Antiseptic Body Washes for Reducing the Transmission of Methicillin-Resistant Staphylococcus aureus: A Cluster Crossover Study

Harris, Patrick N A; Le, Bich Diep; Tambyah, Paul Ananth; Hsu, Li Yang; Pada, Surinder; Archuleta, Sophia; Salmon, Sharon; Mukhopadhyay, Amartya; Dillon, Jasmine; Ware, Robert S.; Fisher, Dale

doi:10.1093/ofid/ofv051

Cited by 16 publications

(7 citation statements)

References 39 publications

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“…T he rise in bacterial infections that are resistant to one or more frontline antibiotics has led to a greater reliance on prevention through effective infection control practices (IPCs). This is essential for reducing the burden of nosocomial infections and includes the use of antiseptics and disinfectants-e.g., the use of body washes to help reduce nosocomial infections in high-risk areas such as intensive care units (ICUs) (1,2). The antiseptic octenidine has showed promising efficacy against a wide variety of multidrug-resistant (MDR) pathogens (3,4), as well as reducing the rate of infection with Gram-negative agents through daily body washing (5).…”

mentioning

confidence: 99%

Long-Term Exposure to Octenidine in a Simulated Sink Trap Environment Results in Selection of Pseudomonas aeruginosa, Citrobacter , and Enterobacter Isolates with Mutations in Efflux Pump Regulators

Garratt

Aranega-Bou

Sutton

et al. 2021

Appl Environ Microbiol

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Octenidine based disinfection products are becoming increasingly popular for infection control of multidrug resistant (MDR) Gram-negative isolates. When a waste trap was removed from a hospital and allowed to acclimatise in a standard tap rig in our laboratory, it was shown that Klebsiella pneumoniae, Pseudomonas aeruginosa, Citrobacter and Enterobacter spp. were readily isolated. This study aimed to understand the potential impact of prolonged exposure to low doses of a commercial product containing octenidine on these bacteria. Phenotypic and genotypic analysis showed that P. aeruginosa strains had increased tolerance to octenidine which was characterised by mutations in the Tet-repressor SmvR. Enterobacter species demonstrated increased tolerance to many other cationic biocides, though not octenidine, as well as the antibiotics ciprofloxacin, chloramphenicol and ceftazidime through mutations in another Tet-repressor RamR. Citrobacter species with mutations in RamR and MarR were identified following octenidine exposure and this is linked to development of resistance to ampicillin, piperacillin and chloramphenicol as well as an increased MIC level for ciprofloxacin. Isolates were able to retain fitness as characterised by growth, biofilm formation and virulence in Galleria mellonella, after prolonged contact with octenidine, although there were strain to strain differences. These results demonstrate that continued low-level octenidine exposure in a simulated sink-trap environment selects for mutations which affect smvR. It may also promote microbial adaptation to other cationic biocides and cross-resistance to antibiotics, whilst not incurring a fitness cost. This suggests that hospital sink traps may act as a reservoir for more biocide tolerant organisms. Importance Multi-drug resistant (MDR) strains of bacteria are a major clinical problem and several reports have linked outbreaks of MDR bacteria with bacterial populations in hospital sinks. Biocides such as octenidine are used clinically in body washes and other products such as wound dressings for infection control. Therefore, increased tolerance to these biocides would be detrimental to infection control processes. Here, we exposed bacterial populations originally from hospital sink traps to repeated dosing with an octenidine containing product over several weeks and observed how particular species adapted. We found mutations in genes related to biocide and antibiotic susceptibility which resulted in increased tolerance, although this was species dependent. Bacteria which became more tolerant to octenidine also showed no loss of fitness. This shows that prolonged octenidine exposure has the potential to promote microbial adaptation in the environment and that hospital sink traps may act as a reservoir for increased biocide and antibiotic tolerant organisms.

