title: Triclosan resistance in methicillin-resistant Staphylococcus aureus expressed as small colony variants: a novel mode of evasion of susceptibility to antiseptics.
abstract: OBJECTIVE
  Triclosan is in widespread use in domestic, commercial and healthcare settings and is used to reduce methicillin-resistant Staphylococcus aureus (MRSA) load in carriers. Triclosan resistance is uncommon, usually being due to mutation in fabI or overexpression of efflux pumps. This study investigated the ability of triclosan-containing silicone elastomer to kill MRSA adherent to its surface.
  
  
  METHODS
  Silicone discs containing triclosan were prepared by a matrix-expansion method previously described. Discs were exposed to three strains of MRSA for 1 h for adhesion to take place. After incubation, discs were removed at intervals, sonicated and the sonicates analysed by chemiluminescence and viable counting. Survivors were found to consist of small colony variants (SCVs). These were then subjected to tests for known SCV characteristics and for susceptibility to triclosan.
  
  
  RESULTS
  Viable counts fell until 51 h, when they began to increase, due to SCV. Of the three SCV strains, two showed impaired coagulase production and all showed reduced deoxyribonuclease production. None was auxotrophic. MICs of triclosan in the SCV rose by between 8- and 67-fold.
  
  
  CONCLUSIONS
  Prolonged exposure of MRSA to triclosan-impregnated silicone, as in 'antimicrobial' plastics or catheters, resulted in the induction of SCV status and triclosan resistance. This has implications for industrial, medical and domestic use of polymers containing triclosan. SCVs are pathogenic and persistent. The widespread use of triclosan could lead to infection with MRSA SCVs, and new antimicrobials with physiological targets similar to that of triclosan might give rise to SCV resistance in clinical use.
authors.affiliation: Biomaterials-Related Infection Group, Division of Orthopaedic and Accident Surgery, School of Medical and Surgical Sciences, University Hospitals Nottingham, Nottingham NG7 2UH, UK. roger.bayston@nottingham.ac.uk
authors.forename: Roger
authors.initials: R
authors.lastname: Bayston
authors.forename: Waheed
authors.initials: W
authors.lastname: Ashraf
authors.forename: Toni
authors.initials: T
authors.lastname: Smith
mesh_terms: D000891:Anti-Infective Agents, Local / Q000494:pharmacology*; D052978:Disk Diffusion Antimicrobial Tests; D024881:Drug Resistance, Bacterial; D006801:Humans; D008163:Luminescent Measurements; D016106:Methicillin Resistance; D050296:Microbial Viability / Q000187:drug effects; D012828:Silicones; D013211:Staphylococcus aureus / Q000166:cytology / Q000187:drug effects* / Q000302:isolation & purification; D014260:Triclosan / Q000494:pharmacology*
chemical_list: D000891:Anti-Infective Agents, Local; D012828:Silicones; D014260:Triclosan