Vali Leila, Dashti Ali A, El-Shazly Sherief, Jadaon Mehrez M
Department of Medical Laboratory Sciences, Faculty of Allied Health Sciences, Kuwait University, P.O. Box 31470-Sulaibekhat, 90805 Sulaibekhat, Kuwait.
Department of Medical Laboratory Sciences, Faculty of Allied Health Sciences, Kuwait University, P.O. Box 31470-Sulaibekhat, 90805 Sulaibekhat, Kuwait.
Int J Infect Dis. 2015 May;34:112-6. doi: 10.1016/j.ijid.2015.03.021. Epub 2015 Mar 30.
In most hospitals, chlorhexidine is used as skin antiseptic prior to clinical procedures, in dressings and when bathing patients. We hereby report, for the first time, the isolation of a clinical Klebsiella oxytoca isolate with reduced sensitivity to chlorhexidine from a foot ulcer of a diabetic patient, which is a common and serious complication associated with diabetes. The Minimum Inhibitory Concentration of the K. oxytoca isolate to chlorhexidine was found to be 30 mg/L and the Minimum Bactericidal Concentration was 60 mg/L. An increased resistance to ethidium bromide (MIC 200 mg/ L) was also observed. Molecular tests revealed that the isolate contained blaCTXM15, blaT(EM-1) and bla(SHV). The other resistant genes detected were qnrB1 and aac(6')-Ib-cr. The resistant determinants were located on a class I integron integrase (intI1) containing qacE gene. DNA sequencing showed homology to K. oxytoca plasmid pACM1. Identification of K. oxytoca with reduced sensitivity to chlorhexidine raises concern regarding dilution standards in hospitals. Adherence to the hospitals' infection control policies should be strictly monitored to avoid continuous low level exposure of bacteria to biocides, specifically in developing countries.
在大多数医院，洗必泰被用作临床操作前的皮肤消毒剂、敷料中以及给患者洗澡时使用。我们在此首次报告，从一名糖尿病患者的足部溃疡中分离出一株对洗必泰敏感性降低的临床产酸克雷伯菌，足部溃疡是糖尿病常见且严重的并发症。该产酸克雷伯菌分离株对洗必泰的最低抑菌浓度为30mg/L，最低杀菌浓度为60mg/L。还观察到对溴化乙锭的耐药性增加（最低抑菌浓度为200mg/L）。分子检测显示该分离株含有blaCTXM15、blaT(EM-1)和bla(SHV)。检测到的其他耐药基因是qnrB1和aac(6')-Ib-cr。耐药决定簇位于含有qacE基因的I类整合子整合酶（intI1）上。DNA测序显示与产酸克雷伯菌质粒pACM1具有同源性。对洗必泰敏感性降低的产酸克雷伯菌的鉴定引发了对医院稀释标准的担忧。应严格监测医院感染控制政策的遵守情况，以避免细菌持续低水平接触杀菌剂，特别是在发展中国家。