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confidence: 99%

Long-Term Exposure to Octenidine in a Simulated Sink Trap Environment Results in Selection of Pseudomonas aeruginosa, Citrobacter , and Enterobacter Isolates with Mutations in Efflux Pump Regulators

Garratt

Aranega-Bou

Sutton

et al. 2021

Appl Environ Microbiol

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“…There was moderate evidence of benefit from one ITS, 104 one controlled trial 148 and one CBA study 101 which investigated the effectiveness of skin decolonisation with octenidine on the incidence of MRSA acquisition and the incidence of MRSA infection. The results of the metaanalyses showed that octenidine alone or in combination with a nasal decolonisation agent was more effective when compared to no decolonisation or placebo.…”

Section: Octenidinementioning

confidence: 99%

“…There was moderate evidence from two studies 101,148 which reported adverse events associated with the use of octenidine. One study which assessed adverse events when using octenidine soap reported no events in a sample of 5277 patients 148 while another assessing octenidine nasal gel reported one case (1/731, 0.14%) of adverse events (not specified) which resulted in discontinuation of use of the nasal gel in the affected patient. 101 No evidence was found from the studies published since 2004 meeting the inclusion criteria for the study design, which assessed the cost-effectiveness of octenidine.…”

Section: J O U R N a L P R E -P R O O Fmentioning

confidence: 99%

Joint Healthcare Infection Society (HIS) and Infection Prevention Society (IPS) guidelines for the prevention and control of meticillin-resistant Staphylococcus aureus (MRSA) in healthcare facilities

Coia

Wilson

Bak

et al. 2021

Journal of Hospital Infection

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“…As observed from previous studies, antiseptic bathing alone is inadequate for reducing MRSA acquisition in acute-care hospitals. 10 Although the nares are the most frequently colonized anatomic site and a major reservoir for MRSA, decolonization strategies commonly include universal antiseptic bathing but not nasal decolonization. With the wider availability of intranasal antiseptics, the inclusion of nasal decolonization in strategies to reduce nosocomial transmission of MRSA can be safely administered without the need for concern of mupirocin resistance.…”

Section: Discussionmentioning

confidence: 99%

Intranasal octenidine for methicillin-resistant Staphylococcus aureus (MRSA) carriers and universal octenidine bathing reduced MRSA acquisition in an acute-care general ward

Aung

Kyaw

Heng

et al. 2021

Infect. Control Hosp. Epidemiol.

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In this quasi-experimental before-and-after study in a methicillin-resistant staphylococcus aureus (MRSA) high-prevalence acute-care dermatology ward from August 2016 to November 2018, patients admitted during intervention period who received additional topical intranasal octenidine were 63% less likely to acquire MRSA than those receiving universal daily octenidine bathing alone during baseline period (aOR, 0.37; 95% CI, 0.14–0.98).

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Antiseptic Body Washes for Reducing the Transmission of Methicillin-Resistant Staphylococcus aureus: A Cluster Crossover Study

Abstract: In a cluster cross-over trial, targeted decolonization with octenidine body washes was not associated with reduction in MRSA transmission or infection

Cited by 16 publications

References 39 publications

Long-Term Exposure to Octenidine in a Simulated Sink Trap Environment Results in Selection of Pseudomonas aeruginosa, Citrobacter , and Enterobacter Isolates with Mutations in Efflux Pump Regulators

Long-Term Exposure to Octenidine in a Simulated Sink Trap Environment Results in Selection of Pseudomonas aeruginosa, Citrobacter , and Enterobacter Isolates with Mutations in Efflux Pump Regulators

Joint Healthcare Infection Society (HIS) and Infection Prevention Society (IPS) guidelines for the prevention and control of meticillin-resistant Staphylococcus aureus (MRSA) in healthcare facilities

Intranasal octenidine for methicillin-resistant Staphylococcus aureus (MRSA) carriers and universal octenidine bathing reduced MRSA acquisition in an acute-care general ward

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