The Pubmed database was searched and English language studies only were included. Search terms for this review included: “antibiotic resistance”, “antimicrobial resistance”, “hospital”, “day care”, “military”, “agriculture”, “community acquired resistance”, “antibacterial”, “cleaning”, “hygiene”, and “triclosan”
ReviewAntibacterial cleaning and hygiene products as an emerging risk factor for antibiotic resistance in the community
Section snippets
The public-health burden of antibiotic resistance
There are two important public-health concerns surrounding infection with an antibiotic-resistant organism. First, infection with a resistant organism may cause a delay in treatment because it can take hours or even days to ascertain the resistance pattern of the infecting organism.20 Second, infection with antibiotic-resistant organisms leads to treatment failure and can therefore increase transmission potential since the resistant organism is able to thrive and survive within the host for a
Known risk factors for the emergence of antibiotic resistance in the community
The primary routes by which an individual may become colonised and subsequently infected with an antibiotic-resistant organism in the community setting include person-to-person transmission of the bacteria and selective pressures from direct exposure to antibiotics (figure). For both of these routes there are established or known risk factors, such as attending day-care centres or other crowded settings, antibiotic use, and consumption of food products treated with antibiotics.
Child-care centres/crowded living conditions.
There is increased risk for the transmission of antibiotic-resistant organisms in crowded environments, a problem that is best illustrated in child-care centres. For example, the presence of antibiotic-resistant Streptococcus pneumoniae in day-care centres has been reported worldwide.24, 25, 26, 27, 28, 29 The use of broad-spectrum antibiotics among susceptible day-care age children as therapy for infections and treatment for recurring infections contributes to the presence and transmission of
Outpatient antibiotic use
Antibiotic use has been established as a risk factor for carrying a resistant organism by both individual and ecological study designs. In a study among the urban poor, individuals reporting antibiotic use in the past 12 months were significantly more likely to be colonised with MRSA.4 By contrast, prior antibiotic use was not associated with carriage of MRSA versus meticillin-susceptible S aureus (MSSA) in an American Indian community.39 In a study among college-age women attending an
Infection and carriage of antibiotic-resistant organisms without known risk factors
Of major concern is the recent appearance of infections with MRSA in people in the community setting who lack traditional risk factors.3, 47, 48 A review by Salgado et al49 reported that for a majority of the caMRSA studies among hospital patients, a case was defined as community-acquired if an MRSA-positive isolate was identified within 48 h of hospital admission, with or without other risk factors for MRSA. Since there are several health-care-related risk factors for carrying MRSA in the
Potential risk from antibacterial cleaning and hygiene products: changes in the susceptibility of microbial flora?
To assess the risk from antibacterial cleaning and hygiene products, it is important to ascertain the baseline prevalence of antibiotic resistance within the home environment. One small survey60 of antibiotic resistance in flora isolated from kitchens and bathrooms of 25 households has been reported. There were no isolates of MRSA (n=51 MSSA) and four of 58 (6·9%) enterococcal isolates were resistant to vancomycin. Most (94%) Escherichia coli isolates were susceptible to ten antibiotics tested.
Recommendations
Although there has been recent growth in the use of products—such as soaps and hand lotions—that contain antibacterial ingredients, there are no guidelines or recommendations regarding the use of home hygiene products from any of the major US federal agencies, such as the Environmental Protection Agency, the Centers for Disease Control and Prevention, or Food and Drug Administration (FDA). The American Medical Association (AMA) has recently published a statement with respect to the use of
Search strategy and selection criteria
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