Antibacterial cleaning products and drug resistance.We examined whether household use of antibacterial antibacterial /an·ti·bac·te·ri·al/ (-bak-ter´e-al) destroying or suppressing growth or reproduction of bacteria; also, an agent that does this. an·ti·bac·te·ri·al adj. cleaning and hygiene products is an emerging risk factor for carriage of antimicrobial antimicrobial /an·ti·mi·cro·bi·al/ (-mi-kro´be-al) 1. killing microorganisms or suppressing their multiplication or growth. 2. an agent with such effects. drug-resistant bacteria on hands of household members. Households (N = 224) were randomized ran·dom·ize tr.v. ran·dom·ized, ran·dom·iz·ing, ran·dom·iz·es To make random in arrangement, especially in order to control the variables in an experiment. to use of antibacterial or nonantibacterial cleaning and hygiene products for 1 year. Logistic regression In statistics, logistic regression is a regression model for binomially distributed response/dependent variables. It is useful for modeling the probability of an event occurring as a function of other factors. was used to assess the influence of antibacterial product use in homes. Antibacterial product use did not lead to a significant increase in antimicrobial drug resistance after 1 year (odds ratio 1.33, 95% confidence interval confidence interval, n a statistical device used to determine the range within which an acceptable datum would fall. Confidence intervals are usually expressed in percentages, typically 95% or 99%. 0.74-2.41), nor did it have an effect on bacterial susceptibility to triclosan. However, more extensive and longer term use of triclosan might provide a suitable environment for emergence of resistant species. Further research on this issue is needed. ********** Concern is growing over the use of household cleaning and hygiene products labeled as antibacterial as a result of laboratory data showing a link between exposure to ingredients in these products, particularly triclosan, and emergence of antimicrobial drag resistance (1-3). This study aimed to determine whether home use of antibacterial cleaning and hygiene products (including use of a handwashing soap containing 0.2% triclosan) or other potential risk factors was associated with carriage of antimicrobial drug resistant bacteria on household members' hands. We also assessed the association of these antibacterial products with carriage of organisms with reduced susceptibility to triclosan. Materials and Methods Study Population The data for this study were collected as part of a double-masked and randomized home intervention trial (4); participant enrollment began in October 2000, and follow-up occurred for a 12-month period. The methods and randomization randomization (ranˈ·d  ·m procedures for this study have been reported
elsewhere (5). A total of 238 households were recruited at baseline; 224
households completed the entire 1-year follow-up (Figure 1). The study
was approved by Columbia University Medical Center Columbia University Medical Center is the name of the medical complex associated with Columbia University, and covers several blocks (primarily between 165th and 168th Streets from the Henry Hudson Parkway to Audubon Avenue) in the Washington Heights section of Manhattan. Institutional Review
Board.[FIGURE 1 OMITTED] Intervention Methods Households were supplied with over-the counter, generically repackaged consumer cleaning and personal hygiene personal hygiene person n → Körperhygiene f products free of charge on a monthly or as-needed basis. Households randomly assigned to use antibacterial products received the following: 1) liquid handwashing soap containing 0.2% triclosan, 2) liquid kitchen spray and liquid all-purpose cleaner for hard surfaces that contained a quaternary quaternary /qua·ter·nary/ (kwah´ter-nar?e) 1. fourth in order. 2. containing four elements or groups. qua·ter·nar·y adj. 1. Consisting of four; in fours. ammonium ammonium /am·mo·ni·um/ (ah-mo´ne-um) the hypothetical radical, NH4, forming salts analogous to those of the alkaline metals. ammonium carbonate component, and 3) oxygenated bleach laundry detergent. Households randomly assigned to the nonantibacterial group received the same products but without antibacterial ingredients. Both groups received the same nonantibacterial liquid dishwashing detergent and bars of body soap to control for potential use of other products that might contain antibacterial ingredients. Study participants were required to use only assigned home hygiene products and were asked not to change any of their normal hygiene practices. Participants, interviewers, and study coordinators were blinded to brand names and ingredients in all products. Adherence to product treatment group was assessed monthly, and products were weighed during each visit to monitor compliance. Households were immediately dropped from the study if they did not adhere to adhere to verb 1. follow, keep, maintain, respect, observe, be true, fulfil, obey, heed, keep to, abide by, be loyal, mind, be constant, be faithful 2. randomized treatments. Data Collection At baseline, and quarterly during the 1-year period, a trained interviewer collected demographic information from the person self-identified as the primary caregiver in the household. The baseline interview determined the type of handwashing soap, hygiene, and cleaning products that were used before randomization into the study (i.e., the brand and whether or not the ingredients were labeled as antibacterial). The baseline and quarterly