Challenges of quaternary ammonium antimicrobial agents: Mechanisms, resistance, persistence and impacts on the microecology

Jiaxin Zhang; Lei Cheng; Hao Li; Xi Chen; Lin Zhang; Tiantian Shan; Jiannan Wang; Ding Chen; Jiawei Shen; Xinxuan Zhou; Lichen Gou; Lixin Zhang; Xuedong Zhou; Biao Ren

doi:10.1016/j.scitotenv.2024.178020

Challenges of quaternary ammonium antimicrobial agents: Mechanisms, resistance, persistence and impacts on the microecology

Sci Total Environ. 2024 Dec 16:958:178020. doi: 10.1016/j.scitotenv.2024.178020. Online ahead of print.

Authors

Jiaxin Zhang¹, Lei Cheng¹, Hao Li², Xi Chen¹, Lin Zhang¹, Tiantian Shan¹, Jiannan Wang³, Ding Chen³, Jiawei Shen³, Xinxuan Zhou³, Lichen Gou³, Lixin Zhang⁴, Xuedong Zhou³, Biao Ren⁵

Affiliations

¹ State Key Laboratory of Oral Diseases, National Center for Stomatology, National Clinical Research Center for Oral Diseases, West China School of Stomatology, Sichuan University, Chengdu 610041, Sichuan, China; Department of Operative Dentistry and Endodontics, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, Sichuan, China.
² State Key Laboratory of Oral Diseases, National Center for Stomatology, National Clinical Research Center for Oral Diseases, West China School of Stomatology, Sichuan University, Chengdu 610041, Sichuan, China; Department of Operative Dentistry and Endodontics, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, Sichuan, China; Department of Endodontics, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, College of Stomatology, Shanghai Jiao Tong University, 500 Quxi Road, Shanghai 200011, China; National Center for Stomatology, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology, No. 639, Zhizaoju Road, Shanghai 200011, China.
³ State Key Laboratory of Oral Diseases, National Center for Stomatology, National Clinical Research Center for Oral Diseases, West China School of Stomatology, Sichuan University, Chengdu 610041, Sichuan, China.
⁴ State Key Laboratory of Bioreactor Engineering, East China University of Science and Technology, Shanghai 200237, China.
⁵ State Key Laboratory of Oral Diseases, National Center for Stomatology, National Clinical Research Center for Oral Diseases, West China School of Stomatology, Sichuan University, Chengdu 610041, Sichuan, China. Electronic address: [email protected].

PMID: 39689472
DOI: 10.1016/j.scitotenv.2024.178020

Abstract

Quaternary ammonium compounds (QACs) served as broad spectrum antimicrobial agents are widely applied for surface disinfection, skin and mucous disinfection, and mouthwash. The daily applications of QACs have significantly increased, especially during the COVID-19 pandemic. However, the environmental residues of QACs have demonstrated harmful impacts on the environment, leading to an increase in environmental contamination, resistant microbes and disruption of microecology. The actions of QACs were related to their cationic character, which can impact the negatively charged cell membranes, but the details are still unclear. Moreover, bacteria with lower sensitivity and resistant pathogens have been detected in clinics and environments, while QACs were also reported to induce the formation of bacterial persisters. Even worse, the resistant bacteria even showed co-resistance and cross-resistance with traditional antibiotics, decreasing therapeutic effectiveness, and disrupting the microecology homeostasis. Unfortunately, the resistance and persistence mechanisms of QACs and the effects of QACs on microecology are still not clear, which even neglected during their daily usages. Therefore, we summarized and discussed current understandings on the antimicrobial actions, resistance, persistence and impacts on the microecology to highlight the challenges in the QACs applications and discuss the possible strategies for overcoming their drawbacks.

Keywords: Co-resistance; Cross resistance; Drug resistance; Efflux pump system; Microecology; Persistence; Quaternary ammonium compounds.

Publication types

Review