disinfectants - center for antimicrobial resistance ... of veterinary pubic health, ... thailand...
TRANSCRIPT
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Department of Veterinary Pubic Health, Faculty of Veterinary Science,
Chulalongkorn University, Bangkok, Thailand
Disinfectants Dr. Rungtip Chuanchuen
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Definitions
Biocides
Antiseptics Formulations that kill microorganisms and are safe for applications to the surface of living tissues.
Disinfectants Formulations that kill microorganisms in the inanimate objects in a specified time.
Molecules that above certain critical concentrations & under defined conditions will kill living cells within specific time.
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Your
Slogan
here
Criteria for a good disinfectant
Rapid & long-last activity
Good compatibility
Ability to maintain efficacy
Lack of unwanted or toxic residues
Stability
No resistance & cross resistance
Environmental friendliness
Safe use
A wide range of microorganisms
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Time of exposure
http://www.bellchemicals.co.za
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Contact time
Factors affecting disinfectant activity
The death of microorganisms exposed to disinfectants takes place over a period of time.
0 5 10 15 sec
Time of exposure
Concentration
In general, the rate of microorganism inactivation
increases when concentrations rises.
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Temperature
In general, most biocides work at >68oF. The antimicrobial activity increases when the temperature rises.
Factors affecting disinfectant activity
Organic matters
Organic matters (e.g. milk, blood, pus, food residues, and faecal
materials), heavy metal, cationic ions, and
surfactants can hamper activity of disinfectants.
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pH
Factors affecting disinfectant activity
More resistant
Less resistant
Prions
Bacterial spores
Mycobacteria
Small, nonenveloped viruses
Gm-negative bacteria
Large, nonenveloped viruses
Gm-positive bacteria
Enveloped viruses
Mycoplasma
Type/number/location of microorganisms
The antimicrobial activity of many disinfectants is
quite markedly influenced by pH.
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Bacterial cell wall structure
Gram positive Gram negative
OM
PM
Lipopolysaccharide
Peptidoglycan
IM Phospholipid
Phospholipid
Teichoic acid
Lipoprotein
Arabinogalactan
Mycolic acid
Phospholipid IM
Sterol Peptidoglycan
Mycobacterium Mycoplasma
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Basic viral structure
Protein
Nucleic acid
Nonenveloped viruses Enveloped viruses
Nucleocapsid Envelope
(lipid/protein)
Parvovirus, Papillomavirus, Poliovirus, Rhinovirus, Coxsachievirus, Piconavirus
Influenza virus, HIV virus Hepatitis B virus, Rabies virus, Vesicular stomatitis virus
Capsid (protein)
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How disinfectants enter the cells?
D
D D
D
D
D
D
D
D
D
D D
D D
D
D
D
D
D
2 This may cause alteration of
outer membrane resulting in the penetration of the biocide.
1 A biocide binds to cell surface. 3 The biocide reach the target
sites within the cells.
Biocide-microorganism interactions
Cell wall/envelope disinfectants
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Glutaraldehyde
Concentrations in formulation: 1.5-3.5% (generally 2%) A stable acidic forms activated at alkaline pH (7-8.5) before use Alkalinized solutions: potent biocides, shorter shelf life
Board spectrum antimicrobial activity; bactericidal, virucidal, and sporicidal
Aldehydes
Stable, non-corrosive No deleterious effect on sensitive materials Good for temperature-sensitive medical devices
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Glutaraldehyde
Irritating & toxic to skin, mucous membrane & respiratory tract Absorbed by plastics and rubber Potential to fix materials onto a surface Mutagenicity??? Resistance development
Glutaraldehyde-resistant M. chelonae (also M. avium)
http://legacy.revoptom.com/publish/images/2_13050_1.gif
http://medicine.yale.edu/yjbm/ati/mycobacterium-chelonae.aspx
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Ortho-phthaldehyde (OPA)
Antimicrobial activity at 0.05-1% (wt/wt) A ready-to-use OPA formulation available at 0.55% Stable over a wide pH range (pH 3-9) No autopolymerization under alkaline conditions
A rapid board spectrum antimicrobial activity Less or no sporicidal activity Active against glutaraldehyde-resistant bacteria
Odorless, less irritating & less noxious No need for activation
Stain surfaces Adverse effects to skin, eyes, throat, lung Limited efficacy in the presence of soils
www.unimedmidwest.com/
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Formaldehyde
Used in an aqueous or gaseous form Typical concentration used 5-50 mg/l Formalin 34-40% (wt/wt) in water with 8-15% methanol
A board spectrum antimicrobial activity: bactericidal, mycobatericidal, virucidal Sporicidal activity?