assessment forms provided information such as the number and age of household members, childcare attendance, symptoms of infectious illnesses (fever, diarrhea, sore throat Sore Throat Definition Sore throat, also called pharyngitis, is a painful inflammation of the mucous membranes lining the pharynx. It is a symptom of many conditions, but most often is associated with colds or influenza. , vomiting vomiting, ejection of food and other matter from the stomach through the mouth, often preceded by nausea. The process is initiated by stimulation of the vomiting center of the brain by nerve impulses from the gastrointestinal tract or other part of the body. , conjunctivitis conjunctivitis (kənjəngtəvī`təs), inflammation or infection of the mucosal membrane that covers the eyeball and lines the eyelid, usually acute, caused by a virus or, less often, by a bacillus, an allergic reaction, or an , skin boils, runny nose runny nose Vox populi → medtalk Rhinorrhea ), antimicrobial drug use, chronic diseases, self-rated health, birthplace, travel outside of the United States United States, officially United States of America, republic (2005 est. pop. 295,734,000), 3,539,227 sq mi (9,166,598 sq km), North America. The United States is the world's third largest country in population and the fourth largest country in area. , and occupation. In addition, reported number of handwashes per day by the primary caregiver and a timed observation of the handwash before hand culturing were gathered. The hands of the primary caregiver were cultured during the home visit at baseline and at the end of the 12-month period before and after washing with the assigned liquid handwashing product. The trained data collector used a coin flip to choose the test hand, which was then inserted into a sterile polyethylene bag containing 50 mL culture medium (0.075 mol/L phosphate buffer, pH 7.9, containing 0.1% polysorbate polysorbate /poly·sor·bate/ (pol?e-sor´bat) any of various oleate esters of sorbitol and its anhydrides condensed with polymers of ethylene oxide, numbered to indicate chemical composition and used as surfactant agents. 80). The hand was massaged for 1 min through the wall of the bag containing culture medium. Only postwash samples were used in analyses since they were considered to be representative of normal versus transient flora found on hands. Laboratory Methods The laboratory methods for this study have been described previously (5,6). The microbiologic analysis and antimicrobial drug susceptibility testing susceptibility test Antimicrobial susceptibility test, see there were conducted at New York New York, state, United States New York, Middle Atlantic state of the United States. It is bordered by Vermont, Massachusetts, Connecticut, and the Atlantic Ocean (E), New Jersey and Pennsylvania (S), Lakes Erie and Ontario and the Canadian province of Presbyterian Hospital Presbyterian Hospital can refer to several places:
cocci [L.] plural of coccus. , gram-negative bacteria (GNB GNB Guinea-Bissau (ISO Country code) GNB Good News Bible GNB Group of Notified Bodies GNB Gram-Negative Bacillus GNB Grenoble, France - St Geoirs (Airport Code) GNB Global Networked Business ), Staphylococcus aureus Staphylococcus au·re·us n. A bacterium that causes furunculosis, pyemia, osteomyelitis, suppuration of wounds, and food poisoning. Staphylococcus aureus Staphylococcus pyogenes , and enterococci enterococci bacteria in the genus Enterococcus. . Only clinically important bacterial species that were prevalent (species with [greater than or equal to] 38 isolates recovered at baseline and end of year combined) on the hands of homemakers were selected for susceptibility analyses (7,8). These included the following GNB: Acinetobacter baumannii Acinetobacter baumannii is a species of pathogenic bacteria which forms opportunistic infections.[1] There have been many reports of drug-resistant A. baumannii infections among American soldiers wounded in Iraq. , A. lwoffi, Enterobacter agglomerans, E. cloacae, Klebsiella pneumoniae Klebsiella pneu·mo·ni·ae n. Friedlander's bacillus. , and Pseudomonas Pseudomonas A genus of gram-negative, nonsporeforming, rod-shaped bacteria. Motile species possess polar flagella. They are strictly aerobic, but some members do respire anaerobically in the presence of nitrate. fluorescens/putida; and the following gram-positive staphylococci staph·y·lo·coc·cus n. pl. staph·y·lo·coc·ci A spherical gram-positive parasitic bacterium of the genus Staphylococcus, usually occurring in grapelike clusters and causing boils, septicemia, and other infections. : S. aureus The aureus (pl. aurei) was a gold coin of ancient Rome valued at 25 silver denarii. The aureus was regularly issued from the 1st century BC to the beginning of the 4th century AD, when it was replaced by the solidus. , S. warneri, S. epidermidis, and S. capitis. Therefore, only persons who were carrying at least 1 of these organisms on their hands were included in the final analyses (N = 164 at baseline and N = 201 at year-end). No significant differences were noted between the measured demographic characteristics (Tables 1 and 2 for listing of demographics) among those included in the final analyses versus those excluded (all p>0.10). Bacterial isolates were tested against a panel of antimicrobial agents Antimicrobial agents Chemical compounds biosynthetically or synthetically produced which either destroy or usefully suppress the growth or metabolism of a variety of microscopic or submicroscopic forms of