Characterization of<i>Staphylococcus epidermidis</i>strains isolated from industrial cleanrooms under regular routine disinfection

Ribič, Urška; Klančnik, Anja; Jeršek, Barbara

doi:10.1111/jam.13424

Cited by 13 publications

(2 citation statements)

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“…Similarly, an outbreak strain of ST228 MRSA was previously shown to harbor qacA in nearly all of the clinical isolates obtained from a tertiary care hospital in Switzerland (Senn et al, 2016 ); in the hospital environment, microbial exposure to chlorhexidine would likely be a constant, selective pressure. In a recent study, S. epidermidis isolates were collected from industrial cleanrooms and startlingly revealed to carry qacA/B at a high rate; 98.3% (56/57) of the isolates carried qacA/B (Ribič et al, 2017 ). This extreme example suggests that in environments where there is a constant exposure to chlorhexidine or other quaternary compounds, there is a strong selective pressure for Staphylococcal species to acquire and maintain qacA/B .…”

Section: Discussionmentioning

confidence: 99%

Conjugative Transfer of a Novel Staphylococcal Plasmid Encoding the Biocide Resistance Gene, qacA

et al. 2018

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Staphylococcus aureus is the leading cause of skin and soft tissue infections (SSTI). Some S. aureus strains harbor plasmids that carry genes that affect resistance to biocides. Among these genes, qacA encodes the QacA Multidrug Efflux Pump that imparts decreased susceptibility to chlorhexidine, a biocide used ubiquitously in healthcare facilities. Furthermore, chlorhexidine has been considered as a S. aureus decolonization strategy in community settings. We previously conducted a chlorhexidine-based SSTI prevention trial among Ft. Benning Army trainees. Analysis of a clinical isolate (C02) from that trial identified a novel qacA-positive plasmid, pC02. Prior characterization of qacA-containing plasmids is limited and conjugative transfer of those plasmids has not been demonstrated. Given the implications of increased biocide resistance, herein we characterized pC02. In silico analysis identified genes typically associated with conjugative plasmids. Moreover, pC02 was efficiently transferred to numerous S. aureus strains and to Staphylococcus epidermidis. We screened additional qacA-positive S. aureus clinical isolates and pC02 was present in 27% of those strains; other unique qacA-harboring plasmids were also identified. Ten strains were subjected to whole genome sequencing. Sequence analysis combined with plasmid screening studies suggest that qacA-containing strains are transmitted among military personnel at Ft. Benning and that strains carrying qacA are associated with SSTIs within this population. The identification of a novel mechanism of qacA conjugative transfer among Staphylococcal strains suggests a possible future increase in the prevalence of antiseptic tolerant bacterial strains, and an increase in the rate of infections in settings where these agents are commonly used.

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Section: Discussionmentioning

confidence: 99%

Conjugative Transfer of a Novel Staphylococcal Plasmid Encoding the Biocide Resistance Gene, qacA

et al. 2018

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“…Other groups have demonstrated increased plasmid stability in subinhibitory concentrations of metals and antiseptics, as well as cross-resistance development in subinhibitory antibiotic concentrations (Braoudaki & Hilton, 2004;Buffet-Bataillon et al, 2012;Gullberg et al, 2014;Kampf, 2018;Wand, Bock, Bonney, & Sutton, 2017). Outside of the aquatic environment, subinhibitory concentrations of antiseptics can also be found on surfaces, which provide similar selective pressures (Bashir et al, 2019;Ribič, Klančnik, & Jeršek, 2017). Herein, we showed that subinhibitory concentrations of antiseptics negated the fitness cost associated with carrying a large plasmid in S. aureus (Figure 2), and in doing so coselected for the presence of multiple antimicrobial resistance genes on pC02.…”

Section: F I G U R E 1 Conjugative Triclosan Resistance (A)mentioning

confidence: 99%

Fitness costs associated with carriage of a large staphylococcal plasmid are reduced by subinhibitory concentrations of antiseptics

LaBreck

Merrell

2020

MicrobiologyOpen

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Staphylococcus aureus carries a collection of mobile genetic elements that often harbor virulence and antimicrobial resistance genes. Since the introduction of antibiotics, plasmids have become a major genetic element responsible for the distribution of antimicrobial resistance. Under antimicrobial selection, resistance plasmids are maintained within bacterial populations as a means to ensure survival. However, in the absence of selection, large plasmids can be lost due to the fitness costs associated with harboring these genetic elements. pC02 is a previously identified multidrug resistance, conjugative plasmid that is found in S. aureus. In addition to antibiotic resistance, pC02 also carries genes known to be associated with antiseptic resistance.Among these, we previously characterized the contribution of qacA to pC02 mediated reduced chlorhexidine susceptibility. Herein, we demonstrate that pC02 also mediates triclosan resistance, likely due to the presence of fabI, a known triclosan resistance gene. Moreover, we demonstrate that conjugative transfer of pC02 increases triclosan resistance in recipient cells. Competition assays demonstrated a fitness cost associated with carriage of the large pC02 plasmid. However, subinhibitory concentrations of either chlorhexidine or triclosan abrogated this fitness cost. Given the widespread use of these antiseptics, both of which accumulate in wastewater and other environmental reservoirs, indiscriminate use of antiseptics likely imposes a constant selective pressure that promotes maintenance of antimicrobial resistance factors within S. aureus. K E Y W O R D Santibiotic resistance, bacterial plasmids, mobile genetic elements, Staphylococcus

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Benzalkonium Chloride

Kampf

2018

Antiseptic Stewardship

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Characterization ofStaphylococcus epidermidisstrains isolated from industrial cleanrooms under regular routine disinfection

Abstract: To assure controlled cleanroom environments, bacterial strains isolated from cleanroom environments need to be characterized regularly using several investigative methods.

Cited by 13 publications

References 42 publications

Conjugative Transfer of a Novel Staphylococcal Plasmid Encoding the Biocide Resistance Gene, qacA

Conjugative Transfer of a Novel Staphylococcal Plasmid Encoding the Biocide Resistance Gene, qacA

Fitness costs associated with carriage of a large staphylococcal plasmid are reduced by subinhibitory concentrations of antiseptics

Benzalkonium Chloride

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