Culture-independent detection of chlorhexidine resistance genes A/B and in bacterial DNA recovered from body sites treated with chlorhexidine-containing dressings Free

Abstract

Dressings containing chlorhexidine gluconate (CHG) are increasingly used in clinical environments for prevention of infection at central venous catheter insertion sites. Increased tolerance to this biocide in staphylococci is primarily associated with the presence of and genes.

We used a culture-independent method to assess the prevalence of these genes in 78 DNA specimens recovered from the skin of 43 patients at catheter insertion sites in the arm that were covered with CHG dressings.

Of the 78 DNA specimens analysed, 52 (67 %) possessed and 14 (18 %) possessed ; all samples positive for were also positive for A/B. These prevalence rates were not statistically greater than those observed in a subsample of specimens taken from non-CHG treated contralateral arms and non-CHG-dressing exposed arms. A statistically greater proportion of specimens with greater than 72 h exposure to CHG dressings were -positive (=0.04), suggesting that the patients were contaminated with bacteria or DNA containing A/B during their hospital stay. The presence of genes was not positively associated with the presence of DNA specific for and in these specimens.

Our results show that CHG genes are highly prevalent on hospital patients’ skin, even in the absence of viable bacteria.

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2017-04-01
2024-03-29
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References

  1. Milstone AM, Passaretti CL, Perl TM. Chlorhexidine: expanding the armamentarium for infection control and prevention. Clin Infect Dis 2008; 46:274–281 [View Article][PubMed]
    [Google Scholar]
  2. Lowbury EJ, Lilly HA. Use of 4 per cent chlorhexidine detergent solution (Hibiscrub) and other methods of skin disinfection. Br Med J 1973; 1:510–515 [View Article][PubMed]
    [Google Scholar]
  3. Derde LP, Dautzenberg MJ, Bonten MJ. Chlorhexidine body washing to control antimicrobial-resistant bacteria in intensive care units: a systematic review. Intensive Care Med 2012; 38:931–939 [View Article][PubMed]
    [Google Scholar]
  4. Ho CM, Li CY, Ho MW, Lin CY, Liu SH et al. High rate of qacA- and qacB-positive methicillin-resistant Staphylococcus aureus isolates from chlorhexidine-impregnated catheter-related bloodstream infections. Antimicrob Agents Chemother 2012; 56:5693–5697 [View Article][PubMed]
    [Google Scholar]
  5. Mcdonnell G, Russell AD. Antiseptics and disinfectants: activity, action, and resistance. Clin Microbiol Rev 1999; 12:147–179[PubMed]
    [Google Scholar]
  6. Noguchi N, Nakaminami H, Nishijima S, Kurokawa I, So H et al. Antimicrobial agent of susceptibilities and antiseptic resistance gene distribution among methicillin-resistant Staphylococcus aureus isolates from patients with impetigo and Staphylococcal scalded skin syndrome. J Clin Microbiol 2006; 44:2119–2125 [View Article][PubMed]
    [Google Scholar]
  7. Longtin J, Seah C, Siebert K, Mcgeer A, Simor A et al. Distribution of antiseptic resistance genes qacA, qacB, and smr in methicillin-resistant Staphylococcus aureus isolated in Toronto, Canada, from 2005 to 2009. Antimicrob Agents Chemother 2011; 55:2999–3001 [View Article][PubMed]
    [Google Scholar]
  8. Mcneil JC, Hulten KG, Kaplan SL, Mahoney DH, Mason EO. Staphylococcus aureus infections in pediatric oncology patients: high rates of antimicrobial resistance, antiseptic tolerance and complications. Pediatr Infect Dis J 2013; 32:124–128 [View Article][PubMed]
    [Google Scholar]
  9. Noguchi N, Hase M, Kitta M, Sasatsu M, Deguchi K et al. Antiseptic susceptibility and distribution of antiseptic-resistance genes in methicillin-resistant Staphylococcus aureus. FEMS Microbiol Lett 1999; 172:247–253 [View Article][PubMed]
    [Google Scholar]