Cost effective and easy Compatible with a range of plastics & metals
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Formaldehyde
Less effective in the presence of soil & microorganism clumping Strong irritancy Toxic, mutagenic & carcinogenic Permanent damages to olfactory tissues Allergic reaction Corrosive to some materials Resistance in PAO & E. coli
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DNA/RNA
Amino acids
Glutaraldehyde
-NH2 -SH
Outside G
G G
G
G
G
G G
G
G
G
G
G
Cross-link protein Inhibit
DNA/RNA synthesis
Lys
Arg
Lys Lysine Arg Arginine
Attack outer membrane proetein
Lys
Arg
Mode of action of glutaraldehydes
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Alcohols
Broad spectrum activity with rapid bactericidal and mycobatericidal activity Variable activity against viruses Little or no activity against bacterial spores
Isopropanol, ethanol, n-propanol Typical in-use concentrations: 50-90% (opt. 60-70%). Limited antimicrobial activity if >80%
Flammability risk Poor penetration
Little odor, nontoxic, inexpensive No residues, no environmental concerns Compatibility with surfaces
http://www.busytrade.com
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Protein
Alcohol
Outside
A
A
A
A
A A A A
H-bond
Protein denaturation coagulation & precipitation
Loss of structure & function
Amino acid
Disruption of amino-amino acid bonds
Formation of amino-hydrogen bonds
A
A
Cell lysis
Mode of action of Alcohols
A
A
A
A
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Biguanides
Chlorhexidine: A cationic-membrane active agent Salt forms: gluconate, diacetate, dihydrobromide More active at pH 5-7 A rapid broad-spectrum bactericidal activity
More active against Gram-positive bacteria
No sporicidal activity
Limited activity against viruses
Used in combination with other biocides
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Biguanides
Alexidine: Formulated in mouthwash & contact len solution A rapid broad-spectrum bactericidal activity More rapid in action No sporicidal activity Higher skin irritancy
Polymeric biguanides: The hetrodiperse mixtures of polyhexamethylbiguanides (PHMB) Widely used for surface disinfection & water treatment Broad spectrum activity Not a potential efflux substrate
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Biguanides
Minimal irritation to skin, mucous membranes & wounds Substantivity on the skin and mucous membrane
Eye irritants, hypersensitivity Environmental concerns Reduced activity in the presence of serum, blood & other organic matters Inactivated by nonionic surfactants and inorganic contaminants e.g., phosphate, chlorine Resistance development
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DNA/RNA
Chlorhexidine
Outside
C
Amino acid
C
C C
C
C
C
C
A biphasic effect on membrane permeability
Cytoplasmic constituents
Disruption of cell wall & cell membrane
Leakage of cytoplasmic contituents Ruptured
area
Mode of action of chlorhexidine
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Halogens & halogen-releasing agents
Only two carrying antimicrobial activity; free iodine (I2), & hypoiodous (HOI) Tinture of iodine, Lugol’s solution Iodophors: - increasing stability and solubility
- N-vinyl-2-pyrrolidone Active at low pH
Iodine (I2)
Broad spectrum activity at low conc. 0.01- 1 mg of available iodine /l, 5 min for killing vegetative cells 10 mg/l, up to 5 h for sporicidal activity
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Iodophors: board spectrum, little or no odor & non staining. Tolerate the presence of soils Little or no odor and taste, not irritating to eyes
Iodine (I2)
Surface staining Inactivated by QACs Irritating to broken wounds and mucous membrane Corrosive to metals and some plastics Thyroid function??? Great resistance in nonenveloped viruses
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Chlorine (Cl2)
The presence of active chlorine compounds, formed in water i.e., Cl2, hypochlorous acid (HOCl), hypochlorite acid (OCl-).
