Tolerance to disinfectants (chlorhexidine and isopropanol) and its association with antibiotic resistance in clinically-related Klebsiella pneumoniae isolates

ABSTRACT

Disinfectants play an essential role in controlling the dissemination of bacteria in health care settings, but it may also contribute to the selection of antibiotic resistance bacteria. This study looked at Klebsiella pneumoniae isolates collected from three hospitals in Lima, Peru, in order to evaluate: their susceptibility to chlorhexidine [CHG] and isopropanol [ISP]), and their association with antimicrobial susceptibility. We analyzed 59 K. pneumoniae isolates and assessed their CHG and ISP susceptibility by minimum inhibitory concentrations (MICs). Additionally, we performed a regression analysis to assess the association between disinfectant tolerance and antibiotic resistance (measured by the disc diffusion method), colistin resistance (by microdilution), carbapenemases presence (by polymerase chain reaction [PCR]), and clonal relationships (by pulsed-field gel electrophoresis [PFGE]). Eleven K. pneumoniae strains were isolated from fomites, and 48 strains from clinical samples. The MIC range of these isolates was 8–128 µg/ml for CHG and 16–256 mg/ml for ISP. We found that resistance to trimethoprim/sulfamethoxazole (TMP/SMX) was the main factor associated with CHG log₂ MIC (ß = 0.65; 95%CI: 0.03, 1.27; R² = 0.07). In the case of ISP, the log₂(MIC) was associated with the institution of origin, showing lower ISP log₂(MIC) in fomites compared to clinical samples(ß = −0.77; 95%CI: −1.54, −0.01; R² = 0.08). Resistance to CHG and ISP among K. pneumoniae isolates found in Peruvian hospitals seems to be elevated and highly variable. Further studies are needed to confirm our results and implement actionable interventions if necessary.

KEYWORDS:

• Disinfectants
• chlorhexidine
• alcohol-based disinfectants
• kKebsiella pneumoniae
• cross-resistance
• antibiotic resistance

Acknowledgments

We thank the members of the Microbiology Laboratory team of the three hospitals involved for their kind collaboration. The authors thank Donna Pringle for editorial assistance.

Disclosure statement

The authors reported no potential competing interests.

Additional information

Funding

This work was supported by the Universidad Cientifica del Sur, ‘Semilla 2019-01 grant’.