  10. Zhang M, O'Donoghue MM, Ito T, Hiramatsu K, Boost MV. Prevalence of antiseptic-resistance genes in Staphylococcus aureus and coagulase-negative Staphylococci colonising nurses and the general population in Hong Kong. J Hosp Infect 2011; 78:113–117 [View Article][PubMed]
    [Google Scholar]
  11. Lyon BR, Skurray R. Antimicrobial resistance of Staphylococcus aureus: genetic basis. Microbiol Rev 1987; 51:88–134[PubMed]
    [Google Scholar]
  12. Suwantarat N, Carroll KC, Tekle T, Ross T, Maragakis LL et al. High prevalence of reduced chlorhexidine susceptibility in organisms causing central line-associated bloodstream infections. Infect Control Hosp Epidemiol 2014; 35:1183–1186 [View Article][PubMed]
    [Google Scholar]
  13. Loveday HP, Wilson JA, Pratt RJ, Golsorkhi M, Tingle A et al. Epic3: national evidence-based guidelines for preventing healthcare-associated infections in NHS hospitals in England. J Hosp Infect 2014; 86:S1–S70 [View Article][PubMed]
    [Google Scholar]
  14. O'Grady NP, Alexander M, Burns LA, Dellinger EP, Garland J et al. Guidelines for the prevention of intravascular catheter-related infections. Clin Infect Dis 2011; 52:e162–e193 [View Article][PubMed]
    [Google Scholar]
  15. Shapiro JM, Bond EL, Garman JK. Use of a chlorhexidine dressing to reduce microbial colonization of epidural catheters. Anesthesiology 1990; 73:625–631 [View Article][PubMed]
    [Google Scholar]
  16. Timsit JF, Schwebel C, Bouadma L, Geffroy A, Garrouste-Orgeas M et al. Chlorhexidine-impregnated sponges and less frequent dressing changes for prevention of catheter-related infections in critically ill adults: a randomized controlled trial. J Am Med Assoc 2009; 301:1231–1241 [View Article][PubMed]
    [Google Scholar]
  17. Timsit JF, Mimoz O, Mourvillier B, Souweine B, Garrouste-Orgeas M et al. Randomized controlled trial of chlorhexidine dressing and highly adhesive dressing for preventing catheter-related infections in critically ill adults. Am J Respir Crit Care Med 2012; 186:1272–1278 [View Article][PubMed]
    [Google Scholar]
  18. Safdar N, O'Horo JC, Ghufran A, Bearden A, Didier ME et al. Chlorhexidine-impregnated dressing for prevention of catheter-related bloodstream infection: a meta-analysis. Crit Care Med 2014; 42:1703–1713 [View Article][PubMed]
    [Google Scholar]
  19. Ullman AJ, Cooke ML, Mitchell M, Lin F, New K et al. Dressings and securement devices for central venous catheters (CVC). Cochrane Database Syst Rev 2015Cd010367 [View Article][PubMed]
    [Google Scholar]
  20. Rickard CM, Marsh N, Webster J, Playford EG, Mcgrail MR et al. Securing All intraVenous devices Effectively in hospitalised patients—the SAVE trial: study protocol for a multicentre randomised controlled trial. BMJ Open 2015; 5:e008689 [View Article][PubMed]
    [Google Scholar]
  21. Noguchi N, Suwa J, Narui K, Sasatsu M, Ito T et al. Susceptibilities to antiseptic agents and distribution of antiseptic-resistance genes qacA/B and smr of methicillin-resistant Staphylococcus aureus isolated in Asia during 1998 and 1999. J Med Microbiol 2005; 54:557–565 [View Article][PubMed]
    [Google Scholar]
  22. Heikens E, Fleer A, Paauw A, Florijn A, Fluit AC. Comparison of genotypic and phenotypic methods for species-level identification of clinical isolates of coagulase-negative staphylococci. J Clin Microbiol 2005; 43:2286–2290 [View Article][PubMed]
    [Google Scholar]
  23. Brakstad OG, Aasbakk K, Maeland JA. Detection of Staphylococcus aureus by polymerase chain reaction amplification of the nuc gene. J Clin Microbiol 1992; 30:1654–1660[PubMed]
    [Google Scholar]
  24. Eveillard M, Martin Y, Hidri N, Boussougant Y, Joly-Guillou ML. Carriage of methicillin-resistant Staphylococcus aureus among hospital employees: prevalence, duration, and transmission to households. Infect Control Hosp Epidemiol 2004; 25:114–120 [View Article][PubMed]
    [Google Scholar]
  25. Weisburg WG, Barns SM, Pelletier DA, Lane DJ. 16S ribosomal DNA amplification for phylogenetic study. J Bacteriol 1991; 173:697–703 [View Article][PubMed]
    [Google Scholar]
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