Multiresistente Erreger – Sind sie auch resistent gegenüber Desinfektionsmitteln?

Epidemiologische Studien zeigen, dass die Versorgung von Patientinnen und Patienten in Zimmern mit vorherigem Aufenthalt einer Person mit Nachweis multiresistenter Erreger (MRE) mit einem erhöhten Risiko des Auftretens dieser Erreger assoziiert ist. Deshalb stellt sich regelmäßig die Frage, ob MRE auch eine Resistenz gegenüber den eingesetzten Desinfektionsmitteln aufweisen. Dieser Artikel gibt einen Überblick über den aktuellen Stand zu dieser Frage.

Abstract

Epidemiological studies show that the care of patients in rooms with a previous stay by a person with evidence of multi-resistant pathogens (MRP) is associated with an increased risk of these pathogens occurring. The question therefore regularly arises as to whether MRP also exhibit resistance to the disinfectants used. To date, there are no standardised definitions for “resistance” to disinfectants. However, disinfectants authorised on the market are also effective against multi-resistant pathogens and the failure of efficient disinfection is mainly caused by application errors (insufficient cleaning, incomplete wetting, incorrect application concentration or exposure time etc.). The effectiveness of disinfectants depends on a variety of environmental factors (especially accompanying contamination). A reduced sensitivity to disinfectants can occur in individual isolates due to selection under sub-inhibitory concentrations of disinfectants. Resistance mechanisms to antibiotics do not mediate cross-resistance to disinfectants, but a change in the permeability of bacterial cells can influence sensitivity to disinfectants and antibiotics. In general, the success of routine disinfection can be improved by suitable process controls and contribute to reducing the transmission of MRP.

Kernaussagen

• Die Wirksamkeit von auf dem Markt zugelassenen Desinfektionsmitteln ist in der Regel auch bei multiresistenten Erregern gegeben.

• Die Wirksamkeit von Desinfektionsmitteln hängt von einer Vielzahl von Umweltfaktoren ab (insbesondere begleitende Verschmutzung).

• Eine verminderte Empfindlichkeit gegenüber Desinfektionsmitteln kann in einzelnen Isolaten durch Selektion unter subinhibitorischen Konzentrationen von Desinfektionsmitteln auftreten.

• Resistenzmechanismen gegenüber Antibiotika vermitteln keine Kreuzresistenz gegen Desinfektionsmittel, jedoch kann eine Permeabilitätsänderung bakterieller Zellen die Empfindlichkeit gegen Desinfektionsmittel und Antibiotika beeinflussen.

• Es existieren bisher keine einheitlichen Definitionen für „Resistenz“ gegenüber Desinfektionsmitteln.

• Das Versagen einer effizienten Desinfektion wird überwiegend durch Anwendungsfehler verursacht (nicht ausreichende Reinigung, nicht vollständige Benetzung, falsche Anwendungskonzentration bzw. Einwirkzeit usw.).

• Der Erfolg von Desinfektionsmaßnahmen kann durch geeignete Prozesskontrollen verbessert werden und zur Verringerung der Übertragung von MRE beitragen.

