title: Klebsiella oxytoca with reduced sensitivity to chlorhexidine isolated from a diabetic foot ulcer.
abstract: In most hospitals, chlorhexidine is used as skin antiseptic prior to clinical procedures, in dressings and when bathing patients. We hereby report, for the first time, the isolation of a clinical Klebsiella oxytoca isolate with reduced sensitivity to chlorhexidine from a foot ulcer of a diabetic patient, which is a common and serious complication associated with diabetes. The Minimum Inhibitory Concentration of the K. oxytoca isolate to chlorhexidine was found to be 30 mg/L and the Minimum Bactericidal Concentration was 60 mg/L. An increased resistance to ethidium bromide (MIC 200 mg/ L) was also observed. Molecular tests revealed that the isolate contained blaCTXM15, blaT(EM-1) and bla(SHV). The other resistant genes detected were qnrB1 and aac(6')-Ib-cr. The resistant determinants were located on a class I integron integrase (intI1) containing qacE gene. DNA sequencing showed homology to K. oxytoca plasmid pACM1. Identification of K. oxytoca with reduced sensitivity to chlorhexidine raises concern regarding dilution standards in hospitals. Adherence to the hospitals' infection control policies should be strictly monitored to avoid continuous low level exposure of bacteria to biocides, specifically in developing countries.
authors.affiliation: Department of Medical Laboratory Sciences, Faculty of Allied Health Sciences, Kuwait University, P.O. Box 31470-Sulaibekhat, 90805 Sulaibekhat, Kuwait. Electronic address: leila@hsc.edu.kw.
authors.forename: Leila
authors.initials: L
authors.lastname: Vali
authors.affiliation: Department of Medical Laboratory Sciences, Faculty of Allied Health Sciences, Kuwait University, P.O. Box 31470-Sulaibekhat, 90805 Sulaibekhat, Kuwait.
authors.forename: Ali A
authors.initials: AA
authors.lastname: Dashti
authors.affiliation: Department of Medical Laboratory Sciences, Faculty of Allied Health Sciences, Kuwait University, P.O. Box 31470-Sulaibekhat, 90805 Sulaibekhat, Kuwait.
authors.forename: Sherief
authors.initials: S
authors.lastname: El-Shazly
authors.affiliation: Department of Medical Laboratory Sciences, Faculty of Allied Health Sciences, Kuwait University, P.O. Box 31470-Sulaibekhat, 90805 Sulaibekhat, Kuwait.
authors.forename: Mehrez M
authors.initials: MM
authors.lastname: Jadaon
mesh_terms: D000890:Anti-Infective Agents / Q000494:pharmacology*; D000891:Anti-Infective Agents, Local / Q000494:pharmacology*; D002710:Chlorhexidine / Q000494:pharmacology*; D017719:Diabetic Foot / Q000382:microbiology*; D024881:Drug Resistance, Bacterial / Q000235:genetics*; D005260:Female; D006801:Humans; D019426:Integrases / Q000235:genetics; D041121:Klebsiella oxytoca / Q000187:drug effects* / Q000235:genetics / Q000302:isolation & purification; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D010957:Plasmids / Q000235:genetics; D001618:beta-Lactamases / Q000378:metabolism
chemical_list: D000890:Anti-Infective Agents; D000891:Anti-Infective Agents, Local; D019426:Integrases; C115006:integron integrase IntI1; D001618:beta-Lactamases; D002710:Chlorhexidine
keywords: Chlorhexidine; Diabetes; Extended-spectrum beta-lactamases; Klebsiella oxytoca; qacE; qnrB