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Neuhaus S, Feßler AT, Dieckmann R, Thieme L, Pletz MW, Schwarz S, Al Dahouk S. Towards a Harmonized Terminology: A Glossary for Biocide Susceptibility Testing. Pathogens 2022; 11:pathogens11121455. [PMID: 36558789 PMCID: PMC9780826 DOI: 10.3390/pathogens11121455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 11/24/2022] [Accepted: 11/29/2022] [Indexed: 12/03/2022] Open
Abstract
Disinfection is a key strategy to reduce the burden of infections. The contact of bacteria to biocides-the active substances of disinfectants-has been linked to bacterial adaptation and the development of antimicrobial resistance. Currently, there is no scientific consensus on whether the excessive use of biocides contributes to the emergence and spread of multidrug resistant bacteria. The comprehensive analysis of available data remains a challenge because neither uniform test procedures nor standardized interpretive criteria nor harmonized terms are available to describe altered bacterial susceptibility to biocides. In our review, we investigated the variety of criteria and the diversity of terms applied to interpret findings in original studies performing biocide susceptibility testing (BST) of field isolates. An additional analysis of reviews summarizing the knowledge of individual studies on altered biocide susceptibility provided insights into currently available broader concepts for data interpretation. Both approaches pointed out the urgent need for standardization. We, therefore, propose that the well-established and approved concepts for interpretation of antimicrobial susceptibility testing data should serve as a role model to evaluate biocide resistance mechanisms on a single cell level. Furthermore, we emphasize the adaptations necessary to acknowledge the specific needs for the evaluation of BST data. Our approach might help to increase scientific awareness and acceptance.
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Affiliation(s)
- Szilvia Neuhaus
- German Federal Institute for Risk Assessment, 10589 Berlin, Germany
- Correspondence: (S.N.); (R.D.)
| | - Andrea T. Feßler
- Centre for Infection Medicine, Department of Veterinary Medicine, Institute of Microbiology and Epizootics, Freie Universität Berlin, 14163 Berlin, Germany
- Veterinary Centre for Resistance Research (TZR), Freie Universität Berlin, 14163 Berlin, Germany
| | - Ralf Dieckmann
- German Federal Institute for Risk Assessment, 10589 Berlin, Germany
- Correspondence: (S.N.); (R.D.)
| | - Lara Thieme
- Institute of Infectious Diseases and Infection Control, Jena University Hospital, Friedrich-Schiller-University Jena, 07747 Jena, Germany
- Leibniz Center for Photonics in Infection Research, Jena University Hospital, Friedrich Schiller University Jena, 07747 Jena, Germany
| | - Mathias W. Pletz
- Institute of Infectious Diseases and Infection Control, Jena University Hospital, Friedrich-Schiller-University Jena, 07747 Jena, Germany
| | - Stefan Schwarz
- Centre for Infection Medicine, Department of Veterinary Medicine, Institute of Microbiology and Epizootics, Freie Universität Berlin, 14163 Berlin, Germany
- Veterinary Centre for Resistance Research (TZR), Freie Universität Berlin, 14163 Berlin, Germany
| | - Sascha Al Dahouk
- German Federal Institute for Risk Assessment, 10589 Berlin, Germany
- Department of Internal Medicine, RWTH Aachen University Hospital, 52074 Aachen, Germany
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Sultan AM, Ahmed MA. Distribution of chlorhexidine resistance genes among Staphylococcus aureus clinical isolates: the challenge of antiseptic resistance. Germs 2022; 12:461-471. [PMID: 38021179 PMCID: PMC10660228 DOI: 10.18683/germs.2022.1352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 10/14/2022] [Accepted: 12/31/2022] [Indexed: 12/01/2023]
Abstract
Introduction Chlorhexidine is an antiseptic agent which is extensively used to prevent nosocomial infections; however, this could result in reduction of its susceptibility. The aim of this work was to determine chlorhexidine susceptibility among Staphylococcus aureus isolates and to detect qacA/B and smr antiseptic resistance genes among these isolates. Furthermore, we aimed to identify possible risk factors for the reduction of chlorhexidine susceptibility among S. aureus isolates. Methods Various clinical samples were collected from patients with evidence of S. aureus infection. Antimicrobial susceptibilities of identified S. aureus isolates were determined by disk diffusion method. Resistance to methicillin was identified by cefoxitin disk diffusion test besides mecA gene detection by PCR. Chlorhexidine minimum inhibitory concentration (MIC) values were measured by broth microdilution method while qacA/B and smr resistance genes were detected by multiplex PCR. Results A total percentage of 25.9% of S. aureus isolates showed reduced susceptibility to chlorhexidine. Methicillin resistant S. aureus (MRSA) had a reported percentage of 39.5%, which was significantly higher than the 11.3% reported for methicillin susceptible S. aureus (MSSA), p<0.001. S. aureus isolates were found to harbor qacA/B and smr genes at 23.2% and 7.7% respectively. Risk factors for reduced susceptibility to chlorhexidine included; ICU setting (OR=2.02, 95%CI: 0.3-1.6), prolonged ICU stay (OR=1.7, 95%CI: 0.4-1.1), presence of central vascular catheter (OR=2.3, 95%CI: 0.2-1.9), mechanical ventilation (OR=1.88, 95%CI: 0.4-1.7) and acquisition of qacA/B (OR=15.7, 95%CI: 3.4-12.1) or smr gene (OR=15.7, 95%CI: 3.4-12.1). Conclusions Our work highlighted the current challenge of antiseptic resistance in our locality. The frequencies of qacA/B and smr genes were significantly higher among MRSA than MSSA isolates. About two thirds of chlorhexidine tolerant isolates displayed an MDR profile. To maintain chlorhexidine efficiency, biocidal stewardship program and ongoing surveillance are essential.
