Sterilization

Sterilization, which is any process, physical or chemical, that destroys all forms of life, is used especially to destroy microorganisms, spores, and viruses. Precisely defined, sterilization is the complete destruction of all microorganisms by a suitable chemical agent or by heat, either wet steam under pressure at 120 °C (250 °F) or more for at least 15 minutes, or dry heat at 160 to 180 °C (320 to 360 °F) for three hours.

Sanitization

A sanitizer is an agent, usually chemical in nature, that is used to reduce the number of microorganisms to a level that has been officially approved as safe. Sanitizers are commonly used to control bacterial levels in equipment and utensils found in dairies, other food-processing plants, eating and drinking establishments, and other places in which no specific pathogenic microorganisms are known to be present and destruction of all microorganisms may not be necessary.

Other antimicrobials

Preservatives, usually chemical agents, are added to certain foods and medicines to prevent the growth of microorganisms that may cause spoilage or disease. Prophylactics also are agents used to prevent infections and diseases. Vaccination is the administration of harmless amounts of disease-causing microorganisms into animals, including humans, to prevent diseases. (See vaccine.) Sterile filtration usually removes large microorganisms (e.g., bacteria, fungi, and their spores) from heat-sensitive solutions, but this physical method does not effectively remove small infectious microorganisms (e.g., filterable viruses and rickettsias).

Modes of action

Some antiseptics, such as alcohols and quaternary ammonium compounds, act directly on microbial cells to dissolve them. Others may penetrate the cells and cause the release of amino acids, nuclear material, and other important chemical constituents. Some compounds penetrate microbial cell walls and inactivate essential membrane transport systems so that the cells can no longer obtain the nutrients necessary for them to survive and to reproduce. Others coagulate certain vital materials in cells, thereby destroying the microorganisms. A few agents disrupt the metabolism of the cells so that they can no longer assimilate nutrients; as a result, the cells starve and die.

Side effects and drug resistance

A number of antimicrobial compounds produce significant toxic effects in humans, but they are used because they have a favourable chemotherapeutic index; that is, the amount required for a therapeutic effect is below the amount that causes a toxic effect. The levels of these drugs in the patient must be controlled carefully so as not to reach toxic levels. Persons with certain altered organ functions, such as occurs in liver or kidney disease, are often especially susceptible to drug toxicity. The agents, however, can be used safely if drug concentrations in the blood are measured, the dose adjusted to avoid toxic levels, and organ function or toxicity monitored closely.

Whether an antimicrobial agent affects a microorganism depends on several factors. The drug must be delivered to a sensitive site in the cell, such as an enzyme that is involved in the synthesis of a cell wall or a protein or enzyme responsible for the synthesis of proteins, nucleic acids, or the cell membrane. Whether the antimicrobial agent enters the cell depends on the ability of the drug to penetrate the outer membrane of the cell, on the presence or absence of transport systems for the antimicrobial, or on the availability of channels in the cell surface. In some cases the microorganism prevents the entry of the antimicrobial by producing an enzyme that destroys or modifies the antimicrobial by transferring a chemical group. If the antimicrobial agent does not penetrate the organism or is destroyed or modified or if the organism does not contain a sensitive site, then the microorganism will not be affected; in such a case it is said to be resistant.

All agents can have adverse effects ranging from relatively harmless to serious and life-threatening. Direct toxicities are expressed in a variety of ways, and many of these are associated with the gastrointestinal tract (nausea, vomiting, and diarrhea) and skin rashes. They are usually minor and do not limit the use of the agent. In more extreme cases, the toxicities can result in serious damage to organs such as the kidneys, the liver, and the ears and to the nervous system. Some antimicrobial agents affect normal red blood cells, which can result in anemia. Allergic or hypersensitivity reactions can range from minor effects such as skin rash and itching to more serious effects that include choking and difficulty in breathing. In some cases a sudden and severe form of allergic reaction (anaphylaxis) can result in death.

The use of antimicrobial agents, in particular the broad-spectrum agents, can result in an alteration in the number and type of microorganisms normally found on the skin and mucosal surfaces. This is due to the inhibitory activity of the antimicrobial agent on sensitive microorganisms found on these tissues. The eradication of some organisms relieves the inhibitory activity they have on each other and thereby allows the surviving organisms to multiply. In some cases organisms (such as yeast) that are generally resistant to antibiotics increase to numbers sufficient to invade and infect tissue.

Some microorganisms have become resistant to drugs, requiring a continuing search for different (and often more expensive) agents. This increase in resistance to drugs has resulted from their widespread and sometimes indiscriminate use. Bacteria undergo spontaneous mutations, and exposure to an antibiotic can eradicate those bacteria sensitive to it while the resistant ones survive and multiply; by such means populations become resistant to a particular drug and sometimes to related drugs. Bacteria sensitive to antibiotics also can become resistant by acquiring resistance genes from other organisms, either by mating (conjugating) with bacteria containing resistance genes or by transduction (a process by which a bacterial virus, or bacteriophage, with resistance genes infects and incorporates these genes into a bacterium, thus conferring resistance). Resistance to antimicrobial agents also results from (1) decreased permeability of the organism to the drug, (2) deactivation or modification of the drug by an enzyme, (3) modification of the drug receptor or binding site, (4) increased synthesis of an essential metabolite whose production is blocked by the antimicrobial agent, or (5) production of an enzyme that is altered so that it is not inhibited or affected by the drug. Resistant bacteria are common in hospitals (nosocomial infections), where patients whose immunity is decreased can be infected.