Schlüsselwörter

Desinfektionsmittel - Resistenz - Toleranz - Umweltkontamination

Keywords

disinfectants - resistance - tolerance - environmental contamination

Publication History

Article published online:
09 September 2024

• Literatur

• 1 Otter JA, Yezli S, French GL. The role played by contaminated surfaces in the transmission of nosocomial pathogens. Infect Control Hosp Epidemiol 2011; 32: 687-699
• 2 Assadian O, Harbarth S, Vos M. et al. Practical recommendations for routine cleaning and disinfection procedures in healthcare institutions: a narrative review. J Hosp Infect 2021; 113: 104-114
• 3 [Anonym]. Hygienemaßnahmen bei Infektionen oder Besiedlung mit multiresistenten gramnegativen Stäbchen. Empfehlung der Kommission für Krankenhaushygiene und Infektionsprävention (KRINKO) beim Robert Koch-Institut (RKI). Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2012; 55: 1311-1354
• 4 Otter JA, Yezli S, Salkeld JAG. et al. Evidence that contaminated surfaces contribute to the transmission of hospital pathogens and an overview of strategies to address contaminated surfaces in hospital settings. Am J Infect Control 2013; 41 (Suppl. 05) S6-S11
• 5 Dancer SJ. The role of environmental cleaning in the control of hospital-acquired infection. J Hosp Infect 2009; 73: 378-385
• 6 Commission for Hospital Hygiene and Infection Prevention (KRINKO). Hygiene requirements for cleaning and disinfection of surfaces: recommendation of the Commission for Hospital Hygiene and Infection Prevention (KRINKO) at the Robert Koch Institute. GMS Hyg Infect Control 2024; 19: Doc13
• 7 Christenson EC, Cronk R, Atkinson H. et al. Evidence Map and Systematic Review of Disinfection Efficacy on Environmental Surfaces in Healthcare Facilities. Int J Environ Res Public Health 2021; 18: 11100
• 8 Uy B, Read H, van de Pas S. et al. The efficacy of commercial decontamination agents differs between standardised test settings and research laboratory usage for a variety of bacterial species. PeerJ 2022; 10: e13646
• 9 Cohen B, Cohen CC, Løyland B. et al. Transmission of health care-associated infections from roommates and prior room occupants: a systematic review. Clin Epidemiol 2017; 9: 297-310
• 10 Mitchell BG, Dancer SJ, Anderson M. et al. Risk of organism acquisition from prior room occupants: a systematic review and meta-analysis. J Hosp Infect 2015; 91: 211-217
• 11 Wu YL, Yang XY, Ding XX. et al. Exposure to infected/colonized roommates and prior room occupants increases the risks of healthcare-associated infections with the same organism. J Hosp Infect 2019; 101: 231-239
• 12 Hirai Y. Survival of bacteria under dry conditions; from a viewpoint of nosocomial infection. J Hosp Infect 1991; 19: 191-200
• 13 Katzenberger RH, Rösel A, Vonberg RP. Bacterial survival on inanimate surfaces: a field study. BMC Res Notes 2021; 14: 97
• 14 Kramer A, Schwebke I, Kampf G. How long do nosocomial pathogens persist on inanimate surfaces? A systematic review. BMC Infect Dis 2006; 6: 130
• 15 Porter L, Sultan O, Mitchell BG. et al. How long do nosocomial pathogens persist on inanimate surfaces? A scoping review. J Hosp Infect 2024; 147: 25-31
• 16 Adams CE, Smith J, Watson V. et al. Examining the association between surface bioburden and frequently touched sites in intensive care. J Hosp Infect 2017; 95: 76-80
• 17 Knobling B, Ulatowski A, Franke G. et al. Superiority of manual disinfection using pre-soaked wipes over automatic UV-C radiation without prior cleaning. J Hosp Infect 2023; 140: 72-78
• 18 Knobloch JKM, Tofern S, Kunz W. et al. “Life-like” assessment of antimicrobial surfaces by a new touch transfer assay displays strong superiority of a copper alloy compared to silver containing surfaces. PLoS One 2017; 12: e0187442
• 19 Ledwoch K, Dancer SJ, Otter JA. et al. Beware biofilm! Dry biofilms containing bacterial pathogens on multiple healthcare surfaces; a multi-centre study. J Hosp Infect 2018; 100: e47-e56
• 20 Maillard JY, Pascoe M. Disinfectants and antiseptics: mechanisms of action and resistance. Nat Rev Microbiol 2024; 22: 4-17
• 21 Parkes LO, Hota SS. Sink-Related Outbreaks and Mitigation Strategies in Healthcare Facilities. Curr Infect Dis Rep 2018; 20: 42
• 22 von Rheinbaben F, Werner S. Desinfektionsmittel – Einflussfaktoren auf die Wirksamkeit. Dial Akt 2014; 18: 138-147
• 23 Otter JA, Vickery K, Walker JT. et al. Surface-attached cells, biofilms and biocide susceptibility: implications for hospital cleaning and disinfection. J Hosp Infect 2015; 89: 16-27
• 24 Neuhaus S, Feßler AT, Dieckmann R. et al. Towards a Harmonized Terminology: A Glossary for Biocide Susceptibility Testing. Pathogens 2022; 11: 1455
• 25 McDonnell G, Russell AD. Antiseptics and disinfectants: activity, action, and resistance. Clin Microbiol Rev 1999; 12: 147-179
• 26 Krewing M, Mönch E, Bolten A. et al. Resistance or tolerance? Highlighting the need for precise terminology in the field of disinfection. J Hosp Infect 2024; 150: 51-60
• 27 Maillard JY. Resistance of Bacteria to Biocides. Microbiol Spectr 2018; 6
• 28 Reiss I, Borkhardt A, Füssle R. et al. Disinfectant contaminated with Klebsiella oxytoca as a source of sepsis in babies. Lancet 2000; 356: 310
• 29 Meyer J, Nippak P, Cumming A. An evaluation of cleaning practices at a teaching hospital. Am J Infect Control 2021; 49: 40-43
• 30 Weber DJ, Rutala WA, Anderson DJ. et al. ..úNo touch..Ñ methods for health care room disinfection: Focus on clinical trials. Am J Infect Control 2023; 51: A134-A143
• 31 Ziegler MJ, Babcock HH, Welbel SF. et al. Stopping Hospital Infections With Environmental Services (SHINE): A Cluster-randomized Trial of Intensive Monitoring Methods for Terminal Room Cleaning on Rates of Multidrug-resistant Organisms in the Intensive Care Unit. Clin Infect Dis 2022; 75: 1217-1223