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Chemical biocides are used for the prevention and control of infection in health care, targeted home hygiene or controlling microbial contamination for various industrial processes including but not limited to food, water and petroleum. However, their use has substantially increased since the implementation of programmes to control outbreaks of methicillin-resistant Staphylococcus aureus, Clostridioides difficile and severe acute respiratory syndrome coronavirus 2. Biocides interact with multiple targets on the bacterial cells. The number of targets affected and the severity of damage will result in an irreversible bactericidal effect or a reversible bacteriostatic one. Most biocides primarily target the cytoplasmic membrane and enzymes, although the specific bactericidal mechanisms vary among different biocide chemistries. Inappropriate usage or low concentrations of a biocide may act as a stressor while not killing bacterial pathogens, potentially leading to antimicrobial resistance. Biocides can also promote the transfer of antimicrobial resistance genes. In this Review, we explore our current understanding of the mechanisms of action of biocides, the bacterial resistance mechanisms encompassing both intrinsic and acquired resistance and the influence of bacterial biofilms on resistance. We also consider the impact of bacteria that survive biocide exposure in environmental and clinical contexts.
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School of Pharmacy and Pharmaceutical Sciences, Cardiff University, Wales, UK
Jean-Yves Maillard & Michael Pascoe
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The authors contributed equally to all aspects of the manuscript.
Correspondence to Jean-Yves Maillard.
J.-Y.M. is the Director of Biocide Consult Ltd. M.P. declares no competing interests.
Nature Reviews Microbiology thanks Anabela Borges, Ilias Tagkopoulos, Manuel Simões and the other, anonymous, reviewer(s) for their contribution to the peer review of this work.
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Maillard, JY., Pascoe, M. Disinfectants and antiseptics: mechanisms of action and resistance. Nat Rev Microbiol (2023). https://doi.org/10.1038/s41579-023-00958-3
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Accepted: 28 July 2023
Published: 30 August 2023
DOI: https://doi.org/10.1038/s41579-023-00958-3
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