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Thursday, September 29, 2011

Doors, Keys and Sledgehammers…

Once upon a time, long, long ago there was door. This door was extremely strong, could rebuild itself and seriously maimed or killed anyone who came in contact with it. In the 1800’s, some bright soul invented a sledgehammer. The people were finally able to break the door down and while the door could rebuild itself, it maimed and killed fewer people. Then in the 1940’s a genius developed a key that could unlock the door and everyone thought the story was over. But this was in fact just the beginning of the Lock and Key war. In 1947 the door changed its lock, the key no longer fit, the door became stronger than ever and the people again began to see the importance of using the sledgehammer. The End.

By now, you are either thinking I am completely off my rocker, or you have deduced that the door is the metaphor for bacteria, the sledgehammer is portraying disinfectants, the key is playing the part of antibiotics and the focus of this blog is whether antibiotic resistance equates to chemical resistance.

The answer to this question is a resounding NO, but rather than take my Coles Notes version for gospel, let’s look at the facts.

Fact #1: Antibiotics have very specific targets where they attack the bacteria just as a lock needs a specific key in order to open. Any changes to the bacteria can make to the target renders the key ineffective.

Fact #2: Antibiotics, while useful, have limits to the concentration that can be used before it will cause harm to the patient. If the bacteria adapts to the therapeutic dose it can become resistant.

Fact #3: The development of antibiotic resistance has been seen to occur within a few years after the introduction of a new antibiotic.

Fact #4: Disinfectants are not specific in their attack, hence a sledgehammer being a perfect metaphor. This makes development of resistance much more difficult.

Fact #5: Disinfectants are used at concentrations far more potent (100 – 10,000 times) than the minimum inhibitory concentration (MIC) making if far more unlikely for bacteria to develop resistance.

Fact #6: Disinfectants have been used for well over 100 years without loss of effectiveness. While there is a hierarchy with respect to some bacteria such as spore-formers or Mycobacteria spp. being less susceptible to chemicals that their gram negative or gram positive cousins, there is no current scientific evidence that supports that antibiotic resistant organisms are more resistant to disinfectants.

In a later blog we will talk further about the development of chemical resistance, but for now we can feel confident that whether we are talking MRSA, VRE, ESBLs, MDR-Pseudo, MDX-TB or CRE the disinfectant you are currently using against the susceptible strains will still be effective against the antibiotic resistant strains.

Bugging Off!

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