790 infection control & hospital epidemiology july 2017, vol. 38, no. 7
collection of GTA-resistant M. chelonae and M. abscessus subsp. massiliense isolates to various disinfectant chemistries using 2 different testing methods. Tests with the GTA-based products Cidex and Aldahol
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confirmed the aldehyde resistance phenotype of the 4 M. abscessus subsp. massiliense and M. chelonae isolates from the United Kingdom and Brazil. Interestingly, increasing the incubation temperature of Aldahol from 20°C to 25°C over- came this resistance in all isolates except M. chelonae Harefield. This finding probably reflecting differences in the physiology and mechanisms of aldehyde-resistance evolved by these iso- lates. Similarly, Cidex OPA at 25°C showed variable efficacy against the GTA-resistant strains, achieving only partial killing of M. chelonae Harefield after the recommended 5-minute time point in the suspension test at the minimum effective concentration of 0.3% OPA; however, CFU counts for all isolates were reduced to zero upon exposure to 0.3% OPA for 12 minutes at 20°C. Under the testing conditions used herein that lacked organic load in the suspensions and, therefore, favored disinfectant activity, all Mycobacterium isolates tested were fully susceptible to the peracetic acid– and hydrogen peroxide–based disinfectants, independent of their level of resistance to GTA. In summary, all oxidizing disinfectants tested in this study
effectively killed GTA-resistant mycobacteria, whereas aldehyde-based products (GTA and OPA) showed variable results despite evidence that changing the product formulation (ie, Aldahol) and increasing the temperature might improve their efficacy against some isolates. Although more isolates need to be tested in the presence and absence of organic load to reach definitive conclusions, it appears that the use of oxidizing chemistry (compatibility with the medical devices permitting) provides a safe alternative to aldehyde-based products, especially when GTA resistance is suspected. Alter- natively, increasing the temperature and/or formulation of aldehyde-based products may increase their efficacy, but this option should carefully be evaluated on a case-to-case basis.
acknowledgments
We thank Dr N. Miner and V. Harris (MicroChem Laboratory) and Dr G. McDonnell and A. Fiorello (Steris) for their advice with the disinfectant testing methods. Financial support: This work received support from the Steris Foundation,
Dow Microbial Control, the College Research Council (College of Veterinary Medicine and Biomedical Sciences) at Colorado State University, and the National Institutes of Health (NIH)/National Institute of Allergy and Infec- tious Diseases (NIAID) (grant no. AI089718). The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH. The funding sources were not involved in the collection, analysis, or interpretation of data; in the writing of the report; or in the deci- sion to submit the article for publication. Potential conflicts of interest: All authors report no conflicts of interest rele- vant to this article.
Address correspondence to Mary Jackson, Department of Microbiology, Immunology and Pathology, Colorado State University, Fort Collins, CO 80523-1682 (
Mary.Jackson@colostate.edu).
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