Effects of Extended Storage of Chlorhexidine Gluconate and Benzalkonium Chloride Solutions on the Viability of Burkholderia cenocepacia
1
조회
0
다운로드
1
인용
0
참고문헌
키워드
초록
Chlorhexidine gluconate (CHX) and benzalkonium chloride (BZK) formulations are frequently used as antiseptics in healthcare and consumer products. Burkholderia cepacia complex (BCC) contamination of pharmaceutical products could be due to the use of contaminated water in the manufacturing process, over-diluted antiseptic solutions in the product, and the use of outdated products, which in turn reduces the antimicrobial activity of CHX and BZK. To establish a “safe use” period following opening containers of CHX and BZK, we measured the antimicrobial effects of CHX (2-10 μg/ml) and BZK (10-50 μg/ml) at sublethal concentrations on six strains of Burkholderia cenocepacia using chemical and microbiological assays. CHX (2, 4, and 10 μg/ml) and BZK (10, 20, and 50 μg/ml) stored for 42 days at 23°C showed almost the same concentration and toxicity compared with freshly prepared CHX and BZK on B. cenocepacia strains. When 5 μg/ml CHX and 20 μg/ml BZK were spiked to six B. cenocepacia strains with different inoculum sizes (100 -105 CFU/ml), their toxic effects were not changed for 28 days. B. cenocepacia strains in diluted CHX and BZK were detectable at concentrations up to 102 CFU/ml after incubation for 28 days at 23°C. Although abiotic and biotic changes in the toxicity of both antiseptics were not observed, our results indicate that B. cenocepacia strains could remain viable in CHX and BZK for 28 days, which in turn, indicates the importance of control measures to monitor BCC contamination in pharmaceutical products.
Abstract
Chlorhexidine gluconate (CHX) and benzalkonium chloride (BZK) formulations are frequently used as antiseptics in healthcare and consumer products. Burkholderia cepacia complex (BCC) contamination of pharmaceutical products could be due to the use of contaminated water in the manufacturing process, over-diluted antiseptic solutions in the product, and the use of outdated products, which in turn reduces the antimicrobial activity of CHX and BZK. To establish a “safe use” period following opening containers of CHX and BZK, we measured the antimicrobial effects of CHX (2-10 μg/ml) and BZK (10-50 μg/ml) at sublethal concentrations on six strains of Burkholderia cenocepacia using chemical and microbiological assays. CHX (2, 4, and 10 μg/ml) and BZK (10, 20, and 50 μg/ml) stored for 42 days at 23°C showed almost the same concentration and toxicity compared with freshly prepared CHX and BZK on B. cenocepacia strains. When 5 μg/ml CHX and 20 μg/ml BZK were spiked to six B. cenocepacia strains with different inoculum sizes (100 -105 CFU/ml), their toxic effects were not changed for 28 days. B. cenocepacia strains in diluted CHX and BZK were detectable at concentrations up to 102 CFU/ml after incubation for 28 days at 23°C. Although abiotic and biotic changes in the toxicity of both antiseptics were not observed, our results indicate that B. cenocepacia strains could remain viable in CHX and BZK for 28 days, which in turn, indicates the importance of control measures to monitor BCC contamination in pharmaceutical products.
