Multiresistente Erreger – Sind sie auch resistent gegenüber Desinfektionsmitteln?

Epidemiologische Studien zeigen, dass die Versorgung von Patientinnen und Patienten in Zimmern mit vorherigem Aufenthalt einer Person mit Nachweis multiresistenter Erreger (MRE) mit einem erhöhten Risiko des Auftretens dieser Erreger assoziiert ist. Deshalb stellt sich regelmäßig die Frage, ob MRE auch eine Resistenz gegenüber den eingesetzten Desinfektionsmitteln aufweisen. Dieser Artikel gibt einen Überblick über den aktuellen Stand zu dieser Frage.

Abstract

Epidemiological studies show that the care of patients in rooms with a previous stay by a person with evidence of multi-resistant pathogens (MRP) is associated with an increased risk of these pathogens occurring. The question therefore regularly arises as to whether MRP also exhibit resistance to the disinfectants used. To date, there are no standardised definitions for “resistance” to disinfectants. However, disinfectants authorised on the market are also effective against multi-resistant pathogens and the failure of efficient disinfection is mainly caused by application errors (insufficient cleaning, incomplete wetting, incorrect application concentration or exposure time etc.). The effectiveness of disinfectants depends on a variety of environmental factors (especially accompanying contamination). A reduced sensitivity to disinfectants can occur in individual isolates due to selection under sub-inhibitory concentrations of disinfectants. Resistance mechanisms to antibiotics do not mediate cross-resistance to disinfectants, but a change in the permeability of bacterial cells can influence sensitivity to disinfectants and antibiotics. In general, the success of routine disinfection can be improved by suitable process controls and contribute to reducing the transmission of MRP.

Kernaussagen

• Die Wirksamkeit von auf dem Markt zugelassenen Desinfektionsmitteln ist in der Regel auch bei multiresistenten Erregern gegeben.

• Die Wirksamkeit von Desinfektionsmitteln hängt von einer Vielzahl von Umweltfaktoren ab (insbesondere begleitende Verschmutzung).

• Eine verminderte Empfindlichkeit gegenüber Desinfektionsmitteln kann in einzelnen Isolaten durch Selektion unter subinhibitorischen Konzentrationen von Desinfektionsmitteln auftreten.

• Resistenzmechanismen gegenüber Antibiotika vermitteln keine Kreuzresistenz gegen Desinfektionsmittel, jedoch kann eine Permeabilitätsänderung bakterieller Zellen die Empfindlichkeit gegen Desinfektionsmittel und Antibiotika beeinflussen.

• Es existieren bisher keine einheitlichen Definitionen für „Resistenz“ gegenüber Desinfektionsmitteln.

• Das Versagen einer effizienten Desinfektion wird überwiegend durch Anwendungsfehler verursacht (nicht ausreichende Reinigung, nicht vollständige Benetzung, falsche Anwendungskonzentration bzw. Einwirkzeit usw.).

• Der Erfolg von Desinfektionsmaßnahmen kann durch geeignete Prozesskontrollen verbessert werden und zur Verringerung der Übertragung von MRE beitragen.

Schlüsselwörter

Desinfektionsmittel - Resistenz - Toleranz - Umweltkontamination

Keywords

disinfectants - resistance - tolerance - environmental contamination

Publication History

Article published online:
09 September 2024

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