ArticleEuropean journal of clinical microbiology & infectious diseases : official publication of the European Society of Clinical Microbiology2021
Chlorhexidine leads to the evolution of antibiotic-resistant Pseudomonas aeruginosa.
Article in European journal of clinical microbiology & infectious diseases : official publication of the European Society of Clinical Microbiology, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 21 papers.
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Who cites it
21 citing papers in PubMed, 41 citations in OpenAlex.
- Comparison of global decolonization efficacy with mupirocin nasal drop and chlorhexidine mouthwash in acute leukemia patients: randomized clinical trial.Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer · 2023Trial
- Protein Expression Profiles of Antiseptic-AdaptedMicroorganisms · 2026Article
- Medical Fabrics with Non-Antibiotic, Supramolecular Antimicrobial Coatings: A Preventive Approach to Combat Biofilm Formation and Bacterial Dissemination.Advanced healthcare materials · 2026Article
- Delayed shifts in salivary microbiota composition following long-term use of 0.06% chlorhexidine toothpaste.Frontiers in oral health · 2026Article
- Disinfectant-induced bacterial resistance and antibiotic cross-resistance-mechanisms and clinical relevance.Clinical and experimental medicine · 2025Review
- Repurposing fusidic acid as an antimicrobial against enterococci with a low probability of resistance development.International microbiology : the official journal of the Spanish Society for Microbiology · 2024Article
- Reversion of KPC-114 to KPC-2 in ceftazidime-avibactam- resistant/meropenem-susceptibleMicrobiology spectrum · 2024Article
- Plumbagin enhances antimicrobial and anti-biofilm capacities of chlorhexidine against clinicalMicrobiology spectrum · 2024Article
- Biofilm Microenvironment Activated Antibiotic Adjuvant for Implant-Associated Infections by Systematic Iron Metabolism Interference.Advanced science (Weinheim, Baden-Wurttemberg, Germany) · 2024Article
- Overcoming antibiotic resistance: non-thermal plasma and antibiotics combination inhibits important pathogens.Pathogens and disease · 2024Review
- Altering Escherichia coli envelope integrity by mimicking the lipoprotein RcsF.Archives of microbiology · 2023Article
- Mechanisms of emerging resistance associated with non-antibiotic antimicrobial agents: a state-of-the-art review.The Journal of antibiotics · 2023Review
- Biofilms as protective cocoons against biocides: from bacterial adaptation to One Health issues.Microbiology (Reading, England) · 2023Review
- Mechanisms of Antibiotic and Biocide Resistance That Contribute toBiomedicines · 2023Review
- Expanding the structure-activity relationships of alkynyl diphenylurea scaffold as promising antibacterial agents.RSC medicinal chemistry · 2023Article
- A 10-year microbiological study of Pseudomonas aeruginosa strains revealed the circulation of populations resistant to both carbapenems and quaternary ammonium compounds.Scientific reports · 2023Article
- Role of efflux pumps, their inhibitors, and regulators in colistin resistance.Frontiers in microbiology · 2023Review
- Polyhexamethylene biguanide promotes adaptive cross-resistance to gentamicin inFrontiers in cellular and infection microbiology · 2023Article
- Effect of povidone-iodine and propanol-based mecetronium ethyl sulphate on antimicrobial resistance and virulence in Staphylococcus aureus.Antimicrobial resistance and infection control · 2022Article
- Applying fluorescent dye assays to discriminate Escherichia coli chlorhexidine resistance phenotypes from porin and mlaA deletions and efflux pumps.Scientific reports · 2022Article
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Authors and funding
4 authors at 1 institution in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Antimicrobial resistance is a major public-health concern. We evaluate chlorhexidine role in selection of resistant Pseudomonas aeruginosa mutants and their antibiotic cross-resistance. Mutation frequency and mutation rate after short-term exposure to sub-inhibitory concentrations of chlorhexidine were compared to those after spontaneous chlorhexidine-exposure, in P. aeruginosa PAO1 strain. Chlorhexidine-resistant mutants were generated, either by serial passage in increasing chlorhexidine concentrations or by single exposure to lethal chlorhexidine concentration. The generated mutants were tested for cross-resistance to different antibiotics, by determination of minimum inhibitory concentrations (MIC). The accompanied phenotypic changes in membrane permeability, outer membrane proteins (OMP), and efflux function were evaluated. The effect of exposure to chlorhexidine on MexAB-OprM, MexEF-oprN, and MexXY efflux pumps expression was investigated. No significant change was recorded between the mutation frequencies and mutation rates after short-term exposure to sub-inhibitory concentrations of chlorhexidine and after spontaneous chlorhexidine-exposure, in P. aeruginosa PAO1 strain. Twelve stable mutants, with ≥ eight-fold increase in chlorhexidine MIC, were generated. Several mutants showed increase in the MIC of colistin, cefepime, ceftazidime, meropenem, ciprofloxacin, and amikacin; seven mutants expressed meropenem cross-resistance. This was accompanied by decreased outer membrane permeability and changes in OMP. Using efflux pump inhibitor, chlorhexidine resistance was reverted in most isolates. Exposure to sub-inhibitory concentration of chlorhexidine induced the expression of MexXY efflux pump. Some resistant mutants had overexpressed MexXY efflux pump. Chlorhexidine can select P. aeruginosa strains with antibiotic cross-resistance. This necessitates implementing special protocols for chlorhexidine use and re-evaluation of its benefit versus risk in personal-care products.
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