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Antibiotic & Antibacterial Resistance of Skin Bacteria from Users & Non-Users of Antibacterial Wash Products

Antibiotic & Antibacterial Resistance of Skin Bacteria from Users & Non-Users of Antibacterial Wash Products. Eugene C. Cole, DrPH Brigham Young University Provo, Utah. Organization. Study conducted through cooperative efforts of two applied research organizations:

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Antibiotic & Antibacterial Resistance of Skin Bacteria from Users & Non-Users of Antibacterial Wash Products

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  1. Antibiotic & Antibacterial Resistance of Skin Bacteria from Users & Non-Users of Antibacterial Wash Products Eugene C. Cole, DrPH Brigham Young University Provo, Utah

  2. Organization • Study conducted through cooperative efforts of two applied research organizations: • Applied Environmental, Inc., Cary, NC • Restoration Sciences, LLC, Cary, NC • Study sponsored by: • The Soap and Detergent Association, Washington, DC

  3. Objective • Investigate relationship between antibiotic and antibacterial resistance in human skin bacteria: • Staphylococcus aureus • Coagulase-negative Staphylococcus sp. • Isolated from forearm skin of persons routinely using or not using body washes and bath soaps containing, exclusively, either: triclosan or triclocarban.

  4. Summary • These study results discount the speculative claim that the use of antibacterial wash products contribute to the selection and propagation of drug-resistant bacteria on human skin.

  5. Approach • Randomized study with 210 qualified male and female participants >18 years • 70 that frequently use body wash products containing only Triclosan (TCS) • 70 that frequently use body wash products containing only Triclocarban(TCC) • 70 that frequently wash, but do not use any antibacterial body wash products (Controls)

  6. Approach • Users were defined as those using TCC or TCS wash products on a regular basis during the last 30 days for body washing. • Exclusion criteria disqualified persons from participating: • Antibiotic therapy within last 90 days • Use of topical skin medications, medicated shampoos, anti-acne products • Employment in health care, day-care, or animal care • Frequent swimmer or hot tub user • Routine exposure to solvents

  7. Approach • Home visits confirmed qualification • Forearm skin samples were collected: • Composite swab sample of both forearms, using a 4 x 16 cm (64 cm2 template) • Lab processing by elution, plating on SBA and incubation for 18-24 hours at 37º C • Colonies selected by criteria: morphology, pigmentation, texture, hemolysis, etc • Presumptive ID by gram stain, catalase, coagulase • Confirmation by reference laboratory

  8. Approach • Antibiotic susceptibility performed by: • Standard MIC testing using MicroScan method • Testing conducted by LabCorp, NC • Antibacterial susceptibility performed by: • Standard broth micro-dilution method (Barry et al, 1999), adapted from NCCLS method M7-A4 (NCCLS, 1997) • All isolates tested against TCC and TCS • All results verified through appropriateQA procedures and microorganism control strains

  9. Standard Antibiotic Susceptibility Panel: Ampicillin Ciprofloxacin Clindamycin Erythromycin Nitrofurantoin Oxacillin Penicillin Tetracycline TMP/SMX Vancomycin Approach

  10. Results • 317 Staphylococcus isolates • 301 CNS isolates • Non-users (n = 106) • TCC users (n = 102 • TCS users (n = 93) • 16 SA isolates • Non-users (n = 4) • TCC users (n = 7) • TCS users (n = 5)

  11. Results • No isolates showed full or intermediate resistance to vancomycin • S. aureus - MRSA • Rates of resistance to oxacillin was less than reported rates for hospital-acquired and community-acquired MRSA: • 12.5% • 20.2% (Fridkin et al, 2002) • 50.0% (Tiemersma et al, 2004)

  12. Results • CNS - MR • Rates of resistance to oxacillin was less than reported rates for hospital-acquired and community-acquired MR-CNS: • 20.6% • 43.6% (Fridkin et al, 2002) • 73.3% (DUMC, 2005)

  13. Results • MRSA • NU = 25.0% (1/4) • TCC = 0.0% (0/7) • TCS = 20.0% (1/5) • MR-CNS • NU = 17.9% (19/106) • TCC = 23.5% (24/102) • TCS = 20.4% (19/93)

  14. Results • Antibiotic Resistance - SA • Distribution across all 10 drugs showed no significant differences among groups, even when TCC and TCS data were pooled and compared with NU results. • Distribution across the 6 preferred drugs showed no significant differences among groups, even when TCC and TCS data were pooled and compared with NU results.