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Affiliation(s)
- Amira M. Sultan
- MD, Medical Microbiology and Immunology Department, Faculty of Medicine, Mansoura University, 35516 Elgomhouria S, Mansoura, Egypt
| | - Mohammad A. Ahmed
- MD, Anesthesia and Surgical Intensive Care Department, Faculty of Medicine, Mansoura University, 35516 Elgomhouria S, Mansoura, Egypt
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Phenotypic and Molecular Detection of Antiseptic Resistance Genes among Clinical Staphylococcus aureus Isolates During COVID-19 Pandemic. JOURNAL OF PURE AND APPLIED MICROBIOLOGY 2022. [DOI: 10.22207/jpam.16.4.29] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
The coronavirus disease (COVID-19) pandemic has expanded the use of chlorhexidine digluconate, a biocide frequently used in hospitals, to inhibit the spread of infection. Genes responsible for resistance against the quaternary ammonium compound qac in Staphylococcus aureus isolates have been shown to confer tolerance to a number of biocidal chemicals, including chlorhexidine. The aim of this study was to determine the occurrence of antiseptic resistance genes (qacA/B and qacC) in clinical isolates of methicillin-susceptible (MSSA) and methicillin-resistant Staphylococcus aureus (MRSA). The study also aimed to investigate the association between the presence of the mecA, qacA/B, and qacC genes in MRSA isolates and the susceptibility of the isolates to chlorhexidine to evaluate its future use in the Theodor Bilharz Research Institute (TBRI) hospital, following the Centers for Disease Control and Prevention recommendations for patients with MRSA. S. aureus isolates (n = 100) were collected from inpatients and outpatients at TBRI. A minimal inhibitory concentration of chlorhexidine was also detected. Polymerase chain reaction was used to detect the mecA, qacA/B, and qacC genes. The results revealed that 84% of S. aureus isolates were MRSA. MRSA (61.9%) and MSSA (68.8%) isolates were susceptible to chlorhexidine. The qacA/B gene was more dominant, being detected in 34%, while qacC was detected in only 5% of S. aureus isolates. All S. aureus isolates with reduced susceptibility to chlorhexidine harbored either the qacA/B or qacC genes. The clinical use of chlorhexidine may continue to increase, emphasizing the significance of continuous caution underlining the emergence of new clones with reduced susceptibility and avoiding antiseptic misuse.
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Bastos LR, Almeida MM, Marques EA, Leão RS. Colonização pré-operatória por Staphylococcus aureus e as bactérias não suscetíveis à cefalosporina, em pacientes com fratura proximal do fêmur. Rev Bras Ortop 2022; 57:726-733. [PMID: 36226207 PMCID: PMC9550373 DOI: 10.1055/s-0041-1735546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 04/07/2021] [Indexed: 11/30/2022] Open
Abstract
Objective
To estimate the frequency of
Staphylococcus aureus
and cephalosporin nonsusceptible bacteria colonization in patients with proximal femoral fracture during preoperative hospitalization.
Methods
Prevalence and incidence assessment in 63 hospitalized patients over 1 year. The median time of pretreatment hospitalization was 12 days. Samples were collected from the nostrils, groin skin and anal mucosa during the pretreatment hospitalization and were tested by the disc-diffusion technique.