참고문헌 (56)
- Gnanadhas DP, "Biocides - resistance, cross-resistance mechanisms and assessment", Expert Opin. Investig. Drugs, 22, pp.191~206 (2013)
- Gilbert P, "Cationic antiseptics: diversity of action under a common epithet", J. Appl. Microbiol, 99, pp.703~715 (2005)
- Weber DJ, "Outbreaks associated with contaminated antiseptics and disinfectants", Antimicrob. Agents Chemother, 51, pp.4217~4224 (2007)
- D’Arcy PF, "Quaternary ammonium compounds in medicinal chemistry. I", J. Pharm. Pharmacol, 14, pp.129~146 (1962)
- D’Arcy PF, "Quaternary ammonium compounds in medicinal chemistry. II", J. Pharm. Pharmacol, 14, pp.193~216 (1962)
- Dabbah R, "The use of preservatives in compendial articles", Pharmacopeial Forum, 22, pp.2696~2704 (1996)
- Brambilla E, "Chlorhexidine concentration in saliva after topical treatment with an antibacterial dental varnish", Am. J. Dent, 17, pp.196~198 (2004)
- Russell AD., "Biocide use and antibiotic resistance: the relevance of laboratory findings to clinical and environmental situations", Lancet Infect. Dis, 3, pp.794~803 (2003)
- Tandukar M, "Long-term exposure to benzalkonium chloride disinfectants results in change of microbial community structure and increased antimicrobial resistance", Environ. Sci. Technol, 47, pp.9730~9738 (2013)
- To MS, "Postadaptational resistance to benzalkonium chloride and subsequent physicochemical modifications of Listeria monocytogenes", Appl. Environ. Microbiol, 68, pp.5258~5264 (2002)
- Mahenthiralingam E, "The multifarious, multireplicon Burkholderia cepacia complex", Nat. Rev. Microbiol, 3, pp.144~156 (2005)
- Govan JRW, "Burkholderia cepacia: medical, taxonomic and ecological issues", J. Med. Microbiol, 45, pp.395~407 (1996)
- Mahenthiralingam E, "Taxonomy and pathogenesis of the Burkholderia cepacia complex", Chron. Respir. Dis, 2, pp.209~217 (2005)
- Dixon RE, "Aqueous quaternary ammonium antiseptics and disinfectants - use and misuse", J. Am. Med. Assoc, 236, pp.2415~2417 (1976)
- "Enforcement report - week of March 20, 2013" (2013)[URL]
- Fox JG, "Nosocomial transmission of Serratia marcescens in a veterinary hospital due to contamination by benzalkonium chloride", J. Clin. Microbiol, 14, pp.157~160 (1981)
- Guinness M, "Contamination of aqueous dilutions of resiguard disinfectant with Pseudomonas", Med. J. Aust, 2, pp.392~392 (1976)
- Kaslow RA, "Nosocomial pseudobacteremia. Positive blood cultures due to contaminated benzalkonium antiseptic", J. Am. Med. Assoc, 236, pp.2407~2409 (1976)
- Lee JC, "Benzalkonium chloride - source of hospital infection with gram-negative bacteria", J. Am. Med. Assoc, 177, pp.708~710 (1961)
- Malizia WF, "Benzalkonium chloride as a source of infection", N. Engl. J. Med, 263, pp.800~802 (1960)
- Nakashima AK, "Epidemic septic arthritis caused by Serratia marcescens and associated with a benzalkonium chloride antiseptic", J. Clin. Microbiol, 25, pp.1014~1018 (1987)
- Nasser RM, "Outbreak of Burkholderia cepacia bacteremia traced to contaminated hospital water used for dilution of an alcohol skin antiseptic", Infect. Control Hosp. Epidemiol, 25, pp.231~239 (2004)
- Plotkin SA, "Bacteremia caused by Pseudomonas sp. following the use of materials stored in solutions of a cationic surface active agent", Am. J. Med. Sci, 235, pp.621~627 (1958)
- Sautter RL, "Serratia marcescens meningitis associated with a contaminated benzalkonium chloride solution", Infect. Control Hosp. Epidemiol, 5, pp.223~225 (1984)
- Sobel JD, "Nosocomial Pseudomonas cepacia infection associated with chlorhexidine contamination", Am. J. Med, 73, pp.183~186 (1982)
- Tiwari TSP, "Forty years of disinfectant failure:outbreak of postinjection Mycobacterium abscessus infection caused by contamination of benzalkonium chloride", Clin. Infect. Dis, 36, pp.954~962 (2003)
- "Multistate outbreak of Burkholderia cepacia bloodstream infections associated with contaminated prefilled saline flush syringes" (2017)[URL]
- "FDA updates on multistate outbreak of Burkholderia cepacia infections" (2016)[URL]
- LiPuma JJ, "Disproportionate distribution of Burkholderia cepacia complex species and transmissibility markers in cystic fibrosis", Am. J. Respir. Crit. Care Med, 164, pp.92~96 (2001)