pH, HOCl, antimicrobial efficacy pH, OCl- , antimicrobial efficacy
Optimal pH 4-7
Cl2 + H20 H+ + HOCl + Cl-
HOCl OCl- + H3O+
OCl- Cl- + O
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Chlorine (Cl2)
HOCl Only found in solution Most active of all chlorine form 80-100% more effective than OCl-
Kill bacteria & viruses within 2 sec OCl-
A weaker form of free chlorine Serve as a bank of less active chlorine
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Chlorine (Cl2)
Reliable broad spectrum antimicrobial activity Remove biofilms Active against both enveloped and nonenveloped viruses
Colorless, cost-effective, easy to handle, nontoxic Remain activity at high water hardness level
Corrosive Irritants and hypersensitivity at higher conc. Produce chloramine resulting in stronger odor Toxic to fish and other aquatic species Produce by product “THM” a potential carcinogen
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Sodium hypochlorite (NaOCl)
Salt of HOCl in powder or liquid preparation Typical liquid form containing 1-15% available chlorine
Need a large scale to get the comparable killing activity
Cl2 + 2NaOH NaOCl + NaCl+ H2O
NaOCl + H2O HOCl + NaOH Na+ + OH- + H+ + OCl-
HOCl + H2O HCl + O
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Chloramine
Liquid or powder form Inorganic chloramine e.g., NH4Cl, NHCl2 Organic chloramine e.g., Chloramine T, sodium dichloroisocyanurate
Less irritant & more stable Greater activity under acidic conditions & in the presence of soil Oxidized some unwanted & harmful organic & inorganic compounds
Less antimicrobial activity than hypochlorite
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Sodium dichloroisocyanurate (SDIC)
Obtained from the reaction of HOCl & amine or imine Provided in either anhydrous or dehydrate forms Slowly releases chlorine and some other compounds, e.g. chlorinated isocyanurates, non-chlorinated isocyanurates & HOCl
An alternative chlorine-releasing agent to hypochlorite Accumulation of cyanuric acid
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Protein
-SH
HOCl
HOCl
HOCl HOCl HOCl
HOCl
-S-S-
HOCl
HOCl
HOCl
DNA
Nucleic acid denaturation
-Alter cell permeability -Interfere cell membrane associated function
-Impair enzyme & protein function -Leakage of intracellular constituents
Mode of action of chlorine
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Peroxygens & other oxygen-releasing agents
Active against bacteria, mycobacterium, spores & viruses More effective against Gram-positive than Gram- negative bacteria
H2O2
Commonly available as the 3-90% colorless solutions Typical conc. for industrial use are 35-50%.
Safe for skin & applicable to many materials Environmental friendly
Needs to be stored in tightly-closed light-proof bottles Can be toxic, corrosive and carcinogenic A potential mutagen Resistance development
http://myselectonline.com
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Commercially available at 5-37% liquid Usually combined with H2O2 and acetic acid & a stabilizer
Peracetic acid (PAA)
Sporicidal, bactericidal, tuberculocidal at low conc. (<0.35%) Variable virucidal activity
A great activity in the presence of organic soils. Decomposes into safe and nontoxic by-products
Corrosive, pungent odor, irritating React with plastics, copper and aluminiums Lose its stability easily during storage Needs to be stored in strong-invented container
http://www.evansvanodine.co.uk/Images/Agri/Livestock_Protection/Vanodox.jpg
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A reactive free radical existing as a water soluble gas
Chlorine dioxide
Spectrum of activity similar to chlorine Active over a wide pH range (pH 6-10) Biofilm control
Very short half life & high-light sensitivity Very irritating at high conc. Corrosive to some metals
No odor & color at typical conc. Neutralize some harmful chemicals Chlorine dioxide gas provides better & faster fumigation.
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Triple salts 2KHSO5.KHSO4.K2SO4 activity against bacteria, virus and fungi. Used in synergistic combination with chlorine-releasing agents, particularly SDIC
Potassium peroxymonosulfate, KHSO5
Rapid antimicrobial activity against bacteria & virus
Heat-tolerant, non-corrosive and non-irritating
Not stain surfaces
Odorless, colorless, highly stable at room temperature
Can cause acute toxicity and be severely toxic to eyes
Toxic to birds??
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Protein
Oxidize –SH in enzymes & proteins
-SH
Oxidation of proteins, fatty acids and nucleic acids
DNA/RNA
free hydroxyl radicals
.OH
.OH .
