Resistance or tolerance? Highlighting the need for precise terminology in the field of disinfection

• Published in: The Journal of hospital infection 2024-08, Vol.150, p.51-60
• Main Authors: Krewing, M., Mönch, E., Bolten, A., Niesalla, H.
• Format: Article
• Language: English
• Subjects: Adaptation; Anti-Bacterial Agents - pharmacology; Antibiotics; Bacteria - classification; Bacteria - drug effects; Disinfectants; Disinfectants - pharmacology; Disinfection - methods; Dosage; Drug Resistance, Bacterial; Drug Tolerance; Exposure time; Humans; Specificity; Terminology as Topic
• ISSN: 0195-6701; 1532-2939; 1532-2939
• DOI: 10.1016/j.jhin.2024.05.006

The terms ‘resistance’ and ‘tolerance’ are well defined in the context of antibiotic research. However, in the field of disinfection, these terms are often used synonymously, which creates ambiguity and can lead to misunderstandings and misconceptions. In addition, this inconsistency in terminology makes it difficult to assess the risk of a disinfectant resistance. This general review aims to discuss existing definitions of the terms ‘adaptation’, ‘susceptibility’, ‘tolerance’, ‘persistence’ and ‘resistance’ in the light of disinfectants. The most ambiguity is found between tolerance and resistance. Whereas the former describes the not necessarily heritable survival of transient exposure to usually lethal concentrations, resistance is the strictly heritable ability to survive otherwise lethal concentrations of an antimicrobial agent, regardless of exposure time. A simple transfer of experience from antibiotic research is not recommended when assessing the risk of resistance to disinfectants, as there are important differences between antibiotics and disinfectants, although both are antimicrobials: (i) disinfectants are usually applied at concentrations that exceed the minimum inhibitory concentration by orders of magnitude, (ii) the exposure times of disinfectants are in the range of seconds, minutes, or a few hours, (iii) the mode of action of disinfectants is less specific, and (iv) disinfectants often contain more than one active agent with additive or synergistic effects. It is important to recognize that disinfectants, like other antimicrobial agents such as antibiotics, have a dualistic nature and should be used correctly and with caution.