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Decreased susceptibility to chlorhexidine and prevalence of disinfectant resistance genes among clinical isolates of Staphylococcus epidermidis
Department of Laboratory Medicine, Clinical Microbiology, Örebro University Hospital, Örebro, Sweden.
Department of Cardiothoracic and Vascular Surgery, Örebro University Hospital, Örebro, Sweden.
Örebro University Hospital. Department of Laboratory Medicine, Clinical Microbiology, Örebro University Hospital, Örebro, Sweden.
Örebro University Hospital. Department of Laboratory Medicine, Clinical Microbiology, Örebro University Hospital, Örebro, Sweden.
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2014 (English)In: Acta Pathologica, Microbiologica et Immunologica Scandinavica (APMIS), ISSN 0903-4641, E-ISSN 1600-0463, Vol. 122, no 10, p. 961-967Article in journal (Refereed) Published
Abstract [en]

Staphylococcus epidermidis, despite regarded as a commensal, is recognized as a nosocomial pathogen usually by acting as an opportunist, especially in infections associated 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). The currently most widely used antiseptic compounds are alcohols and quaternary ammonium compounds (QACs), predominantly chlorhexidine.

The aim of this study was to investigate if decreased susceptibility to chlorhexidine among S. epidermidis was present in our setting. S. epidermidis (n=143) were obtained from prosthetic joint infections (PJI) (n=61), commensals (n=24), post-operative infections after cardiothoracic surgery (n=31), and the skin of the chest after routine disinfection prior cardiothoracic surgery (n=27). Determination of MIC of chlorhexidine was performed on Müeller 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 cardiothoracic isolates, 21% of commensals, and 7% of isolates obtained from the skin of cardiothoracic 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 cardiothoracic isolates, 25% of commensals, and 19% of isolates obtained from the skin of cardiothoracic patients. In conclusion, decreased susceptibility to chlorhexidine as well as QAC resistance genes was highly prevalent among S. epidermidis causing deep SSIs.

Place, publisher, year, edition, pages
Hoboken, USA: Wiley-Blackwell, 2014. Vol. 122, no 10, p. 961-967
Keywords [en]
Staphylococcus epidermidis, chlorhexidine, prosthetic joint infection, biocide resistance, nosocomial infection
National Category
Immunology in the medical area Microbiology in the medical area
Identifiers
URN: urn:nbn:se:oru:diva-32651DOI: 10.1111/apm.12239ISI: 000342341100008PubMedID: 24628476Scopus ID: 2-s2.0-84895913075OAI: oai:DiVA.org:oru-32651DiVA, id: diva2:676497
Note

Funding Agency:

Örebro County Council Research Committee

Available from: 2013-12-06 Created: 2013-12-06 Last updated: 2018-06-04Bibliographically approved
In thesis
1. The effect  of peroperative skin preparation on bacterial growth during cardiac surgery
Open this publication in new window or tab >>The effect  of peroperative skin preparation on bacterial growth during cardiac surgery
2013 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Routine products are used and procedures are followed in order to prevent and minimize the bacterial contamination of the surgical wound, and thus reduce the risk of postoperative wound infections. The overall aim of this thesis was to investigate the effect of different preoperative skin preparation before cardiac surgery.

In study I, 10 healthy volunteers were compared in time to recolonization of the skin and bacterial growth with or without plastic adhesive drape. Bacterial samples were taken as paired samples on both side of the sternum. Plastic drape on disinfected skin seems to hasten recolonization compared with bare skin.

In study II, 135 cardiac surgery patients were comparing plastic adhesive drape versus bare skin on the chest regarding intra-operative bacterial growth. Plastic adhesive drape did not reduce the bacterial recolonization or wound contamination, P. acnes colonizes males more often than females and P. acnes is not affected by disinfection with 0.5% chlorhexidine in ethanol.

Study III, compared the leg harvesting site with or without microbal skin sealant in 135 CABG patients regarding intraoperative bacterial growth and postoperative wound infection. Almost no bacterial growth was found during surgery regardless of the use of microbial skin sealant and bare skin. A high incidence of postoperative wound infections (16.8%) in 2 month follow up was present and SSI was largely caused by S. aureus, i.e. other bacterial species than observed intraoperative.

Study IV, a descriptive study using phenotypic and genotypic methods investigate susceptibility to chlorhexidine among S. epidermidis indicating that S. epidermidis isolates following preoperative skin disinfection are sensitive tochlorhexidine.

Place, publisher, year, edition, pages
Örebro: Örebro universitet, 2013. p. 99
Series
Örebro Studies in Care Sciences, ISSN 1652-1153 ; 50
Keywords
OR, plastic adhesive drape, microbial skin sealent, chlorhexidine
National Category
Nursing
Research subject
Nursing Science
Identifiers
urn:nbn:se:oru:diva-31039 (URN)978-91-7668-978-3 (ISBN)
Public defence
2013-12-16, Wilandersalen, Universitetssjukhuset i Örebro, S. Grev Rosengatan 18, 703 62 Örebro, 09:00 (Swedish)
Opponent
Supervisors
Available from: 2013-09-30 Created: 2013-09-30 Last updated: 2017-09-15Bibliographically approved

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Falk-Brynhildsen, KarinJacobsson, SusanneHellmark, BengtUnemo, MagnusSöderquist, Bo

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Falk-Brynhildsen, KarinJacobsson, SusanneHellmark, BengtUnemo, MagnusSöderquist, Bo
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Örebro University HospitalSchool of Medicine, Örebro University, Sweden
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Acta Pathologica, Microbiologica et Immunologica Scandinavica (APMIS)
Immunology in the medical areaMicrobiology in the medical area

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