OH
.OH
.OH
.OH
Dissociation & conversion of 70S ribosomes to ribosomal units
Disruptions of peptide bonds
70s ribosome
.OH
Mode of action of oxidizing agents
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Copper (Cu2+)
Essential element Available in variety of form Most common used form is CuSO4.5H2O. Less active at pH>8 Cu2+ is the actual biocide.
Bactericidal particularly at low conc. Effective against both enveloped & nonenveloped viruses No sporicidal or sporistatic activity
Heavy metals
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Copper (Cu2+)
Powerful & stable even at low conc. Cost effective, easy to use, colorless & odorless “Copper-silver ionization” alternatives to chlorine water treatment Toxic and skin irritancy at high conc. Bioaccumulation, particularly aquatic environment React with other chemicals producing unwanted deposits on surfaces Resistance development
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Silver (Ag2+)
Widely used biocide silver: AgNO3, AgSD Ag2+ is the active species.
Active against bacteria, particularly Gram-positive bacteria Effective bactericidal activity at low conc. Little virucidal activity
Not irritating to skin or mucous membrane Residue antibacterial activity Less aggressive on surfaces
Skin and mucous membrane burn at high conc. Resistance development Reduced efficacy by contaminants
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Cu2+
Protein
Cu2+ Cu2+
Cu2+
Cu2+
Rapidly attach to cell surfaces
Disrupt 2nd & 3rd structures of proteins
Copper-mediated catalysis
Produce hydroxyl radicals
-SH -SH
Damage protein, lipid, nucleic acid
Alter cell permeability, disrupt cell wall,
protein denaturation & precipitation
Bind to phosphate back bone of DNA
DNA degradation
DNA
1
2
3
Mode of action of copper
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Ag2+
Produce membrane & surface blebs
Bind to DNA helix
Inhibit transcription & replication
Rapidly attach to cell surfaces
Disrupt cell wall
Bind to –SH, amino & carboxyl groups leading to protein denaturation
DNA
Ag2+
Ag2+
SD
Ag2+
Ag2+
Protein
-SH -SH NH2-
-COOH
Ag2+ AgSD
SD
SD
Ag2+
Mode of action of silver & silver sulfadiazine
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Phenolics
Various types of phenolic compounds
Coal tar phenol, cresol, xylenol
Non-coal tar 2-phenylphenol, 4 hexylresorcinol
Halogenated phenols chloroxylenol, 4-nitrophenol, 2-chlorophenol, chlorocresol
Bisphenols triclosan, hexachlorophene, fenichlor
Others salicylic acid, 8-hydroxyquinoline, 2,3-diaminophenol
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Insoluble in water Combine w/ soap, oils & anionic detergent Formulation effects play a key role in the optimization of phenol activity. The more lipophilic the phenolic, the more activity against enveloped viruses.
Phenolics
Broad spectrum intermediate-level disinfectants Rapid activity against Gram-positive, Gram-negative bacteria, Mycobacteria and viruses Sporistatic but not sporicidal
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Tolerate the presence of organic & inorganic soils Formulated for both cleaning & disinfection Some residue activity Stable in storage
Phenolics
Skin/eye irritants, relatively toxic Strong odor Restricted use in nurseries Corrosive to some plastic & rubber surfaces Resistance development
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-OH group is very reactive.
Form H-bond w/ macromolecules,
particularly protein
Inactivate essential membrane function
P -OH P -OH P -OH
P -OH Phenolics
Damage cell wall & membrane
Leakage of intracellular constituents
DNA/RNA Protein
P -OH
P -OH
Mode of action of phenolics
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Surface-active agents (Surfactants) QACs, the most widely used cationic surfactant BKC, cetrimide (CTAB), cetylpyridinium chloride (CPC)
QACs
Vary in antimicrobial activity type & formulation No sporicidal activity Bacteristatic, tuberoculostatic, sporistatic at low conc. (< 500 g/ml) Gram positive bacteria are very sensitive (<10 g/ml). Effective against enveloped viruses
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No requirement of rinsing off following application Noncorrosive, nonstaining, pleasant odor Retain efficacy in organic materials Nontoxic, no skin irritation at conc. used Stable in storage
QACs
Reduced activity in hard water, fatty materials, anionic surfactants Difficult to rinse off Excessive foaming At higher conc., irritating to skin and mucous membrane Resistance development
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Leakage of cytoplasmic contituents
QACs Q
Protein
Q
Q Q
Q
Q Q
Q
Cytoplasmic constituents
Rapid absorption & penetration of cell wall
Disruption of structure & function
of cell wall
Disruption of membrane lipid, enzyme, protein
Q
Q
Mode of action of QACs
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DNA
IM
Cell wall/OM Chlorhexidine QACs, Phenols Alcohols Hexchlorophene
-NH2
-SH
coagulation
Amino acids
leakage
PMF Electron transport
Lysis
Chlorhexidine QACs, Phenols Phenoxyethanol Hexchlorophene
Organic acids Hexchlorophene
Hexchlorophene
Chlorine Iodine H2O2, Ag2+
High conc. Chlorhexidine QACs, Phenols Hexchlorophene
Chlorhexidine QACs Glutaraldehyde Chlorine
Glutaraldehyde Formaldehyde Chlorhexidine
ATPase
Summary of target sites & effects of disinfectants
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Inactivation of viruses
Enveloped viruses Nonenveloped viruses
Capsid (protein) D
D
D
D
D
D
D
D
“Complete viral inactivation must include destruction or damages of nucleic acids.”