Results
The hospital colonization incidence and the prevalence of positive results were 14.3 and 44.4% for
S. aureus
; 3.2 and 6.4% for meticillin-resistant
S. aureus
; 28.6 and 85.7% for meticillin-resistant coagulase-negative
Staphylococcus
; 28.6 and 61.9% for cefazolin nonsusceptible
Enterobacteriaceae
(KFNSE); and 20.6 and 28.6% for cefuroxime nonsusceptible
Enterobacteriaceae
(CXNSE). In addition, factors such as to the duration of the pretreatment hospitalization period, being non-walker before fracture, antimicrobial use, American Society of Anesthesiologists (ASA) 4 surgical risk, and previous hospitalization, were related to an increase in the incidence of hospital acquisition and prevalence of colonization by the evaluated strains. The prevalence of colonization by KFNSE was three times higher than by CXNSE on admission, and twice as high at the time of fracture treatment.
Conclusion
There was a high incidence of hospital colonization and prevalence of colonization by all strains studied, which may guide the indication of prophylactic measures for infection.
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Affiliation(s)
- Leonardo R. Bastos
- Seção de Ortopedia e Traumatologia, Hospital Geral de Fortaleza/Exército Brasileiro, Fortaleza, CE, Brasil
- Departamento de Microbiologia, Imunologia e Parasitologia, Faculdade de Ciências Médicas, Universidade do Estado do Rio de Janeiro, RJ, Brasil
| | - Mila M. Almeida
- Departamento de Microbiologia, Imunologia e Parasitologia, Faculdade de Ciências Médicas, Universidade do Estado do Rio de Janeiro, RJ, Brasil
| | - Elizabeth A. Marques
- Departamento de Microbiologia, Imunologia e Parasitologia, Faculdade de Ciências Médicas, Universidade do Estado do Rio de Janeiro, RJ, Brasil
| | - Robson Souza Leão
- Departamento de Microbiologia, Imunologia e Parasitologia, Faculdade de Ciências Médicas, Universidade do Estado do Rio de Janeiro, RJ, Brasil
- Laboratórios de Bacteriologia e Micobactérias, Hospital Universitário Pedro Ernesto, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brasil
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Elkhatib WF, Khalil MAF, Ashour HM. Integrons and Antiseptic Resistance Genes Mediate Resistance of Acinetobacter baumannii and Pseudomonas aeruginosa Isolates from Intensive Care Unit Patients with Wound Infections. Curr Mol Med 2020; 19:286-293. [PMID: 30907313 DOI: 10.2174/1566524019666190321113008] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Revised: 03/12/2019] [Accepted: 03/18/2019] [Indexed: 11/22/2022]
Abstract
BACKGROUND Acinetobacter baumannii and Pseudomonas aeruginosa are of major concern for hospitalized patients. METHODS We evaluated antibiotic and antiseptic resistance of A. baumannii (n = 29) and P. aeruginosa (n = 37) isolates recovered from 66 intensive care unit (ICU) patients and determined the prevalence of qacE, qacEΔ1, and integrons in these clinical isolates. Antibiotic and antiseptic susceptibility testing was performed via Kirby Bauer disk diffusion and broth microdilution methods, respectively. The resistance genes and integrons were detected by PCR. A. baumannii and P. aeruginosa ICU isolates showed 100% and 70.3% antibiotic multiple drug resistance patterns, respectively. RESULTS The isolates also revealed high levels of resistance (MIC ≥ 16 µg/ml) against antiseptics commonly used in Egyptian hospitals (Benzalkonium, Benzethonium, and Chlorhexidine). The qacEΔ1 gene showed higher levels of prevalence in both A. baumannii and P. aeruginosa isolates (93.5% and 78%, respectively) as compared to that of qacE gene (52.0% and 33.0%, respectively). The intI1 was more prevalent among A. baumannii isolates (65.5%) compared to P. aeruginosa isolates (37.8%). P. aeruginosa resistance genotypes were significantly associated with antibiotic and antiseptic resistance patterns. A. baumannii resistance genotypes were associated with antiseptic-resistance patterns. CONCLUSION The excessive usage of antiseptics may escalate bacterial resistance, especially with high prevalence of intI1 integron in these pathogens.
