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#UFSExpertOpinion: The Approaching Storm of Disinfectant Resistance

14 April 2023 | Story Prof Robert Bragg, Wanja Swart and Samantha Mc Carlie | Photo Supplied

Opinion article by Prof Robert Bragg, Wanja Swart, and Samantha Mc Carlie, Infection Control Group within the Veterinary Biotechnology Research Group, Department of Microbiology and Biochemistry, University of the Free State.

The storm is coming, and it has, in fact, already had significant effects in health care and agriculture. This is the storm of resistance to disinfectants.

In the age where antibiotics are ever decreasing in efficacy and the search for novel antimicrobials is not progressing very well, our last line of defence against bacterial diseases is biosecurity. Biosecurity is the concept of preventing the infection before the individual becomes infected. The individual can be human, animal or plant. The main weapons in the arsenal for good biosecurity are disinfectants and sanitisers, of which there are many. In fact, way too many! Many of these disinfectants are not used correctly, and in many cases, there is no effort to monitor the efficacy of the disinfectants used in a particular situation. Many of these are not registered for use and have never been tested in a clinical setting. This is a big part of the problem.

Antibiotic resistance is a well-known global crisis currently challenging the healthcare community. However, the COVID-19 pandemic has highlighted our reliance on disinfectants and sanitisers as infection control measures. In 2020 alone, it was estimated that 700 000 tons of quaternary ammonium compound (QAC)-based disinfectants were released into the environment. The presence of these disinfectants environmentally leads to selection for resistant microorganisms and can lead to the development of resistant populations in our water systems, on farms, and around hospitals. This has prompted the Infection Control research group at the UFS to explore new research regarding microbial resistance to disinfectant and sanitiser compounds, as well as whether resistance to disinfectants and antibiotics is linked.

The coming storm in health care

Nosocomial infections, otherwise known as hospital-acquired infections (HAIs), affect 30% of ICU patients in high-income countries and up to 70% in low-income countries, with more than 52% of these infections being fatal. According to the World Health Organisation (WHO), HAIs are also responsible for up to 56% of all deaths in neonates.

In 2014, an article was published with a powerful title: The future if we do not act now, where the author stated that if we do not address antimicrobial resistance (AMR), it will be responsible for the death of 10 million individuals by the year 2050, which would make it a bigger killer than cancer today. This information was widely regarded as an over-dramatisation as, at the time, AMR was estimated to have claimed the lives of 700 000 individuals annually. However, the WHO estimated that AMR was directly responsible for 1,27 million deaths in 2019 and 4,95 million deaths in 2022. It is now becoming abundantly clear that this article was not an over-dramatisation, and the number of 10 million mortalities will be reached long before 2050. We are already halfway there in 2022.

With health care being the environment where most cases of AMR and HAIs occur in conjunction, it is concerning that research is underway that shows exponential increases in resistance when bacteria are exposed to sub-minimum levels of disinfectants regularly used within the health-care setting.

The coming storm in agriculture

The need to reduce the use of antibiotics in agriculture has been in place for several years now. The concept of biosecurity is well established in the agricultural sector, but disinfectants are still being misused. It is difficult to produce meat products without the use of antibiotics; this will result in an increase in the cost of meat products, which will put it beyond the reach of many people. Good biosecurity is essential in the animal production area, and this research group has been working in the area for many years. The experience gained in this field is now being applied to the healthcare setting. If we can reduce mortalities in a poultry pen by 56% through good biosecurity prevention practices, it should certainly be possible to achieve similar or much better results in the health-care sector.

Research on the mechanisms of disinfectant resistance

Current projects in Prof Robert Bragg’s laboratory include a PhD by Samantha Mc Carlie, investigating how bacteria become resistant to disinfectant and sanitiser products. A highly resistant ‘superbug’ bacterium related to Serratia marcescens has been discovered, and Mc Carlie is working with this isolate to determine the reason for the high level of resistance to disinfectant and sanitiser products. This work is being done on a genetic level to reveal which resistance genes and metabolic systems are responsible for high levels of antimicrobial resistance. Master of Science (MSc) projects by Boudine van der Walt and Wanja Swart are investigating how disinfectant resistance is transferred between bacterial species, and whether disinfectant resistance and antibiotic resistance are linked. Wanja Swart’s MSc project focuses on investigating the simultaneous development of antibiotic and disinfectant resistance within one bacterium. Resistance occurs despite the absence of one of these products in a familiar nosocomial pathogen, Serratia marcescens. Gene-based analysis will shed light on how these mechanisms present on a genetic level. In addition, resistance to disinfectants and antibiotics may be inducted to higher levels, which could provide new insights to just how dangerous incorrectly used disinfectants can be.

