promotion of alcohol-based hand rubs containing various emollients instead of irritating soaps and detergents is one strategy to reduce skin damage, dryness, and irritation. Irritant contact dermatitis is highest with preparations containing 4% chlorhexidine gluconate, less frequent with nonantimicrobial soaps and preparations containing lower concentrations of chlorhexidine gluconate, and lowest with well-formulated alcohol-based hand rubs containing emollients and other skin conditioners. Too few published data from comparative trials are available to reliably rank triclosan. Personnel should be reminded that it is neither necessary nor recommended to routinely wash hands after each application of an alcohol-based hand rub. Long-lasting improvement of compliance with hand hygiene protocols can be successful if an effective and accessible alcohol-based hand rub with a proven dermal tolerance and an excellent user acceptability is supplied, accompanied by education of health care workers and promotion of the use of the product.
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Affiliation(s)
- Günter Kampf
- Bode Chemie GmbH & Co., Scientific Affairs, Melanchthonstrasse 27, 22525 Hamburg, Germany.
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32
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Aiello AE, Larson E. Antibacterial cleaning and hygiene products as an emerging risk factor for antibiotic resistance in the community. THE LANCET. INFECTIOUS DISEASES 2003; 3:501-6. [PMID: 12901892 DOI: 10.1016/s1473-3099(03)00723-0] [Citation(s) in RCA: 101] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Antibiotic resistance within the community setting is an emerging public-health concern. Infection with antibiotic-resistant organisms in the community among people lacking traditional risk factors has been reported. In addition, prevalence studies have identified individuals carrying antibiotic-resistant organisms in the absence of known risk factors. These studies strongly suggest the presence of contributing factors that have yet to be identified. In this paper we review the burden of antibiotic resistance and known risk factors within the community setting, assess the potential role of antibacterial cleaning and hygiene products containing triclosan in the emergence of resistance, and recommend future research on the assessment of household cleaning and hygiene products containing triclosan.
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Affiliation(s)
- Allison E Aiello
- Department of Epidemiology, Joseph Mailman School of Public Health, Columbia University, New York 10032, USA
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