Envelope (lipid + protein)
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Chlorine inactivation of viruses HOCl
HOCl
HOCl
HOCl
HOCl
HOCl
HOCl
HOCl
Penetration of lipid envelope & proteinaceous capsid
(conformation shift)
Disruption of peptide bonds
Substitution of benzene rings on Tyr
Deamination of ammonia
Change of viral antigenic properties
Disruption of viral genome
HOCl
HOCl
HOCl
HOCl
HOCl
HOCl
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Combination of biocides
Possible responses
Examples: Chlorhexidine, Alcohol, QACs Phenolics, alcohol QACs, surfactants, propan-2-ol
Possible responses
antagonistic Synergistic
Additive
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Which disinfectants potentially promote resistance?
Nonresidue producers Residue producers
Alcohols Aldehyde Oxidizing agents Chlorine Iodine
Biguanides Phenols and cresols Heavy metals QACs
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Gram-negative bacterial cell envelope
Hydrophobic Hydrophilic
Outer membrane
Periplasm
Inner membrane
Cytoplasm
Gram-negative bacterial cell envelope & the Mycobacterium-complex cell wall provides an effective barrier to the entry of disinfectants.
Cell membrane
Peptidoglycan
Arabinogalactan
Mycolic acid Lipoarabi- nomannan
Lipophilic/ Hydrophobic Hydrophilic
Mycobacterial cell wall structure
Example of resistance mechanisms to disinfectants
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Slime/biofilm production reduced permeability to disinfectants.
http://farm1.static.flickr.com/166/377207561_2d550d471d_m.jpg
P. aeruginosa biofilm
disinfectants
disinfectants
Mucoid strains of S. aureus http://t3p-sfb34.rz.uni-greifswald.de/typo3temp/pics/9a16487dd6.jpg
Example of resistance mechanisms to disinfectants
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Active efflux pumps out low concentration of disinfectants, resulting in reduction of the intracellular concentration of disinfectants.
The QacA system in S. aureus
Substrates: QACs, chlorhexidine, salts, acridine, ethidium bromide
QacA
H+
H+
Drug
Drug
Drug
Example of resistance mechanisms to disinfectants
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Resistance to disinfectants in viruses
1. Indirect factor
Virus clumping
Protective factors e.g., cell debris,
soil, organic salts, lipids, carbohydrate etc.
2. Direct factor
The structure of virus particle e.g. the presence of envelope, lack of damage to nucleic acid
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How can virus acquire resistance?
Poliovirus
Gradual passage through increased conc. of chlorine
Virus adaptation
Secondary or tertiary changes of structural capsid
Increased tolerance of chlorine inactivation in poliovirus
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Microorganisms expose to a disinfectant at sub-lethal level.
Microorganisms develop resistance to the disinfectant.
Microorganisms develop resistance to multiple antibiotics simultaneously.
Development of cross-resistance between disinfectants and antibiotics
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Active efflux is a common mechanism for biocide and antibiotic resistance.