Gunther Staats has just completed yet another MSc project, focusing on efflux pumps that pump out antimicrobial agents from the inside of bacterial cells.

Evaluation of the efficacy of disinfectants

Registration of disinfectants, where applicable, has specific guidelines according to which bacterial pathogens need to be tested against these products. The required cultures are generally environmental reference ATCC (American type culture collection) strains, which ensure consistency and fair treatment when doing product registration.

However, the situation in the field, farm, or hospital ward may be very different. The pathogens that are found in these settings may be totally different from the ATCC strains, as they are regularly challenged with disinfectants and antibiotics.

Work performed by Wanja Swart showed that in just 10 consecutive days of exposure to disinfectants, resistance to commonly used disinfectants can increase 32-fold. So why is this important? Firstly, accurate dilution of disinfectants appears to be a challenge for many, so the likelihood of the products being used correctly is relatively small. Also, some of the products have substantial residual activity on surfaces. This will result in the exposure of bacteria to sub-lethal levels for extended periods of time as well as a build-up of disinfectant – which will in turn result in a further increase in resistance.

Research outputs so far for 2023 include two publications by Samantha Mc Carlie on bacterial resistance to disinfectants in the accredited peer-reviewed journal, Microorganisms, titled ‘Genomic Islands Identified in Highly Resistant Serratia sp. HRI: A Pathway to Discover New Disinfectant Resistance Elements’ and ‘The Hermetic Effect Observed for Benzalkonium Chloride and Didecyldimethylammonium Chloride in Serratia sp. HRI’. In addition, three book chapters have been published in the book Antimicrobial Resistance and One Health in Africa by Springer Publishers, titled ‘Biosecurity and Disinfectant resistance in a Post-antibiotic era’, ‘The Linkage between Antibiotic and Disinfectant Resistance’, and ‘The Current State of Antimicrobial resistance in Bovine Mastitis in Various African Countries’.

News Archive

Inauguration of Prof Francis Petersen as 14th Vice-Chancellor and Rector of the UFS

2017-05-23

Dr Khotso Mokhele, Chancellor of the UFS, robes Prof Francis Petersen as Vice-Chancellor and Rector of the UFS.
Photo: Charl Devenish

“At the UFS, we want to produce graduates for the world, and we need to ensure that we use our knowledge to uplift society”
— Prof Francis Petersen, 14th Vice-Chancellor and Rector of the University of the Free State (UFS)

On Friday 19 May 2017, the University of the Free State (UFS) celebrated the inauguration of its 14th Vice-Chancellor and Rector, Prof Francis Petersen. The formal inauguration was held in the Odeion Theatre on the Bloemfontein Campus. The ceremony was preceded by a week-long welcoming programme on the three UFS campuses.

The guest list included representatives from local and provincial government, vice-chancellors and rectors from across South Africa, and senior members of the university’s executive management.

During the inaugural address, Prof Petersen paid tribute to his predecessors for the role they played in making the university what it is today. This included former rectors and vice-chancellors who attended the ceremony, such as Prof Francois Retief and Prof Frederick Fourie, and Prof Stef Coetzee and Prof Jonathan Jansen who were unable to attend.

Prof Petersen characterised 2015 and 2016 as watershed years for the South African higher-education system. “The Rhodes Must Fall, and subsequent Fees Must Fall student and staff protests challenged us, and re-energised a critical engagement around the purpose of the university in an equal society, both as a site of complicity and as a potential agent for social change,” said Prof Petersen.

He committed himself to developing the UFS into an institution that will have an even greater impact than before.

“This institution I am striving to establish will be one that responds positively to inclusivity, diversity, and transformation, and which can incorporate these values into our curriculum, scholarship, and research in a productive way,” said Prof Petersen.

Prof Petersen emphasised the importance of the three-campus model. “The University of the Free State is ONE university with three campuses: the Bloemfontein Campus, our South Campus, and the Qwaqwa Campus. I am committed to align the activities of the three campuses, and to integrate our activities to a greater extent.

“We must work together to infuse each campus with the values we have identified as essential if we are to make our mark as a united University of the Free State: academic excellence, diversity and inclusivity, and innovation.”

The Chancellor, Dr Khotso Mokhele, had the honour of handing over the gown to Prof Petersen. Prof Lis Lange, Vice-Rector: Academic, explained the relationship between the university and the Basotho people, and how this relationship is honoured through the official procession gowns of the UFS. The Basotho blanket is worn by kings, and the university therefore hopes that the symbolism of the gown would be a source of inspiration to Prof Petersen.