  15. Results • Antibiotic Resistance - CNS • Distribution across all 10 drugs showed no significant differences among groups, even when TCC and TCS data were pooled and compared with NU results. • Greatertetracycline resistance in NU group isolates.

  16. Results • Antibiotic Resistance to more than 1preferred drug • CNS - for 69 isolates, rates of resistance for each of the 3 groups were comparable • NU = 25.5% (27/106) • TCC = 24.5% (25/102) • TCS = 18.3% (17/93)

  17. Results • Antibiotic Resistance to more than 1preferred drug • SA - for 2 isolates, rates of resistance for each of the 3 groups were comparable • NU = 25.0% (1/4) • TCC = 00.0% (0/7) • TCS = 20.0% (1/5)

  18. Results • Antibacterial (TCC/TCS) Resistance • All isolates (n=317) were tested for resistance to TCC and TCS • CNS isolates from all 3 groups had comparable MIC values when tested against TCC and TCS • SA isolates had comparable MIC values when tested against TCC and TCS

  19. Results • Antibacterial Resistance CNS – MIC Values TCC TCS NU 0.0117-0.750 0.128-2.020 TCC 0.0234-0.750 0.004-2.020 TCS 0.0117-0.750 0.008-2.020

  20. Results • Antibacterial Resistance SA – MIC Values TCC TCS NU 0.0469-0.1875 0.510-2.040 TCC 0.0029-0.1875 0.124-1.020 TCS 0.0469-0.1875 1.020-2.040

  21. Results • Cross-Resistance Testing • CNS – 9 isolates most resistant to preferred treatment drugs (4-5) • Antibacterial MICs for TCC were comparable across all 3 groups, with none showing highest MICs (as did less antibiotic-resistant isolates) • MICs for TCS were comparable, and with one exception, none showed highest MICs (as did less antibiotic-resistant isolates)

  22. Results • Cross-Resistance Testing • CNS – 7 isolates w/highest antibacterial MICs for TCC • Comparable antibiotic resistance across the 3 groups (resistance to 0-2 preferred drugs), as opposed to resistance to 4-5 drugs shown by less TCC-resistant isolates.

  23. Results • Cross-Resistance Testing • CNS – 60 isolates w/highest antibacterial MICs for TCS • Comparable antibiotic resistance across the 3 groups, as opposed to resistance to drugs shown by less TCS-resistant isolates.

  24. Results • Cross-Resistance Testing • SA • No isolates showing highest possible MIC value for TCC. • Of 3 isolates showing the highest MIC value for TCS, none were resistant to any of the preferred treatment drugs.

  25. Conclusion • These study results confirm similar findings from recent assessments of antibiotic and antibacterial resistance in home environments • Cole et al, J Appl Micro 2003 Aiello et al, Emer Inf Dis 2005

  26. Conclusion • These study results further discount the speculative claim that the use of antibacterial wash products contribute to the selection and propagation of drug-resistant bacteria on human skin.

  27. References • Cole et al, 20003, Investigation of antibiotic and antibacterial agent cross-resistance in target bacteria from homes of antibacterial product users and non-users. Journal of Applied Microbiology 95:664-676. • Aiello et al, 2005, Antibacterial cleaning products and drug resistance. Emerging Infectious Diseases, 11(10):1565-1570. • DUMC (2005), Summary of Antimicrobial Susceptibility Test Results 1999-2004, Duke University Medical Center, Durham, NC, htpp://pathology.mc.duke.edu/microbiology/susceptibility.htm. • Fridkin SF, Hill HA, Volkova NV, Edwards JR, Lawton RM, Gaynes RP, McGowan , Jr JE, 2002, Temporal changes in prevalence of antimicrobial resistance in 23 U.S. hospitals, Emerging Infectious Diseases, (8)7:697-701. • Tiemersma EW, Bronzwaer SL, Lyytikainen O, Degener JE, Schrijnemakers P, Bruinsma N, Monen J, Witte W, Grundmann H, 2004, Methicillin-resistant Staphylococcus aureus in Europe, 1999-2002, Emerging Infectious Diseases, 10(9):1627-1634.

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