life. by using MicroScan WalkAway 96 SI (Dade Behring, Deerfield, IL, USA). Using the recommendations of the Clinical and Laboratory Standards Institute (formerly NCCLS NCCLS National Committee for Clinical Laboratory Standards ), we classified antimicrobial drug susceptibility as resistant, intermediate, or susceptible to a particular antimicrobial agent (9). Organisms that tested as either resistant or intermediately resistant to antimicrobial agents were classified as "antibiotic resistant" (10). The selection of antimicrobial agents to be tested for each organism was based on clinical applicability of the antimicrobial drug and consistency with earlier studies that examined a link between triclosan and antimicrobial drug resistance (11-14). GNB were tested against several antimicrobial agents, and staphylococci were tested against oxacillin oxacillin /ox·a·cil·lin/ (ok?sah-sil´in) a semisynthetic penicillinase-resistant penicillin used as the sodium salt in infections due to penicillin-resistant, gram-positive organisms. to indicate methicillin methicillin /meth·i·cil·lin/ (meth?i-sil´in) a semisynthetic penicillin highly resistant to inactivation by penicillinase; used as the sodium salt. meth·i·cil·lin n. resistance. For analytic purposes, GNB species were classified as resistant if a given isolate was resistant to [greater than or equal to] 1 antimicrobial agent(s). Triclosan susceptibility was examined at Tufts University School of Medicine The Tufts University School of Medicine is one of the eight schools that comprise Tufts University. Located on the university's health sciences campus in the Chinatown district of Boston, Massachusetts, the medical school has clinical affiliations with thousands of doctors and , Boston, Massachusetts “Boston” redirects here. For other uses, see Boston (disambiguation). Boston is the capital and most populous city of Massachusetts.[3] The largest city in New England, Boston is considered the unofficial economic and cultural center of the entire New , by using a modified NCCLS agar dilution method (10). Minimum inhibitory concentration minimum inhibitory concentration Lab medicine The minimum antibiotic concentration needed to inhibit bacterial growth from a clinical isolate–eg, a bloodborne infection, which is a form of antimicrobial susceptibility testing. Cf Minimum bactericidal concentration. (MIC) was defined as the lowest dilution of triclosan that inhibited visible growth. A detailed description of antimicrobial drug and triclosan testing, including controls used and MIC distribution for each organism, has been described previously (6). Since data from the literature regarding triclosan susceptibility testing are sparse and provide no standardized breakpoints (6), we dichotomized triclosan MIC values for each isolate by using the median MIC as a cutoff, low MIC represents less than or equal to the median value Noun 1. median value - the value below which 50% of the cases fall median statistics - a branch of applied mathematics concerned with the collection and interpretation of quantitative data and the use of probability theory to estimate population and high MIC indicates greater than the median value. Analytic Methods First, chi-square and Student t tests were used to compare demographic characteristics of antibacterial and nonantibacterial users. Next, chi-square tests were used to compare the overall proportion of antimicrobial drug-resistant isolates found on the hands of the antibacterial and nonantibacterial groups. Finally, multivariate The use of multiple variables in a forecasting model. logistic regression analyses were conducted to examine the relationship between antibacterial product use and 2 separate outcome variables: antimicrobial drug resistance (measured by the presence of [greater than or equal to] 1 antimicrobial drug-resistant species on the hand) and increased triclosan MICs (measured by the presence of [greater than or equal to] 1 species exhibiting a triclosan MIC above the median value). Each potential covariate (i.e., characteristics of the household and primary caregiver) and our 2 outcome variables were examined in univariate analyses to establish criteria for inclusion in final multivariate models by using a p value <0.05 as the cutoff. Covariates meeting the cutoff criteria were included in multivariate models along with the main effect of the randomized treatment (i.e., antibacterial versus nonantibacterial product use). Analyses were conducted separately for baseline and after 1 year of study participation. Unadjusted and adjusted odds ratios (OR) and 95% confidence intervals (CIs) were generated from logistic regression analyses by using SPSS A statistical package from SPSS, Inc., Chicago (www.spss.com) that runs on PCs, most mainframes and minis and is used extensively in marketing research. It provides over 50 statistical processes, including regression analysis, correlation and analysis of variance. V.10 (SPSS Inc., Chicago, IL, USA). Results GNB and staphylococci were recovered from 164 participants at baseline and 201 participants at year-end. None of the measured demographic and hygiene characteristics differed significantly between the randomized groups (all p [greater than or equal to] 0.10) (Tables 1 and 2). When comparing isolates from the antibacterial users and nonantibacterial users (Figure 2 and online Appendix Figure, available from http://www.cdc.gov/ncidod/EID/vol11no10/04-1276_app.htm), no significant differences in the proportions of resistance were