Dramatic Increase of Multiresistant Microorganisms We are approaching the Postantibiotic Era?
Copyright (c) 2020 J. Peter Guggenbichler
This work is licensed under a Creative Commons Attribution 4.0 International License.
Clinical environments provide an ideal reservoir for the growth, proliferation, and transmission of pathogenic
organisms. Surfaces in hospitals e.g. hospital furniture, ECG lead wires and other cables, push buttons of infusion pumps, control knobs of ventilation machines, textiles as well as implantable biomaterials like central venous catheters, urologic catheters, endotracheal tubes are contaminated increasingly frequent with multiresistant microorganisms. These microorganisms are distributed by the hands of the nursing personnel throughout the hospital with serious, life threatening consequences. 1.8 million patients suffer from a nosociomial infection per year in Europe; approximately 180,000 deaths are attributed to these infections. The Centers for Disease Control (CDC) estimates that 2 million U.S. patients per year acquire a hospital-related infection. These infections cause 90,000 deaths each year and cost an average of $47,000 per patient to treat. The added cost to hospitals is $4.8 billion annually for extended care treatment. Microorganisms show an increasing rate of resistance against the majority of antibiotics including carbapenems as last available antibiotic. 700,000 deaths have been reported worldwide, 30 000 deaths alone in Europe during the last year due to infections where no effective antimicrobial substance was available. The use of disinfectants is ostensibly
intended to remove/kill pathogens on surfaces. However studies have shown that more than one-half the time,
surfaces are not adequately cleaned or are recontaminated within minutes. Much emphasis has been put therefore on hand disinfection. However there are also reports of the emergence of alcohol tolerant/insensitive microorganisms e.g., vancomycin resistant enterococci. This phenomenon has the potential to undermine the effectiveness of alcohol based disinfectant standard precautions. The reason for this dramatic development of resistant microorganisms is still in debate. The indiscriminate use of antibiotics for viral infections is frequently incriminated, however this seems to have little impacton the occurrence of multiresistant hospital pathogens. In contrast there is increasing evidence that the widespread use of disinfectants is responsible: disinfectants - analogous to antibiotics - must be incorporatedinto the metabolism of microorganisms. This is inevitably associated with induction of resistance by transfer ofresistance plasmids e.g. induction of efflux pumps. 7880 publications (Aug 2019) are available in the internationalliterature which document the induction of resistance by disinfectants and 649 papers describe the cross resistance with antibiotics.