CLINICAL MICROBIOLOGY REVIEWS, Jan. 1999, p. 147–179 Vol. 12, No. 1 0893-8512/99/$04.0010 Copyright © 1999, American Society for Microbiology. All Rights Reserved. Antiseptics and Disinfectants: Activity, Action, and Resistance 1 2 GERALD MCDONNELL * AND A. DENVER RUSSELL STERIS Corporation, St. Louis Operations, St. Louis, Missouri 63166,1 and Welsh School of Pharmacy, Cardiff University, Cardiff CF1 3XF, United Kingdom2 INTRODUCTION .......................................................................................................................................................148 DEFINITIONS ............................................................................................................................................................148 MECHANISMS OF ACTION ...................................................................................................................................148 Introduction.............................................................................................................................................................148 General Methodology .............................................................................................................................................148 Alcohols ....................................................................................................................................................................151 Aldehydes .................................................................................................................................................................151 Glutaraldehyde....................................................................................................................................................151 Formaldehyde ......................................................................................................................................................153 Formaldehyde-releasing agents.........................................................................................................................153 o-Phthalaldehyde.................................................................................................................................................153 Anilides.....................................................................................................................................................................153 Biguanides................................................................................................................................................................153 Chlorhexidine ......................................................................................................................................................153 Alexidine...............................................................................................................................................................154 Polymeric biguanides..........................................................................................................................................154 Diamidines ...............................................................................................................................................................155 Halogen-Releasing Agents .....................................................................................................................................155 Chlorine-releasing agents ..................................................................................................................................155 Iodine and iodophors .........................................................................................................................................155 Silver Compounds...................................................................................................................................................155 Silver nitrate........................................................................................................................................................156 Silver sulfadiazine...............................................................................................................................................156 Peroxygens ...............................................................................................................................................................156 Hydrogen peroxide..............................................................................................................................................156 Peracetic acid ......................................................................................................................................................156 Phenols .....................................................................................................................................................................156 Bis-Phenols ..............................................................................................................................................................157 Triclosan ..............................................................................................................................................................157 Hexachlorophene.................................................................................................................................................157 Halophenols .............................................................................................................................................................157 Quaternary Ammonium Compounds ...................................................................................................................157 Vapor-Phase Sterilants ..........................................................................................................................................158 MECHANISMS OF RESISTANCE..........................................................................................................................158 Introduction.............................................................................................................................................................158 Bacterial Resistance to Antiseptics and Disinfectants ......................................................................................158 Intrinsic Bacterial Resistance Mechanisms........................................................................................................158 Intrinsic resistance of bacterial spores............................................................................................................159 Intrinsic resistance of mycobacteria ................................................................................................................160 Intrinsic resistance of other gram-positive bacteria......................................................................................161 Intrinsic resistance of gram-negative bacteria ...............................................................................................161 Physiological (phenotypic) adaption as an intrinsic mechanism.................................................................162 Acquired Bacterial Resistance Mechanisms .......................................................................................................164 Plasmids and bacterial resistance to antiseptics and disinfectants ............................................................164 (i) Plasmid-mediated antiseptic and disinfectant resistance in gram-negative bacteria......................164 (ii) Plasmid-mediated antiseptic and disinfectant resistance in staphylococci .....................................165 (iii) Plasmid-mediated antiseptic and disinfectant resistance in other gram-positive bacteria..........166 Mutational resistance to antiseptics and disinfectants.................................................................................166 Mechanisms of Fungal Resistance to Antiseptics and Disinfectants ..............................................................167 Mechanisms of Viral Resistance to Antiseptics and Disinfectants .................................................................168 Mechanisms of Protozoal Resistance to Antiseptics and Disinfectants..........................................................169 Mechanisms of Prion Resistance to Disinfectants.............................................................................................169 * Corresponding author. Present address: STERIS Corporation, 5960 Heisley Rd., Mentor, OH 44060. Phone: (440) 354-2600. Fax: (440) 354-7038. E-mail: [email protected]. 147 148 MCDONNELL AND RUSSELL CLIN.MICROBIOL.REV. CONCLUSIONS .........................................................................................................................................................169 REFERENCES ............................................................................................................................................................170 INTRODUCTION MECHANISMS OF ACTION Antiseptics and disinfectants are used extensively in hospi- Introduction tals and other health care settings for a variety of topical and Considerable progress has been made in understanding the hard-surface applications. In particular, they are an essential mechanisms of the antibacterial action of antiseptics and dis- part of infection control practices and aid in the prevention of infectants (215, 428, 437).