found in all species combined or within single species (all p>0.05). [FIGURE 2 OMITTED] The odds of carrying [greater than or equal to] 1 antimicrobial drug-resistant strain(s) among antibacterial product users and nonusers were not significant at baseline (OR 0.97, 95% CI 0.50-1.89) or alter 1 year of antibacterial product use (OR 1.33, 95% CI 0.74-2.41) (Table 3). In addition, the odds of carrying [greater than or equal to] 1 organism with high triclosan MIC among antibacterial product users or nonusers were similar at baseline (OR 1.59, 95% CI 0.84-3.01) and at year-end (OR 1.73, 95% CI 0.97-3.09). Individual and Household Characteristics and Susceptibility At baseline, primary caregivers with higher than average CFU CFU see colony-forming units. on their hands were twice as likely to carry antimicrobial drug-resistant organisms (Table 3). A slightly increased risk of carrying antimicrobial drug-resistant organisms occurred among those who washed their hands for a longer duration before the culture sample at baseline (Table 3). However, longer duration of handwashing was not associated with reduced bacterial CFU on hands (OR 1.02, 95% CI 0.99-1.06). At year-end, both the number of times hands were washed per day and the presence of any household member(s) with a healthcare or daycare occupation were significantly associated with reduced carriage of antimicrobial drug-resistant organisms on hands of the primary caregiver (Table 3). Primary caregivers residing in households with members working in healthcare or daycare were significantly more likely to report above-average number of handwashes per day (OR 3.05, 95% CI 1.71-5.44). None of the other characteristics, such as health conditions or antimicrobial drug use, were significantly associated with carriage at baseline or alter 1 year (all p>0.05). Discussion This study is the first randomized intervention study to investigate the relationship between antibacterial cleaning and hygiene product use and antimicrobial drug susceptibility of hand microflora microflora /mi·cro·flo·ra/ (-flor´ah) the microscopic vegetable organisms of a special region. Microflora The bacterial population in the intestine. within the community setting. Our earlier research, conducted among the same study population described here, showed that use of antibacterial hand soap containing 0.2% triclosan was no more beneficial than plain soap in reducing infectious illness symptoms or bacterial counts on bands of household members (4,5,15). Several avenues of research have contributed to the view that use of products containing triclosan may foster the emergence of antimicrobial drug- or biocide-resistant organisms. This concern stems from reports that exposure to triclosan can lead to bacterial target mutations conferring cross-resistance to isoniazid isoniazid (ī'sōnī`əzĭd), drug used to treat tuberculosis. Also known as isonicotinic acid hydrazide, isoniazid is the most effective antituberculosis drug currently available. and selects for mutants bearing resistance to various antimicrobial agents through expression of multidrug-resistant efflux efflux Medtalk That which flows outward pumps (12,16). Our findings suggest that household use of antibacterial cleaning and hygiene products for a 1-year period is not a significant risk factor for increasing antimicrobial drug-resistant organisms on the hands of persons in the home. Few data compare resistance patterns among hand microflora and susceptibility to antibacterial handwashing ingredients. One recent cross-sectional study cross-sectional study n. See synchronic study. cross-sectional study, n the scientific method for the analysis of data gathered from two or more samples at one point in time. (17) reported a higher prevalence of decreased susceptibility to triclosan among methicillin-resistant S. epidermidis compared to methicillin-sensitive S. epidermidis clinical isolates. The findings reported in other cross-sectional studies have mainly examined environmental and clinical isolates of bacteria, and the correlations reported have been inconsistent (11,13,18-20). Other Factors Associated with Antimicrobial Drug Resistance Several hygiene-related factors were significantly associated with carriage, regardless of antibacterial product use. Longer handwashes were slightly associated with increased risk for carriage of antimicrobial drug-resistant species at baseline; as reported previously, these findings may be an artifact A distortion in an image or sound caused by a limitation or malfunction in the hardware or software. Artifacts may or may not be easily detectable. Under intense inspection, one might find artifacts all the time, but a few pixels out of balance or a few milliseconds of abnormal sound of sampling technique (5). The culture was taken directly alter the handwash; an increased duration of the wash may have allowed greater dispersal of bacteria into the culture bag. Primary caregivers residing in households with healthcare or daycare workers had significantly fewer antimicrobial drug--resistant organisms on their hands. This association appears to be influenced by above-average number of handwashes per day by the primary caregiver and indicates that hygiene, regardless of antibacterial ingredients, may reduce household transmission of antimicrobial drug--resistant bacteria. Limitations for Detecting Changes in Resistance A factor that might have attenuated Attenuated Alive but weakened; an attenuated microorganism can no longer produce disease. Mentioned in: