Acquired resistance to chlorhexidine – is it time to establish an “antiseptic stewardship” initiative?

• Published in: The Journal of hospital infection Vol. 94; no. 3; pp. 213 - 227
• Main Author: Kampf, Günter
• Format: Journal Article
• Language: English
• Published: England Elsevier Ltd 01.11.2016
• Subjects: Anti-Infective Agents, Local - pharmacology; Antisepsis - methods; Antisepsis - standards; Antiseptic stewardship; Bacteria - drug effects; Chlorhexidine; Chlorhexidine - pharmacology; Cross-resistance; Drug Resistance, Bacterial; Drug Utilization - standards; Exposure; Infectious Disease; Microbial Sensitivity Tests; Resistance; Selection pressure; chlorhexidine; exposure; selection pressure; cross resistance; resistance; antiseptic stewardship; Resistance; Selection pressure; Chlorhexidine; Exposure; Antiseptic stewardship; Cross-resistance
• ISSN: 0195-6701; 1532-2939
• DOI: 10.1016/j.jhin.2016.08.018

Summary Chlorhexidine digluconate (CHG) is an antimicrobial agent used for different types of applications in hand hygiene, skin antisepsis, oral care and patient washing. Increasing use raises concern on a development of acquired bacterial resistance. Published data from clinical isolates with CHG MICs were reviewed and compared to epidemiological cut-off values to determine resistance. CHG resistance is rarely found in E. coli , Salmonella spp., S. aureus and CNS. In Enterobacter spp., Pseudomonas spp., Proteus spp., Providencia spp. and Enterococcus spp., however, isolates are more often CHG resistant. CHG resistance can be detected in multi-resistant isolates such as XDR K. pneumoniae . Isolates with a higher MIC are often less susceptible to CHG for disinfection. Although cross-resistance to antibiotics remains controversial some studies indicate that the overall exposure to CHG increases the risk for resistance to some antibiotic agents. Resistance to CHG has resulted in numerous outbreaks and healthcare-associated infections. On an average intensive care unit most of the CHG exposure would be explained by hand hygiene agents when liquid soaps or alcohol-based hand rubs contain CHG. Exposure to sublethal CHG concentration can enhance resistance in Acinetobacter spp., K. pneumoniae and Pseudomonas spp., all species well known for emerging antibiotic resistance. In order to reduce additional selection pressure in nosocomial pathogens it seems to make sense to restrict the valuable agent CHG to those indications with a clear patient benefit and to eliminate it from applications without any benefit or with a doubtful benefit.