OUT
IN
outer membrane
inner membrane
The AcrAB-TolC efflux systems in Salmonella enterica
TonB
Porin
H+
H+
AcrB
AcrA
TolC
CHX TET
ERY AMP
CHP
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Biocide adaptation/mutation and cross-resistance
Species Adapted to Cross-resistance
MRSA BKC Ofloxacin, oxacillin, cloxacillin
S. aureus QACs, Chlorxidine norfloxacin, ofloxacin
E. coli Chloroxylenol, Tetracycline, ampicillin, chlorhexidine, QACs, streptomycin, chloramphenicol glutaraldehyde, iodine
E. coli BKC Ampicilin, penicillin, nalidixic acid, kanamycin, gentamycin, erythromycin,
S. Virchow Chlorhexidine, BKC Amikacin, amoxillin, imipenem, chloramphenicol, trimethroprim
Salmonella Phenolics ampicillin, ciprofloxacin
E. coli Formaldehyde Glutaradehyde
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How important in clinical settings?
Agent Sources % of isolates with MICs (µg/ml)
2 4 8 16 32 64 128 256 512 1024 2048
BKC Poultry 12.0 41.6 32.0 14.4
Swine 0.8 0.8 6.8 45.5 25.0 21.2
CHK Poultry 1.6 4.0 68.0 17.6 8.0 2.4
Swine 13.4 59.8 23.5 4.5 0.8
ZnCl2 Poultry 14.4 50.4 35.2
Swine 15.9 43.2 40.9
CuSO4 Poultry 0.8 1.6 97.6
Swine 100
Chuanchuen et al, 2008 JVMS, 595-601
No or only a limited degree of developed resistance to the
disinfectants
Susceptibility of Salmonella enterica to selected biocides (n=180)
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How important in clinical settings?
Strains MIC (µg/ml)
CHP ERY BKC
SA030
(pre- exposed)
2 2 2
SA030
(post-exposed)
64 8 32
In vitro exposure to BKC promote cross-resistance to antibiotics
Chuanchuen et al. unpublished data
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Are bootbaths really efficient?
Poor boot bath maintenance
Personnel avoid stepping into boot bath.
Insufficient contact time
No removal of visible manure
A sense of responsibility Awareness of biosecurity
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Stepping through or standing without removing organic
material first did not disinfect boots
Scrubbing manure off in a water bath is as effective as that in
a disinfectants bath for reducing bacterial
counts Soak boots scrubbed free of manure for 5 min or more to meet
the standard for disinfection
The bootbath principle
Type of disinfectants is irrelevant if manure is
not removed.
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Which disinfectants are good for boot baths?
Broad spectrum Fast working Retaining a long residual action
Most commonly used: Phenolics Chlorhexidine Per-oxy compounds Didecyldimethylammonium chloride A combination of aldehydes & QACs or peracetic acid & hydrogen peroxide
http://www.fwi.co.uk/academy/article/116013/salmonella-in-layers-2-control.html
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New development of disinfectants
A combination of FeCl3.H2O, cysteine,
ascorbic acid, potassium, SDS
Potassium fluoride peroxohydrate
Superoxidized Water
Peracetic acid and 5,7-diphenyl-1,3-diazoadamantan-6-one)
Poly-[2-(2-ethoxy)-ethoxyethyl)-guanidinium-chloride]
A mixture of polymeric biquanides (poly-(hexamethylene-guanidinium-chloride
& poly-[2-(2-ethoxy)-ethoxyethyl)-guanidinium-chloride])
Novel formaldehyde-releasing agents e.g., taurolin, hexamine
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The Chuanchuen lab
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1 H Y P O C H L O R O U S
2 R E S I S T A N C E
3
4
5
P E R A C E T I C A C I D
D I S I N F E C T A N T S
S D I C
6 S
N
G
I
T
C
7 E
F
L
U
X
8
9
Q
C
S
H
M
Across 1. An acid that is the most powerful of all chlorine form
Across 2. A phenomenon that an infectious agent is no longer effective against
an infection previously treatable by the agent
Across 3. A disinfectant obtained the reaction between hydrogen peroxide
and acetic acid
Across 4. A substance that can kill microorganisms and are suitable to
use on inanimate objects only
Across 5. A chlorine-releasing chlorine agent
Down 6. When combine two disinfectants, the combined activity is
greater than that of sum of individual ones.
Down 7. A mechanism that mediates cross resistance between
disinfectants and antibiotics
Down 8. A cationic surfactant that is commonly used for disinfection
Down 9. A potentially-carcinogenic agent produced by chlorine
I