Tuberculin Skin Test attenuated having undergone a process of attenuation. the associations found in this study is a higher baseline level of antimicrobial drug resistance in this community. Higher baseline levels would make detecting small changes in susceptibility attributed solely to use of antibacterial cleaning and hygiene products more difficult. Most persons from our study population were from the Dominican Republic Dominican Republic (dəmĭn`ĭkən), republic (2005 est. pop. 8,950,000), 18,700 sq mi (48,442 sq km), West Indies, on the eastern two thirds of the island of Hispaniola. The capital and largest city is Santo Domingo. , a country that provides over-the-counter access to antimicrobial agents. In an earlier study within this same community, antimicrobial agents were taken by 354 (39%) of 911 persons reporting infectious disease Infectious disease A pathological condition spread among biological species. Infectious diseases, although varied in their effects, are always associated with viruses, bacteria, fungi, protozoa, multicellular parasites and aberrant proteins known as prions. symptoms within the previous 30 days, which suggests high levels of use (21). In addition, this study was conducted for a 1-year period and therefore may not adequately reflect the time-course for development of resistance attributable to use of antibacterial products. Changes in antimicrobial drug resistance during the 1-year period might have been lower than the level of detection that this study was statistically powered to identify. This study was designed to detect an OR [greater than or equal to] 2.11 after l year of use, given a power of 80% and a 2-sided [alpha] level of 0.05. Although triclosan susceptibility was examined among various species, we were not able to evaluate potential mechanisms for cross-resistance, such as overexpression of efflux pumps. In addition, when we examined the association between use of antibacterial cleaning and hygiene products and antimicrobial drug resistance, the definition of resistance ([greater than or equal to] 1 organism[s] with antimicrobial drug resistance) did not allow exploration of the potential association with each separate species or antimicrobial drug tested. However, the purpose of our study was to examine overall trends and shifts in antimicrobial drug resistance attributed to the use of antibacterial cleaning and hygiene products, given that the effects of these products in the community are relatively unexplored. Conclusion Currently, no evidence suggests that use of antibacterial soap antibacterial soap A bactericidal agent used to clean the skin–eg, Betadine, pHisoHex containing 0.2% triclosan provides a benefit over plain soap in reducing bacterial counts and rate of infectious symptoms in generally healthy persons in the household setting (4,5,15). Our l-year randomized community intervention study adds to these earlier findings by assessing the potential risks associated with antibacterial product use in the home. The results from our study do not implicate im·pli·cate tr.v. im·pli·cat·ed, im·pli·cat·ing, im·pli·cates 1. To involve or connect intimately or incriminatingly: evidence that implicates others in the plot. 2. use of antibacterial cleaning and hygiene products as an influential factor in carriage of antimicrobial drug resistant bacteria on the hands of household members. Although we did not observe a significant impact on antimicrobial drug resistance during the 1-year period, a longer duration and more extensive use of triclosan might provide a suitable environment for emergence of antimicrobial drug--resistant species in the community setting. Further surveillance for the effect of long-term use of antibacterial cleaning and hygiene products on antimicrobial drug resistance in the community is needed. This study was funded by Home Hygiene Practices and Infection Transmission in Households, 3 R01, NR05251-02s1, funded by National Institute of Nursing Research The National Institute of Nursing Research (NINR), as part of the U.S. National Institutes of Health, supports clinical and basic research to establish a scientific basis for the care of individuals across the life span--from management of patients during illness and recovery, to , National Institutes of Health. Support was also given by the Robert Wood Johnson Robert Wood Johnson was the name shared by members of the family that descended from the President of Johnson & Johnson:
References (1.) Aiello AE, Larson E Antibacterial cleaning and hygiene products as an emerging risk factor for antimicrobial drug resistance in the community. Lancet Infect Dis. 2003;3:501-6. (2.) Levy SB. Antibiotic and antiseptic antiseptic, agent that kills or inhibits the growth of microorganisms on the external surfaces of the body. Antiseptics should generally be distinguished from drugs such as antibiotics that destroy microorganisms internally, and from disinfectants, which destroy resistance: impact on public health. Pediatr Infect Dis J. 2000:19(10 Suppl):S120-2. (3.) Levy SB. Antibacterial household products: cause for concern. Emerg Infect Dis. 2001 ;7(3 Suppl):512-5. (4.) Larson E, Lin, SX, Gomez-Duarte, C, Della-Latta, P. Effect of antibacterial home cleaning and handwashing products on infections disease symptoms. Ann Intern intern /in·tern/ (in´tern) a medical graduate serving in a hospital preparatory to being licensed to practice medicine. in·tern or in·terne n. Med. 2004;140:1-9. (5.) Larson E, Aiello A, Lee LV, Della-Latta P. Gomez-Duarte C, Lin S. Short- and long-term effects of handwashing with antimicrobial or plain soap in the community. J Community Health. 