Detection of benzalkonium chloride phenotypic resistance and its association with qacG, qacH, qacJ resistance genes among methicillin-resistant Staphylococcus aureus clinical isolates

Document Type : Original Article

Authors

1 Department of Microbiology and Infection Prevention and Control Unit, Theodor Bilharz Research Institute (TBRI), Giza 12411, Egypt

2 Department of Microbiology, Theodor Bilharz Research Institute, (TBRI), Egypt

3 Department of Infectious Diseases - Aix-Marseille University, Marseille, France

4 General Medicine Practice Program, Department of Microbiology, Batterjee Medical College, Jeddah 21442, Saudi Arabia

Abstract

Background: Benzalkonium chloride (BAC) is a quaternary ammonium compound (QAC) used as a handwashing agent and skin antiseptic to control and prevent infections in hospitals. The qac genes contribute to reduced susceptibility to QACs by promoting the overexpression of efflux pump activity, which actively expels biocides and antibiotics from the bacterial cell. The objective of this study was to identify the presence of resistance genes to antiseptics (qacG, qacH, qacJ) in clinical isolates of methicillin-resistant Staphylococcus aureus (MRSA) and to evaluate the correlation between these genes and susceptibility to benzalkonium chloride (BAC). Methods: One hundred MRSA isolates were collected from Theodor Bilharz Research Institute from January 2018 to July 2021. The minimal inhibitory concentration of BAC was determined. The mecA gene and qacJ, qacG and qacH genes were determined by conventional polymerase chain technique. Results: Qac J was the most frequent biocide resistance gene found in 16/100 (16%) of MRSA isolates, while qacG was found in 10/100 (10%) of MRSA isolates. QacH gene was absent in all tested MRSA isolates. The association between the occurrence of resistance genes of antiseptics and the MIC of BAC (>8 μg/mL) in MRSA was statistically significant (p < 0.01). Conclusion: In Conclusion, the association between the occurrence of resistance genes of antiseptic and the MIC of BAC (>8 μg/mL) in MRSA in this study was statistically significant (p < 0.01). The use of BAC will continue thus all medical facilities should revise their protocols for the proper use of antiseptics.

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