Tolerance to disinfectants (chlorhexidine and isopropanol) and its association with antibiotic resistance in clinically-relatedKlebsiella pneumoniaeisolates

Abstract

Disinfectants play an essential role in controlling the dissemination of bacteria in health care settings, but it may also contribute to the selection of antibiotic resistance bacteria. This study looked at Klebsiella pneumoniae isolates collected from three hospitals in Lima, Peru, in order to evaluate: their susceptibility to chlorhexidine [CHG] and isopropanol [ISP]), and their association with antimicrobial susceptibility. We analyzed 59 K. pneumoniae isolates and assessed their CHG and ISP susceptibility by minimum inhibitory concentrations (MICs). Additionally, we performed a regression analysis to assess the association between disinfectant tolerance and antibiotic resistance (measured by the disc diffusion method), colistin resistance (by microdilution), carbapenemases presence (by polymerase chain reaction [PCR]), and clonal relationships (by pulsed-field gel electrophoresis [PFGE]). Eleven K. pneumoniae strains were isolated from fomites, and 48 strains from clinical samples. The MIC range of these isolates was 8-128 µg/ml for CHG and 16-256 mg/ml for ISP. We found that resistance to trimethoprim/sulfamethoxazole (TMP/SMX) was the main factor associated with CHG log 2 MIC (ß = 0.65; 95%CI: 0.03, 1.27; R 2 = 0.07). In the case of ISP, the log 2 (MIC) was associated with the institution of origin, showing lower ISP log 2 (MIC) in fomites compared to clinical samples(ß = −0.77; 95%CI: −1.54, −0.01; R 2 = 0.08). Resistance to CHG and ISP among K. pneumoniae isolates found in Peruvian hospitals seems to be elevated and highly variable. Further studies are needed to confirm our results and implement actionable interventions if necessary.

The effect of disinfectants and antiseptics on co- and cross-selection of resistance to antibiotics in aquatic environments and wastewater treatment plants

“…For alcohol-based disinfectants, reports have claimed no cross-resistance between DAs and antibiotics (Kampf, 2018a , b ). This is supported by a recent study of Morante et al ( 2021 ) which found no relation in Klebsiella pneumoniae isolates resistant to isopropanol and antibiotic resistances. This is contrary to de Carvalho et al ( 2020 ) who showed that Mycobacterium vaccae were more resistant to antibiotics after disinfectant exposure.…”

Disinfection Strategies for Carbapenem-Resistant Klebsiella pneumoniae in a Healthcare Facility

“…The efflux pumps can change the structure and physiological functions of the bacterial outer membrane, and protect themselves against biocides [ 15 , 21 ]. Some multi-drug efflux pump families are able to mediate the efflux of multiple disinfectants and antibiotics at the same time, leading to cross resistance [ 22 , 23 ]. To explore the correlation of efflux pump genes with the resistance of CRKP strains to disinfectants, we detected three efflux pump genes ( oqxA , oqxB , and qacE ∆1-sul1 ) [ 24 , 25 , 26 ].…”

Fungal, parasitological, and bacterial coinfection in a severely ill COVID‐19 patient in Peru

“…Future studies are needed to understand the spectrum of Cp‐Kpn during the COVID‐19 pandemic. In Peru, there is increasing antibiotic resistance 13 in isolated patients resistant to hospital disinfectants 18 and may spread the virus in ICUs, impacting the safety of COVID‐19 patients and causing rapid mortality.…”