2003;28:139-50. (6.) Aiello AE, Marshall B, Levy SB, Della-Latta P. Larson E. Relationship between triclosan and susceptibilities of bacteria isolated from hands in the community. Antimicrob Agents Chemother. 2004;48:2973-9. (7.) NNIS NNIS National Nosocomial Infection Surveillance System . National Nosocomial Infections Nosocomial infections Infections that were not present before the patient came to a hospital, but were acquired by a patient while in the hospital. Mentioned in: Enterobacterial Infections, Staphylococcal Infections Surveillance (NNIS) System report, data summary from January 1992 through June 2004, issued October 2004. Am J Infect Control. 2004;32:470-85. (8.) Wisplinghoff H, Edmond MB, Pfaller MA, Jones RN, Wenzel RP, Seifert H. Nosocomial nosocomial /noso·co·mi·al/ (nos?o-ko´me-il) pertaining to or originating in a hospital. nos·o·co·mi·al adj. 1. Of or relating to a hospital. 2. bloodstream infections caused by Acinetobacter species in United States hospitals: clinical features, molecular epidemiology molecular epidemiology Molecular medicine An evolving field that combines the tools of standard epidemiology–case studies, questionnaires and monitoring of exposure to external factors with the tools of molecular biology–eg, restriction endonucleases, , and antimicrobial susceptibility. Clin Infect Dis. 2000;31:690-7. (9.) National Committee for Clinical Laboratory Standards, editor. Performance standards for antimicrobial disk susceptibility tests M2-A6. Wayne (PA): The Committee: 1997. (10.) National Committee for Clinical Laboratory Standards. Methods for dilution antimicrobial susceptibility tests for bacteria that grow aerobically. Approved standard- 6th edition. Wayne (PA): The Committee; 2003. (11.) Suller MT, Russell AD. Triclosan and antibiotic resistance antibiotic resistance, n the ability of certain strains of microorganisms to develop resistance to antibiotics. antibiotic resistance in Staphylococcus aureus. J Antimicrob Chemother. 2000;46:11-8. (12.) Schweizer HP. Triclosan: a widely used biocide biocide (bī`əsīd'), synonym for pesticide. and its link to antimicrobial agents. FEMS FEMS Federation of European Microbiological Societies FEMS Federation of European Materials Societies FEMS Fabrication Engineering Management System FEMS Facility Equipment Maintenance System (PMEL/TMDE) Microbiol Lett. 2001;202:1-7. (13.) Cole EC, Addison RM, Rubino JR, Leese KE, Dulaney PD, Newell MS, et al. Investigation of antibiotic and antibacterial agent cross-resistance in target bacteria from homes of antibacterial product users and nonusers. J Appl Microbiol. 2003;95:664-76. (14.) Chuanchuen R, Beinlich K, Hoang TT, Becher A, Karkhoff-Schweizer RR, Schweizer HP. Cross-resistance between triclosan and antimicrobial agents in Pseudomonas aeruginosa Pseudomonas aeruginosa A normal soil inhabitant and human saprophyte that may contaminate various solutions in a hospital, causing opportunistic infection in weakened Pts Clinical Infective endocarditis in IVDAs, RTIs, UTIs, bacteremia, meningitis, 'malignant' is mediated by multidrug efflux pumps: exposure of a susceptible mutant strain to triclosan selects nfxB mutants overexpressing MexCD-OprJ. Antimicrob Agents Chemother. 2001:45:428-32. (15.) Aiello AE, Lee LV, Della-Latta P, Lin S, Larson E. Types of microbial microbial pertaining to or emanating from a microbe. microbial digestion the breakdown of organic material, especially feedstuffs, by microbial organisms. flora on hands of subjects and an environmental surface in homes randomized to antimicrobial or non-antimicrobial cleaning and hygiene products. In: IDSA IDSA Infectious Diseases Society of America IDSA Industrial Designers Society of America IDSA Interactive Digital Software Association IDSA Institute for Defense Studies and Analyses (India) IDSA International Dark Sky Association , editor. 40th annual meeting of the infectious disease society of America. Chicago (IL): Infectious Disease Society of America; 2002. (16.) Chuanchuen R, Karkhoff-Schweizer RR, Schweizer HP. High-level triclosan resistance in Pseudomonas aeruginosa is solely a result of efflux. Am J Infect Control. 2003:31:124-7. (17.) Schmid MB, Kaplan N. Reduced triclosan susceptibility in methicillin-resistant Staphylococcus epidermidis Staphylococcus epidermidis Microbiology A coagulase-negative staphylococcus that comprises up to 80% of clinical isolates Infections by S epidermidis . Antimicrob Agents Chemother. 2004;48:1397-9. (18.) Cookson BD, Farrelly H, Stapleton P, Garvey RP, Price MR. Transferable resistance to triclosan in MRSA MRSA Methicillin-resistant Staphylococcus aureus. See MARSA. . Lancet. 1991;337:1548-9. (19.) Bamber AI, Neal TJ. An assessment of triclosan susceptibility in methicillin-resistant and methicillin-sensitive Staphylococcus aureus. J Hosp Infect. 1999;41:107-9. (20.) Lear JC, Maillard JY, Dettmar PW, Goddard PA, Russell AD. Chloroxylenol- and triclosan-tolerant bacteria from industrial sources. J Ind Microbiol Biotechnol. 2002;29:238-42. (21.) Larson E, Lin SX, Gomez-Duarte C. Antibiotic use in Hispanic households, New York City New York City: see New York, city. New York City City (pop., 2000: 8,008,278), southeastern New York, at the mouth of the Hudson River. The largest city in the U.S. . Emerg Infect Dis. 2003;9:1096-102. Allison E. Aiello, * Bonnie bon·ny also bon·nie adj. bon·ni·er, bon·ni·est Scots 1. Physically attractive or appealing; pretty. 