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Affiliation(s)
- Walid F Elkhatib
- Department of Microbiology and Immunology, School of Pharmacy & Pharmaceutical Industries, Badr University in Cairo (BUC), Entertainment Area, Badr City, Cairo, Egypt.,Microbiology and Immunology Department, Faculty of Pharmacy, Ain Shams University, African Union Organization St., Abbassia, Cairo11566, Egypt
| | - Mahmoud A F Khalil
- Department of Microbiology and Immunology, Faculty of Pharmacy, Fayoum University, Fayoum City, Egypt
| | - Hossam M Ashour
- Department of Biological Sciences, College of Arts and Sciences, University of South Florida St. Petersburg, St. Petersburg, Florida, United States.,Department of Microbiology and Immunology, Faculty of Pharmacy, Cairo University, Cairo, Egypt
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Cartography of opportunistic pathogens and antibiotic resistance genes in a tertiary hospital environment. Nat Med 2020; 26:941-951. [PMID: 32514171 PMCID: PMC7303012 DOI: 10.1038/s41591-020-0894-4] [Citation(s) in RCA: 103] [Impact Index Per Article: 25.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Accepted: 04/20/2020] [Indexed: 01/10/2023]
Abstract
Although disinfection is key to infection control, the colonization patterns and resistomes of hospital-environment microbes remain underexplored. We report the first extensive genomic characterization of microbiomes, pathogens and antibiotic resistance cassettes in a tertiary-care hospital, from repeated sampling (up to 1.5 years apart) of 179 sites associated with 45 beds. Deep shotgun metagenomics unveiled distinct ecological niches of microbes and antibiotic resistance genes characterized by biofilm-forming and human-microbiome-influenced environments with corresponding patterns of spatiotemporal divergence. Quasi-metagenomics with nanopore sequencing provided thousands of high-contiguity genomes, phage and plasmid sequences (>60% novel), enabling characterization of resistome and mobilome diversity and dynamic architectures in hospital environments. Phylogenetics identified multidrug-resistant strains as being widely distributed and stably colonizing across sites. Comparisons with clinical isolates indicated that such microbes can persist in hospitals for extended periods (>8 years), to opportunistically infect patients. These findings highlight the importance of characterizing antibiotic resistance reservoirs in hospitals and establish the feasibility of systematic surveys to target resources for preventing infections. Spatiotemporal characterization of microbial diversity and antibiotic resistance in a tertiary-care hospital reveals broad distribution and persistence of antibiotic-resistant organisms that could cause opportunistic infections in a healthcare setting.
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Epidemiology of efflux pumps genes mediating resistance among Staphylococcus aureus; A systematic review. Microb Pathog 2019; 139:103850. [PMID: 31706002 DOI: 10.1016/j.micpath.2019.103850] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Revised: 10/22/2019] [Accepted: 11/05/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND Efflux of antibiotics is an effective resistance mechanism among antibiotic-resistant Staphylococcus aureus. This systematic review aims to evaluate the frequency and expression of efflux pump genes in S.aureus around the world. METHOD A comprehensive literature search of several databases (Medline Pub Med, ISI, Scopus, Google Scholar, ISC, Science direct and Persian Journals Online, and citation lists) was performed. We considered published studies from 2001 to 2018. Articles reporting the prevalence and expression of efflux pump genes were selected. RESULT Among 183 articles, 36 studies were selected. Of the 36, 23 articles were conducted in Asia.6 in Europe, 5 in America and 2 in African countries. In most of these studies norA, norB, qacA/B genes were commonly evaluated by molecular methods. The presence of efflux pump genes such as norA, norB, norC, mepA, mdeA, qacA/B was detected by PCR in 21 studies and over-expression of genes were reported in 13 studies. The most frequently reported genes in Asia were norA (75%), norB (60%), mepA (35%), mdeA (33%) and qacA/B (20.8%). In European studies, the prevalence of norB was mostly reported among S.aureus isolates and norA and qacA/B were commonly found in similar studies in America. The investigation of gene expression patterns showed that norA was most frequent single-pattern in Asia and America, norB or mdeA in Europe. CONCLUSION According to this study MDR efflux pumps not only cause high-level resistance but also it considerably associated with over-expression of these genes. Due to the selective pressure on MRSA isolate, the enormous diversity of plasmid-encoded genes had been recorded in different regions, owing to the various numbers and types of isolates in each study or types of disinfectants for general use.