- Reik R, "Distribution of Burkholderia cepacia complex species among isolates recovered from persons with or without cystic fibrosis", J. Clin. Microbiol, 43, pp.2926~2928 (2005)
- Shehabi AA, "Investigation of Burkholderia cepacia nosocomial outbreak with high fatality in patients suffering from diseases other than cystic fibrosis", Scand. J. Infect. Dis, 36, pp.174~178 (2004)
- Kim JM, "Survival and susceptibility of Burkholderia cepacia complex in chlorhexidine gluconate and benzalkonium chloride", J. Ind. Microbiol. Biotechnol, 42, pp.905~913 (2015)
- Rose H, "Biocide susceptibility of the Burkholderia cepacia complex", J. Antimicrob. Chemother, 63, pp.502~510 (2009)
- Vigeant P, "An outbreak of Serratia marcescens infections related to contaminated chlorhexidine", Infect. Control Hosp. Epidemiol, 19, pp.791~794 (1998)
- Ahn Y, "Evaluation of liquid and solid culture media for the recovery and enrichment of Burkholderia cenocepacia from distilled water", J. Ind. Microbiol. Biotechnol, 41, pp.1109~1118 (2014)
- Ahn Y, "Intrinsic resistance of Burkholderia cepacia complex to benzalkonium chloride", MBio, 7, pp.e01716~ (2016)
- Hajaya MG, "Fate and effect of benzalkonium chlorides in a continuous-flow biological nitrogen removal system treating poultry processing wastewater", Bioresour. Technol, 118, pp.73~81 (2012)
- Hazan R, "A method for high throughput determination of viable bacteria cell counts in 96-well plates", BMC Microbiol, 12, pp.259~ (2012)
- Cassidy MB, "A comparison of enumeration methods for culturable Pseudomonas fluorescens cells marked with green fluorescent protein", J. Microbiol. Methods, 40, pp.135~145 (2000)
- "Expiration dating and stability testing for human drug products" (2015)[URL]
- Dolby J, "Stability of chlorhexidine when autoclaving", Pharm. Acta Helv, 47, pp.615~620 (1972)
- Franck M, "Degradation of chlorhexidine in antacid suspensions - a novel approach to describe degradation kinetics", Eur. J. Pharm. Biopharm, 39, pp.19~24 (1993)
- Zong Z, "Studies on the instability of chlorhexidine, part I: kinetics and mechanisms", J. Pharm. Sci, 101, pp.2417~2427 (2012)
- Das R, "Remediation of antiseptic components in wastewater by photocatalysis using TiO2 nanoparticles", Ind. Eng. Chem. Res, 53, pp.3012~3020 (2014)
- Rucker RR, "An investigation of the bactericidal action and fish toxicity of two homologous series of quaternary ammonium compounds", J. Bacteriol, 57, pp.225~234 (1949)
- Jovovic M, "Investigation of tropicamide and benzalkonium chloride stability using liquid chromatography", J. Liq. Chromatogr. Relat. Technol, 35, pp.231~239 (2012)
- Parhizkari G, "A stability indicating HPLC method for the determination of benzalkonium chloride in 0.5 percent tramadol ophthalmic solution", Chromatographia, 40, pp.155~158 (1995)
- Parhizkari G, "A stability indicating HPLC method for the determination of benzalkonium chloride in phenylephrine HCl 10 percent ophthalmic solution", J. Liq. Chromatogr, 18, pp.553~563 (1995)
- Cheriaa J, "Phenotypic stress response of Pseudomonas aeruginosa following culture in water microcosms", J. Water Health, 10, pp.130~139 (2012)
- Goh EB, "Transcriptional modulation of bacterial gene expression by subinhibitory concentrations of antibiotics", Proc. Natl. Acad. Sci. USA, 99, pp.17025~17030 (2002)
- Ramos JL, "Responses of gramnegative bacteria to certain environmental stressors", Curr. Opin. Microbiol, 4, pp.166~171 (2001)
- Chen HY, "Mechanisms of resistance to beta-lactam antibiotics amongst Pseudomonas aeruginosa isolates collected in the UK in 1993", J. Med. Microbiol, 43, pp.300~309 (1995)
- Jung JY, "Improved high-quality draft genome sequence and annotation of Burkholderia contaminans LMG 23361T", Genome Announc, 5, pp.e00245~e00217 (2017)
- Ong HS, "Comparative genome sequence analysis reveals the extent of diversity and conservation for glycan-associated proteins in Burkholderia spp", Comp. Funct. Genomics, 2012, pp.752867~ (2012)
- Guglierame P, "Efflux pump genes of the resistance nodulation division family in Burkholderia cenocepacia genome", BMC Microbiol, 6, pp.66~ (2006)
- Kido Y, "Microbial degradation of disinfectants. II. Complete degradation of chlorhexidine", Eisei Kagaku, 34, pp.97~101 (1988)