2. Excellent. Marshall, ([dagger]) Stuart B. Levy, ([dagger]) Phyllis Della-Latta, ([double dagger double dagger n. A reference mark (  ) used in printing and writing. Also called diesis.Noun 1. ]) Susan X. Lin, ([double dagger]) and Elaine Larson ([double dagger]) * University of Michigan (body, education) University of Michigan - A large cosmopolitan university in the Midwest USA. Over 50000 students are enrolled at the University of Michigan's three campuses. The students come from 50 states and over 100 foreign countries. School of Public Health, Ann Arbor, Michigan  “Ann Arbor” redirects here. For other uses, see Ann Arbor (disambiguation). Ann Arbor is a city in the U.S. state of Michigan and the county seat of Washtenaw County. , USA; ([dagger]) Tufts University School of Medicine, Boston, Massachusetts, USA; and ([double dagger]) Columbia University, New York, New York, USA A.E. Aiello conceived the aims of the study, conducted the statistical analyses, and wrote the manuscript; B. Marshall, S. B. Levy, and P. Della-Latta conducted the clinical testing of the samples and contributed to the concepts and writing of the manuscript; S. Lin aided in the data management and provided statistical consultation and review of the manuscript; and E. Larson created the home hygiene study design and contributed to the concepts and writing of the manuscript. At the time of this writing, Dr Aiello was a Robert Wood Johnson Health & Society Scholar in the Department of Epidemiology, Center for Social Epidemiology & Population Health, at the University of Michigan School of Public Health. She is now an Assistant Professor of Epidemiology at that center. Her research interests include antimicrobial drug and antibacterial resistance within the community and clinical setting, multidisciplinary approaches for examining antimicrobial drug resistance, and life-course socioeconomic determinants of infectious diseases. Address for correspondence: Allison E. Aiello, Robert Wood Johnson Health & Society Scholar, Center for Social Epidemiology & Population Health, University of Michigan, School of Public Health, 1214 S. University, Ann Arbor Ann Arbor, city (1990 pop. 109,592), seat of Washtenaw co., S Mich., on the Huron River; inc. 1851. It is a research and educational center, with a large number of government and industrial research and development firms, many in high-technology fields such as , MI 48104-2548; fax: 734-998-0006: email: aielloa@umicb.edu
Table 1. Proportion of all study participants
with baseline characteristics
Nonantibacterial
groups ([dagger])
Characteristics * (N = 118), %
Primary caregiver
Male primary caregivers 4.2
Caregivers born outside of United States 94.1
Caregivers with high CFU counts on 35.8
hands ([double dagger])
Household
Antibacterial cleaning and hygiene 41.5
products used prebaseline
Characteristics reported for
[greater than or equal to] 1 members
of the household
Child in daycare 15.9
Chronic illness 39.0
Chronic illness or fair to poor health 61.0
Symptoms of infection in past 30 days 54.2
Use of antimicrobial agents in past 11.9
30 days ([section])
Traveled outside United States in 12.8
past month
Healthcare or daycare occupation 41.0
Antibacterial
groups ([dagger])
Characteristics * (N = 120), %
Primary caregiver
Male primary caregivers 42
Caregivers born outside of United States 98.3
Caregivers with high CFU counts on 39.4
hands ([double dagger])
Household
Antibacterial cleaning and hygiene 40.0
products used prebaseline
Characteristics reported for
[greater than or equal to] 1 members
of the household
Child in daycare 17.8
Chronic illness 37.0
Chronic illness or fair to poor health 55.8
Symptoms of infection in past 30 days 54.2
Use of antimicrobial agents in past 11.7
30 days ([section])
Traveled outside United States in 12.5
past month
Healthcare or daycare occupation 45.0
* No significant differences in demographic characteristics between
persons with or without available cultures or between participants
with or without gram-negative bacteria or staphylococci of interest
were noted in this study (all p>0.10).
([dagger]) No significant differences between the antibacterial and
nonantibacteria I users in any of the characteristics measured were
noted (all p>0.05).
([double dagger]) Culture information was not available at baseline
for 20 study participants. High counts were determined by whether
the participant had a CFU above the mean for the entire group.
([section]) Information on use of antimicrobial agents use was only
gathered from study participants reporting infectious symptoms.
Therefore, all persons reporting no infectious symptoms were
coded as having "no reported antibiotic use."
Table 2. Mean values for baseline or year-end
characteristics of study participants
Nonanti- Anti-
bacterial bacterial
group * group *
(N = 118) (N = 120)
Characteristic Mean SD Mean SD
Primary caregiver
Age (y) of primary caregiver (baseline) 34.6 10.0 33 8.1
No. of daily washes (reported)
Baseline 13.3 9.8 11.6 7.1
End of year 11.6 6.3 10.3 5.1
Length(s) of handwash (observed)
Baseline 15.5 9.4 16.4 9.7
End of year 18.7 8.3 18.5 8.3
Household
Age (y) of all household members 20.1 4.9 20.0 5.9
combined (baseline)
No. of children [less than or equal to] 1.5 0.6 1.5 0.7
5 y in home (baseline)
No of persons in household (baseline) 5.0 1.5 5.0 1.8
* No significant differences were observed between
the antibacterial and non antibacterial product
users in any of the characteristics measured
(all p>0.05).