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Molecular Characteristics of Methicillin-Resistant Staphylococci Clinical Isolates from a Tertiary Hospital in Northern Thailand. CANADIAN JOURNAL OF INFECTIOUS DISEASES & MEDICAL MICROBIOLOGY 2018; 2018:8457012. [PMID: 30581514 PMCID: PMC6276523 DOI: 10.1155/2018/8457012] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/16/2018] [Revised: 09/17/2018] [Accepted: 10/17/2018] [Indexed: 02/04/2023]
Abstract
Methicillin-resistant staphylococci are now recognized as a major cause of infectious diseases, particularly in hospitals. Molecular epidemiology is important for prevention and control of infection, but little information is available regarding staphylococcal infections in Northern Thailand. In the present study, we examined antimicrobial susceptibility patterns, detection of antimicrobial resistance genes, and SCCmec types of methicillin-resistant S. aureus (MRSA) and methicillin-resistant coagulase-negative staphylococci (MR-CoNS) isolated from patients in a hospital in Northern Thailand. The species of MRSA and MR-CoNS were identified using combination methods, including PCR, MALDI-TOF-MS, and tuf gene sequencing. The susceptibility pattern of all isolates was determined by the disk diffusion method. Antimicrobial resistance genes, SCCmec types, and ST239 were characterized using single and multiplex PCR. ST239 was predominant in MRSA isolates (10/23). All MR-CoNS (N=31) were identified as S. haemolyticus (N=18), S. epidermidis (N=3), S. cohnii (N=3), S. capitis (N=6), and S. hominis (N=1). More than 70% of MRSA and MR-CoNS were resistant to cefoxitin, penicillin, oxacillin, erythromycin, clindamycin, gentamicin, and ciprofloxacin. In MRSA isolates, the prevalence of ermA (78.3%) and ermB (73.9%) genes was high compared to that of the ermC gene (4.3%). In contrast, ermC (87.1%) and qacA/B genes (70.9%) were predominant in MR-CoNS isolates. SCCmec type III was the dominant type of MRSA (13/23), whereas SCCmec type II was more present in S. haemolyticus (10/18). Ten MRSA isolates with SCCmec type III were ST239, which is the common type of MRSA in Asia. This finding provides useful information for a preventive health strategy directed against methicillin-resistant staphylococcal infections.
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Chan MKL, Koo SH, Quek Q, Pang WS, Jiang B, Ng LSY, Tan SH, Tan TY. Development of a real-time assay to determine the frequency of qac genes in methicillin resistant Staphylococcus aureus. J Microbiol Methods 2018; 153:133-138. [PMID: 30267717 DOI: 10.1016/j.mimet.2018.09.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Revised: 09/24/2018] [Accepted: 09/25/2018] [Indexed: 10/28/2022]
Abstract
PURPOSE The emergence of antiseptic resistance and/or antiseptic-resistance genes in methicillin-resistant Staphylococcus aureus (MRSA) may result in failure of decolonization treatments. Plasmid-encoded efflux pump genes qacA/B and qacC (smr) confer tolerance to chlorhexidine and quaternary ammonium compounds. The objective of this study was to develop and validate a multiplex real time-PCR assay for detection of antiseptic-resistance genes, apply the assay on 200 MRSA isolates and explore if carriage of these genes was associated with resistance to topical antibiotics. METHODOLOGY A SYBR-Green based multiplex real time-PCR assay was developed to detect qacA/B, qacC, and mecA (internal control) simultaneously. The multiplex assay was compared against conventional single-plex PCR followed by agarose gel electrophoresis, using DNA from the first 73 MRSA isolates, followed by multiplex testing of the remaining 127 MRSA isolates. All 200 MRSA isolates were tested for susceptibility to mupirocin, retapamulin, neomycin, bacitracin and octenidine. The genetic diversity of the isolates was investigated by spa-typing. RESULTS The concordance between multiplex and conventional PCR, in assignments of qacA/B and qacC status were 99%(72/73) and 100%(73/73) respectively. Among 200 MRSA isolates, 48(24%) and 44(23%) were found to harbour qacA/B and qacC genes, respectively. These isolates remained susceptible to many common decolonization agents, except mupirocin. The predominant spa-types were t020 and t1081 (41 and 32 isolates respectively). CONCLUSION The real-time assay performed acceptably for the detection of qac genes. A high prevalence of antiseptic-resistance genes were detected in the MRSA isolates in our population and appeared to be associated with spa-type t1081.
