ArticleAntimicrobial agents and chemotherapy2017
Mechanisms of Increased Resistance to Chlorhexidine and Cross-Resistance to Colistin following Exposure of Klebsiella pneumoniae Clinical Isolates to Chlorhexidine.
Article in Antimicrobial agents and chemotherapy, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 166 papers, 3 of them syntheses that pooled it.
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Who cites it
166 citing papers in PubMed, 3 syntheses or guidelines pooled it, 300 citations in OpenAlex.
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- How long do bacteria, fungi, protozoa, and viruses retain their replication capacity on inanimate surfaces? A systematic review examining environmental resilience versus healthcare-associated infection risk by "fomite-borne risk assessment".Clinical microbiology reviews · 2024Pooled it
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- Effectiveness of Bath Wipes After Hematopoietic Cell Transplantation: A Randomized Trial.Journal of pediatric oncology nursing : official journal of the Association of Pediatric Oncology NursesTrial
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- Determination of frequency of spontaneous resistance for gepotidacin and levofloxacin against a collection of gram-positive and gram-negative organisms.Antimicrobial agents and chemotherapy · 2026Article
- Sustained chlorhexidine susceptibility in clinical MRSA isolates despite recent exposure.JAC-antimicrobial resistance · 2026Article
- Novel Fluorinated Chlorhexidine Analogues Overcome Resistance in Gram-Negative Bacteria.ACS omega · 2026Article
- Klebsiella pneumoniae in the global AMR: resistance mechanisms and genomic adaptation.World journal of microbiology & biotechnology · 2026Review
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- Impact of Incremental Antiseptic Selection on Antibiotic Cross-Resistance and Enhanced Biofilm Formation inInternational journal of microbiology · 2026Article
- Evaluation of the Preoperative Antiseptic Efficacy of Ozone on Dog Skin in Comparison with Traditional Methods.Veterinary sciences · 2025Article
- Octenidine effectively reduces Candida auris colonisation on human skin.Scientific reports · 2025Article
106 more citing papers are in PubMed but not listed here.
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4 authors at 1 institution in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Klebsiella pneumoniae is an opportunistic pathogen that is often difficult to treat due to its multidrug resistance (MDR). We have previously shown that K. pneumoniae strains are able to "adapt" (become more resistant) to the widely used bisbiguanide antiseptic chlorhexidine. Here, we investigated the mechanisms responsible for and the phenotypic consequences of chlorhexidine adaptation, with particular reference to antibiotic cross-resistance. In five of six strains, adaptation to chlorhexidine also led to resistance to the last-resort antibiotic colistin. Here, we show that chlorhexidine adaptation is associated with mutations in the two-component regulator phoPQ and a putative Tet repressor gene (smvR) adjacent to the major facilitator superfamily (MFS) efflux pump gene, smvA Upregulation of smvA (10- to 27-fold) was confirmed in smvR mutant strains, and this effect and the associated phenotype were suppressed when a wild-type copy of smvR was introduced on plasmid pACYC. Upregulation of phoPQ (5- to 15-fold) and phoPQ-regulated genes, pmrD (6- to 19-fold) and pmrK (18- to 64-fold), was confirmed in phoPQ mutant strains. In contrast, adaptation of K. pneumoniae to colistin did not result in increased chlorhexidine resistance despite the presence of mutations in phoQ and elevated phoPQ, pmrD, and pmrK transcript levels. Insertion of a plasmid containing phoPQ from chlorhexidine-adapted strains into wild-type K. pneumoniae resulted in elevated expression levels of phoPQ, pmrD, and pmrK and increased resistance to colistin, but not chlorhexidine. The potential risk of colistin resistance emerging in K. pneumoniae as a consequence of exposure to chlorhexidine has important clinical implications for infection prevention procedures.
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