Table 3. Logistic regression models for examining factors
associated with carriage of organisms with antimicrobial
resistance or increased triclosan MICs *
Outcome 1 ([greater than or equal to] 1
organism with resistance to antimicrobial
agents on hand) OR
Baseline characteristics (N = 164)
Antibacterial product use in
household ([double dagger]) 1.16
Observed no. of seconds for handwash
by primary caregiver 1.05
Above average log total CFU on hands
of primary caregiver after handwash 2.06
Reported no. of hands washes per day
for primary caregiver 1.01
[greater than or equal to] 1 household
members with job in healthcare or daycare 1.28
Year-end characteristics (N = 201)
Antibacterial product use in
household ([double dagger]) 1.44
Observed no. of seconds for handwash
by primary caregiver 1.00
Above average log total CFU on hands
of primary caregiver after handwash 0.62
Reported no. of hands washes per day
for primary caregiver 0.94
[greater than or equal to] 1 household
members with job in healthcare or daycare 0.51
Outcome 2 ([greater than or equal to] 1
organism with increased triclosan MIC on hand)
Baseline (N = 164)
Antibacterial product use in household
([double dagger]) 1.59
Year-end (N = 201)
Antibacterial product use in household 1.73
Outcome 1 ([greater than or equal to] 1
organism with resistance to antimicrobial
agents on hand) 95% CI, p value
Baseline characteristics (N = 164)
Antibacterial product use in
household ([double dagger]) 0.62-2.17, 0.63
Observed no. of seconds for handwash
by primary caregiver 1.01-1.09, 0.01
Above average log total CFU on hands
of primary caregiver after handwash 1.08-3.93, 0.03
Reported no. of hands washes per day
for primary caregiver 0.97-1.04, 0.74
[greater than or equal to] 1 household
members with job in healthcare or daycare 0.68-2.40, 0.44
Year-end characteristics (N = 201)
Antibacterial product use in
household ([double dagger]) 0.82-2.52, 0.20
Observed no. of seconds for handwash
by primary caregiver 0.97-1.04, 0.91
Above average log total CFU on hands
of primary caregiver after handwash 0.35-1.98, 0.09
Reported no. of hands washes per day
for primary caregiver 0.89-0.99, 0.04
[greater than or equal to] 1 household
members with job in healthcare or daycare 0.29-0.90, 0.02
Outcome 2 ([greater than or equal to] 1
organism with increased triclosan MIC on hand)
Baseline (N = 164)
Antibacterial product use in household
([double dagger]) 0.84-3.01, 0.16
Year-end (N = 201)
Antibacterial product use in household 0.97-3.09, 0.06
Outcome 1 ([greater than or equal to] 1
organism with resistance to antimicrobial aOR
agents on hand) ([dagger])
Baseline characteristics (N = 164)
Antibacterial product use in
household ([double dagger]) 0.97
Observed no. of seconds for handwash
by primary caregiver 1.05
Above average log total CFU on hands
of primary caregiver after handwash 1.81
Reported no. of hands washes per day
for primary caregiver --
[greater than or equal to] 1 household
members with job in healthcare or daycare --
Year-end characteristics (N = 201)
Antibacterial product use in
household ([double dagger]) 1.33
Observed no. of seconds for handwash
by primary caregiver --
Above average log total CFU on hands
of primary caregiver after handwash --
Reported no. of hands washes per day
for primary caregiver 0.95
[greater than or equal to] 1 household
members with job in healthcare or daycare 0.52
Outcome 2 ([greater than or equal to] 1
organism with increased triclosan MIC on hand)
Baseline (N = 164)
Antibacterial product use in household
([double dagger]) --
Year-end (N = 201)
Antibacterial product use in household --
Outcome 1 ([greater than or equal to] 1
organism with resistance to antimicrobial
agents on hand) 95% CI, p value
Baseline characteristics (N = 164)
Antibacterial product use in
household ([double dagger]) 0.50-1.89, 0.91
Observed no. of seconds for handwash
by primary caregiver 1.01-1.09, 0.01
Above average log total CFU on hands
of primary caregiver after handwash 0.93-3.52, 0.08
Reported no. of hands washes per day
for primary caregiver --
[greater than or equal to] 1 household
members with job in healthcare or daycare --
Year-end characteristics (N = 201)
Antibacterial product use in
household ([double dagger]) 0.74-2.41, 0.34
Observed no. of seconds for handwash
by primary caregiver --
Above average log total CFU on hands
of primary caregiver after handwash --
Reported no. of hands washes per day
for primary caregiver 0.89-1.01, 0.10
[greater than or equal to] 1 household
members with job in healthcare or daycare 0.29-0.95, 0.04
Outcome 2 ([greater than or equal to] 1
organism with increased triclosan MIC on hand)
Baseline (N = 164)
Antibacterial product use in household
([double dagger]) --
Year-end (N = 201)
Antibacterial product use in household --
* OR, odds ratio; CI, confidence interval; aOR, adjusted
odds ratio.
([dagger]) OR adjusted for all variables that were
significant univariate analyses at p<0.05.
([double dagger]) Prior reported antibacterial product
use was controlled for but did not have any effect on
the point estimate. Therefore, "group" point estimates
reflect use of antibacterial product after randomization.
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