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Affiliation(s)
- Maurice Kok Leong Chan
- Department of Laboratory Medicine, Changi General Hospital, 2 Simei Street 3, 529889, Singapore
| | - Seok Hwee Koo
- Clinical trials and Research Unit, Changi General Hospital, 2 Simei Street 3, 529889, Singapore
| | - Qingyao Quek
- School of Life Sciences and Chemical Technology, Ngee Ann Polytechnic, 535 Clementi Road, 599489, Singapore
| | - Wan Sia Pang
- School of Life Sciences and Chemical Technology, Ngee Ann Polytechnic, 535 Clementi Road, 599489, Singapore
| | - Boran Jiang
- Department of Laboratory Medicine, Changi General Hospital, 2 Simei Street 3, 529889, Singapore
| | - Lily Siew Yong Ng
- Department of Laboratory Medicine, Changi General Hospital, 2 Simei Street 3, 529889, Singapore
| | - Si Huei Tan
- Department of Laboratory Medicine, Changi General Hospital, 2 Simei Street 3, 529889, Singapore
| | - Thean Yen Tan
- Department of Laboratory Medicine, Changi General Hospital, 2 Simei Street 3, 529889, Singapore.
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Ignak S, Nakipoglu Y, Gurler B. Frequency of antiseptic resistance genes in clinical staphycocci and enterococci isolates in Turkey. Antimicrob Resist Infect Control 2017; 6:88. [PMID: 28861267 PMCID: PMC5577796 DOI: 10.1186/s13756-017-0244-6] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Accepted: 08/20/2017] [Indexed: 11/20/2022] Open
Abstract
Background Disinfectants and antiseptics are biocides widely used in hospitals to prevent spread of pathogens. It has been reported that antiseptic resistance genes, qac’s, caused tolerance to a variety of biocidal agents, such as benzalkonium chloride (BAC) and chlorhexidine digluconate (CHDG) in Staphylococcus spp. isolates. We aimed to search the frequency of antiseptic resistance genes in clinical Staphylococcus spp. and Enterococcus spp. isolates to investigate the possible association with antiseptic tolerance and antibiotic resistance. Methods Antiseptic resistance genes (qacA/B, smr, qacG, qacH, and qacJ) isolated from Gram-positive cocci (69 Staphylococcus spp. and 69 Enterococcus spp.) were analyzed by PCR method. The minimum inhibitory concentrations (MICs) of BAC and CHDG were determined by agar dilution method, whereas antibiotic susceptibility was analyzed by disk diffusion method according to Clinical and Laboratory Standards Institute (CLSI) criteria. Results The frequency of antiseptic resistance genes was found to be high (49/69; 71.0%) in our clinical staphylococci isolates but absent (0/69; 0%) in enterococci isolates. The frequency of qacA/B and smr genes was higher (25/40; 62.5% and 7/40; 17.5%, respectively) in coagulase negative staphylococci (CNS) when compared to Staphylococcus aureus strains (3/29; 10.3%, and 4/29; 13.8%, respectively). In contrast, the frequency of qacG and qacJ genes was higher (11/29; 37.9% and 8/29; 27.5%, respectively) in S. aureus than those of CNS (5/40; 12.5%, 10/40; 25.0%) strains. qacH was not identified in none of the strains. We found an association between presence of antiseptic resistance genes and increased MIC values of BAC (>4 μg/mL) in staphylococci and it was found to be statistically statistically significant (p < 0.01). We also showed that MICs of BAC and CHDG of vancomycin-resistant enterococci (VRE) isolates were significantly higher than those of vancomycin-susceptible enterococci (VSE) isolates (p < 0.01). Conclusions For our knowledge, our study is the first to investigate antiseptic resistance genes in enterococci and also qacG, qacH, and qacJ genes in staphylococci isolates in Turkey. Further studies are needed to revise the biocide policy and to support infection control programs to avoid the development of new resistance mechanisms.
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Affiliation(s)
- Seyda Ignak
- Department of Medical Biology, Bahcesehir University School of Medicine, Sahrayıcedid Mah. Batman Sok. No:66-68, Yenisahra-Göztepe, Istanbul, Turkey
| | - Yasar Nakipoglu
- Istanbul Faculty of Medicine, Department of Medical Microbiology, Istanbul University, Istanbul, Turkey
| | - Bulent Gurler
- Istanbul Faculty of Medicine, Department of Medical Microbiology, Istanbul University, Istanbul, Turkey
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Kampf G. Acquired resistance to chlorhexidine – is it time to establish an ‘antiseptic stewardship’ initiative? J Hosp Infect 2016; 94:213-227. [DOI: 10.1016/j.jhin.2016.08.018] [Citation(s) in RCA: 196] [Impact Index Per Article: 24.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2016] [Accepted: 08/18/2016] [Indexed: 01/12/2023]
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