Reduced Chlorhexidine and Daptomycin Susceptibility in Vancomycin-Resistant Enterococcus Faecium after Serial Chlorhexidine Exposure

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dc.contributor.ORCID0000-0002-7343-9271 (Palmer, KL)en_US
dc.contributor.authorBhardwaj, Poojaen_US
dc.contributor.authorHans, Amritaen_US
dc.contributor.authorRuikar, Kinnarien_US
dc.contributor.authorGuan, Ziqiangen_US
dc.contributor.authorPalmer, Kelli L.en_US
dc.contributor.utdAuthorBhardwaj, Poojaen_US
dc.contributor.utdAuthorHans, Amritaen_US
dc.contributor.utdAuthorRuikar, Kinnarien_US
dc.contributor.utdAuthorPalmer, Kelli L.en_US
dc.date.accessioned2018-10-22T19:36:48Z
dc.date.available2018-10-22T19:36:48Z
dc.date.created2018-01en_US
dc.date.issued2018-10-22
dc.description.abstractVancomycin-resistant Enterococcus faecium strains (VREfm) are critical public health concerns because they are among the leading causes of hospital-acquired bloodstream infections. Chlorhexidine (CHX) is a bisbiguanide cationic antiseptic that is routinely used for patient bathing and other infection control practices. VREfm are likely frequently exposed to CHX; however, the long-term effects of CHX exposure have not been studied in enterococci. In this study, we serially exposed VREfm to increasing concentrations of CHX for a period of 21 days in two independent experimental evolution trials. Reduced CHX susceptibility emerged (4-fold shift in CHX MIC). Subpopulations with reduced daptomycin (DAP) susceptibility were detected, which were further analyzed by genome sequencing and lipidomic analysis. Across the trials, we identified adaptive changes in genes with predicted or experimentally confirmed roles in chlorhexidine susceptibility (efrE), global nutritional stress response (relA), nucleotide metabolism (cmk), phosphate acquisition (phoU), and glycolipid biosynthesis (bgsB), among others. Moreover, significant alterations in membrane phospholipids were identified for some populations with reduced DAP susceptibility. Our results are clinically significant because they identify a link between serial subinhibitory CHX exposure and reduced DAP susceptibility. In addition, the CHX-induced genetic and lipidomic changes described in this study offer new insights into the mechanisms underlying the emergence of antibiotic resistance in VREfm.en_US
dc.description.departmentSchool of Natural Sciences and Mathematicsen_US
dc.description.sponsorshipNIH grant nos. GM-069338 and EY023666en_US
dc.identifier.bibliographicCitationBhardwaj, Pooja, Amrita Hans, Kinnari Ruikar, Ziqiang Guan, et al. 2018. "Reduced chlorhexidine and daptomycin susceptibility in vancomycin-resistant enterococcus faecium after serial chlorhexidine exposure." Antimicrobial Agents and Chemotherapy 62(1), doi:10.1128/AAC.01235-17en_US
dc.identifier.issn0066-4804en_US
dc.identifier.issue1en_US
dc.identifier.urihttp://hdl.handle.net/10735.1/6225
dc.identifier.volume62en_US
dc.language.isoenen_US
dc.publisherAmer Soc Microbiologyen_US
dc.relation.urihttp://dx.doi.org/10.1128/AAC.01235-17
dc.rightsCC BY 4.0 (Attribution)en_US
dc.rights©2017 The Authorsen_US
dc.rights.urihttp://creativecommons.org/licenses/by/4.0/en_US
dc.sourceAntimicrobial Agents and Chemotherapy
dc.subjectDaptomycinen_US
dc.subjectCross Infectionen_US
dc.subjectBloodborne infectionsen_US
dc.subjectCritically illen_US
dc.subjectPatientsen_US
dc.subjectStaphylococcus aureusen_US
dc.subjectCardiolipinen_US
dc.subjectEscherichia colien_US
dc.subjectMicrobiologyen_US
dc.subjectEnterococcusen_US
dc.subjectChlorhexidineen_US
dc.subjectEnterococcus faecalisen_US
dc.titleReduced Chlorhexidine and Daptomycin Susceptibility in Vancomycin-Resistant Enterococcus Faecium after Serial Chlorhexidine Exposureen_US
dc.type.genrearticleen_US

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