Phenotypic, genotypic, and metabolic resistance mechanisms of ESKAPE bacteria to chemical disinfectants: a systematic review and meta-analysis

ABSTRACT

Background

The presence of resistant ESKAPE pathogens to antimicrobials including chemical disinfectants (ChDs) is a serious threat to public health worldwide. In the present study, we systematically reviewed published reports on mechanisms beyond ChD resistance of ESKAPE bacteria.

Research design and methods

Several databases without date limitations were searched. Studies focused on the ChD resistance/tolerance mechanisms of ESKAPE bacteria were included. Meta-analysis was done to assess the frequency of tolerance and genes in ESKAPE clinical isolates. By screening of initial 6733 records, finally, 41 studies were included.

Results

The overall tolerance to at least one ChD was 48.6%. Pseudomonas aeruginosa and Acinetobacter baumannii were highly ChD-resistant. In several studies, phenotypic changes including changes in general morphology, pump function, cell surface, and membrane, as well as metabolic changes were observed after ChD addition. The resistance gene frequency was 70.2% for norfloxacin efflux pump genes, 40.6% for qac major facilitator superfamily genes, and 22.2% for qac small multidrug resistance genes.

Conclusion

We systematically reviewed the effect of various mechanisms in the resistance process of ESKAPE bacteria to ChDs. However, except for the impact of genes, the numbers of studies investigating other mechanisms were very limited, demanding carrying out more studies in this field.

KEYWORDS:

• Antimicrobials
• chemical disinfectants
• ESKAPE
• mechanism
• resistance
• tolerance

Declaration of financial/other relationships

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Acknowledgments

The support of this work by the Infectious Diseases Research Center of Kermanshah University of Medical Sciences is highly appreciated.

Supplementary material

Supplemental data for this article can be accessed online at https://doi.org/10.1080/14787210.2023.2256975

Author contributions

Mosayeb Rostamian contributed to the study initial idea, design and funding acquisition. Data collection was performed by Roya Chegene Lorestani and Ali Shojaeian. All authors contributed to the conception and design of the review article and interpreting the relevant literature. All authors involved in writing the review article or revised it for intellectual content. All authors read and approved the final manuscript.

Data availability statement

All data related to this study are presented in the text, table and figures of the article.

Notes

1. PRISMA: Preferred Reporting Items for Systematic Reviews and Meta-Analysis.

2. CI: confidence interval.

Additional information

Funding

This manuscript was funded by the Kermanshah University of Medical Sciences.