The event was concluded by congratulatory messages from former colleagues and the President of the Student Representative Council on the Bloemfontein Campus, SK Luwaca. The event was elegant and graceful – the inaugural address was thought-provoking and inspiring.

Official Inauguration Ceremony:

19 May 2017
Bloemfontein Campus

Description: Official Inauguration photo small Tags: Official Inauguration photo small

"I challenge you to dream big and do big." - Prof Petersen

Photo Caption: Dr Khotso Mokhele, Chancellor of the UFS, robes Prof Francis Petersen as Vice-Chancellor and Rector of the UFS.
Photo: Johan Roux

Short biography of Prof Francis Petersen
Inaugural address: 19 May 2017
Transcription of the ceremony
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Video

Welcoming Ceremonies:

The week of 11-19 May 2017 was one of the highlights in this year’s calendar for staff and students of the University of the Free State (UFS), with various ceremonies taking place to welcome Prof Francis Petersen – who assumed his duties on 1 April 2017 – as the 14th Vice-Chancellor and Rector. The festivities culminated in the official inauguration ceremony at the Bloemfontein Campus on 19 May 2017.

The Qwaqwa Campus welcoming ceremony took place on Thursday 11 May 2017, attracting a wide spectrum of community leaders from the area. Prof Petersen was welcomed by representatives from the two trade unions, National Education Health and Allied Workers Union (Nehawu) and UVPERSU, as well as representatives from the Student Representative Council (SRC), the Thabo Mofutsanyana Education District, and the House of Traditional Leaders. Paramount Queen Mopeli of the Bakoena Royal House bestowed a special honour upon Prof Petersen by clothing him in a traditional Basotho blanket and hat. She said, "From our heart of hearts, welcome, Prof Francis ..., and all Godspeed during your tenure."

The South Campus in Bloemfontein hosted a welcoming ceremony for the new Vice-Chancellor and Rector on 18 May 2017. The ceremony included a number of vocal performances and messages from various stakeholder groups. The same afternoon, the Institute for Reconciliation and Social Justice (IRSJ) also facilitated a panel discussion, titled Diversity, inclusivity, and social justice and the renewed call for decolonisation, in the Albert Wessels Auditorium (AWO) on the Bloemfontein Campus.

The welcoming ceremonies culminated in an event in the Callie Human Centre on Friday 19 May 2017 at the Bloemfontein Campus, with a number of performances by musicians associated with the UFS, marimbas, drum majorettes from Jim Fouche Secondary School, the Grey College Gumboots, and school choirs from Eunice Secondary School, Brebner Primary School, and Willem Postma Primary School. Representatives from key stakeholders such as Nehawu, UVPERSU, the Campus Ministries Forum, SRC, Alumni, Convocation, and the UFS Council had the opportunity to convey their messages of welcome to Prof Petersen.

The formal inauguration ceremony took place in the Odeion Theatre on the Bloemfontein Campus the same day.

Qwaqwa Campus ceremony:

11 May 2017
Qwaqwa Campus

"Qwaqwa Campus is the perfect laboratory for sustainable sciences.” – Prof Petersen

Photo caption: Paramount Queen Mopeli of the Bakoena Royal House with Prof Petersen and his wife, Cheslyn.
Photo: Mamosa Makaya

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Video

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Transcription of the ceremony

South Campus ceremony:

18 May 2017
South Campus

"South Campus: you aspire excellence, adding to diversity and you are innovative in what you do." - Prof Petersen

Photo caption: Flag bearers and drummers walking to the Madiba Arena.
Photo: Hannes Pieterse

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Transcription of the ceremony

Bloemfontein Campus panel discussion:

Panel discussion: Diversity, inclusivity and social justice and the renewed call for decolonisation
18 May 2017
Bloemfontein Campus

Description: Panel discussion 18 May 2017 Tags: Panel discussion 18 May 2017

"The UFS should be a place of belonging for everyone." - Prof Petersen

Photo caption: from left: SK Luwaca (SRC President, Bloemfontein Campus), Prof Elelwani Ramugondo (UCT), Prof Francis Petersen (UFS), Prof Melissa Steyn (WITS), Prof Andre Keet (UFS)
Photo: Lelanie de Wet

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Transcription of panel discussion

Bloemfontein Campus ceremony:
19 May 2017
Bloemfontein Campus

Description: Bloem welcoming ceremony on 19 May 2017 Tags: Bloem welcoming ceremony on 19 May 2017

"I can just say, Wow! I've experienced a lot during the welcoming functions on all three campuses." - Prof Petersen

Photo caption: Prof Francis Petersen, Vice-Chancellor and Rector of the UFS
Photo: Rulanzen Martin

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Photo gallery of Inauguration and Welcoming Ceremonies

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