title: Decreased susceptibility to chlorhexidine and prevalence of disinfectant resistance genes among clinical isolates of Staphylococcus epidermidis.
abstract: Staphylococcus epidermidis is a versatile agent, being both a commensal and a nosocomial pathogen usually with an opportunistic role in association with implanted foreign body materials. Pre-operative antiseptic preparation is an important strategy for reducing the risk of complications such as surgical site infection (SSI). Currently, the most widely used antiseptics are alcohols, quaternary ammonium compounds (QACs), and the bisbiguanide chlorhexidine. Occurrence of resistance to the latter agent has drawn increasing attention. The aim of this study was to investigate if decreased susceptibility to chlorhexidine among S. epidermidis was present in our setting, a Swedish university hospital. Staphylococcus epidermidis (n = 143), retrospectively collected, were obtained from prosthetic joint infections (PJI) (n = 61), post-operative infections after cardiac surgery (n = 31), and the skin of the chest after routine disinfection prior to cardiac surgery (n = 27). In addition, 24 commensal isolates were included. Minimum inhibitory concentration (MIC) of chlorhexidine was determined on Mueller Hinton agar plates supplemented with serial dilutions of chlorhexidine. Five QAC resistance genes, qacA/B, smr, qacH, qacJ, and qacG, were detected using PCR. Decreased susceptibility to chlorhexidine was found in 54% of PJI isolates, 68% of cardiac isolates, 21% of commensal isolates, and 7% of skin isolates from cardiac patients, respectively. The qacA/B gene was present in 62/143 isolates (43%), smr in 8/143 (6%), and qacH in one isolate (0.7%). The qacA/B gene was found in 52% of PJI isolates, 61% of cardiac isolates, 25% of commensal isolates, and 19% of the skin isolates. In conclusion, decreased susceptibility to chlorhexidine, as well as QAC resistance genes, were prevalent among S. epidermidis isolates associated with deep SSIs.
authors.affiliation: Department of Laboratory Medicine, Clinical Microbiology, Örebro University Hospital, Örebro, Sweden.
authors.forename: Gustaf
authors.initials: G
authors.lastname: Prag
authors.forename: Karin
authors.initials: K
authors.lastname: Falk-Brynhildsen
authors.forename: Susanne
authors.initials: S
authors.lastname: Jacobsson
authors.forename: Bengt
authors.initials: B
authors.lastname: Hellmark
authors.forename: Magnus
authors.initials: M
authors.lastname: Unemo
authors.forename: Bo
authors.initials: B
authors.lastname: Söderquist
mesh_terms: D000891:Anti-Infective Agents, Local / Q000627:therapeutic use; D002710:Chlorhexidine / Q000627:therapeutic use*; D004202:Disinfectants / Q000627:therapeutic use*; D024881:Drug Resistance, Bacterial / Q000235:genetics*; D006801:Humans; D008826:Microbial Sensitivity Tests; D015995:Prevalence; D000644:Quaternary Ammonium Compounds / Q000627:therapeutic use; D012189:Retrospective Studies; D012867:Skin / Q000382:microbiology; D013203:Staphylococcal Infections / Q000188:drug therapy* / Q000235:genetics; D013212:Staphylococcus epidermidis / Q000187:drug effects*
chemical_list: D000891:Anti-Infective Agents, Local; D004202:Disinfectants; D000644:Quaternary Ammonium Compounds; D002710:Chlorhexidine
keywords: Staphylococcus epidermidis; biocide resistance; chlorhexidine; nosocomial infection; prosthetic joint infection