Characterization of reduced susceptibility to chlorhexidine among Gram-negative bacteria

Abstract

Chlorhexidine gluconate (CHG) is one of the most commonly used antiseptic, acting against Gram-negative, Gram-positive bacteria, yeast and fungi. However, over use may lead to reduced susceptibility of different bacteria to CHG. This study aimed to characterize the CHG susceptibility among Gram-negative strains in Israel, to evaluate factors that may affect this susceptibility, and to compare CHG susceptibility between ESBLs bacteria to strains without these enzymes. Pseudomonas aeruginosa, Proteus mirabilis, Klebsiella spp, Escherichia coli, and Acinetobacter baumannii were isolated from clinical samples of 193 patients hospitalized at Padeh-Poriya Medical Center. Phenotypic CHG susceptibility was assessed by determining minimum inhibitory concentration (MIC) and minimum bactericidal concentration (MBC). The highest CHG MIC was found among P. mirabilis. The differences between the CHG MIC values among the different strains were statistically significant (p < 0.001). ESBL-positive strains had higher MIC values as compared to ESBL-negative strains (p = 0.030). A significant association was found between CHG susceptibility and sample source (p = 0.015). In conclusion, the information gathered here significantly improves our knowledge on the reduced susceptibility to CHG among Gram-negative bacteria in Israel. Moreover, ESBL-positive bacteria are less susceptible to CHG and finally, bacteria in sputum, wounds, and body fluids are less CHG-susceptible.

Keywords: Antiseptics; Chlorhexidine gluconate; Gram-negative bacteria; Reduced susceptibility.