Impact of Health Care Exposure on Genotypic Antiseptic Tolerance in Staphylococcus aureus Infections in a Pediatric Population

Antimicrob Agents Chemother. 2017 Jun 27;61(7):e00223-17. doi: 10.1128/AAC.00223-17. Print 2017 Jul.


Staphylococcus aureus possessing either the smr gene or the qacA/B genes is associated with decreased susceptibility to chlorhexidine gluconate (CHG) and other antiseptics. Previous studies of antiseptic-tolerant staphylococci have focused largely on high-risk populations, and the exact role of health care exposure in the acquisition of these organisms is unclear. We sought to describe the risk factors and features of infection caused by antiseptic-tolerant S. aureus in a general pediatric population. Isolates were selected from an ongoing S. aureus surveillance study. Every third sequential isolate in the year 2014 was selected for inclusion. All isolates underwent PCR for the genes qacA/B and smr Medical records were reviewed. Five hundred six isolates were included in the study, with 377 (74.3%) being community acquired. One hundred (19.8%) isolates were smr positive and 79 (15.6%) qacA/B positive. In univariable analyses, the presence of either gene was associated with underlying medical conditions, nosocomial acquisition, recent hospitalization, central venous lines, and CHG exposure. In multivariable analyses, only differences between patients with chronic medical conditions (odds ratio [OR] = 1.72; 95% confidence interval [CI], 1.22 to 2.64) and nosocomial acquisition (OR = 2.48; 95% CI, 1.16 to 8.17) remained statistically significant. Among patients without risk factors, 27.9% had infection with an antiseptic-tolerant isolate. smr- or qacA/B-positive S. aureus isolates are common in children and are independently associated with nosocomial acquisition and underlying medical conditions. These findings imply a role for the health care environment in acquisition of these organisms. However, genotypic antiseptic tolerance was seen in >25% of healthy children with an S. aureus infection, indicating that these organism are prevalent in the community as well.

Keywords: Staphylococcus aureus; children; chlorhexidine; qacA/B; smr.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Anti-Infective Agents, Local / pharmacology*
  • Anti-Infective Agents, Local / therapeutic use
  • Child
  • Child, Preschool
  • Chlorhexidine / analogs & derivatives
  • Chlorhexidine / pharmacology
  • Chlorhexidine / therapeutic use
  • Female
  • Genotype
  • Humans
  • Infant
  • Male
  • Microbial Sensitivity Tests
  • Retrospective Studies
  • Staphylococcal Infections / drug therapy
  • Staphylococcal Infections / genetics
  • Staphylococcal Infections / microbiology
  • Staphylococcus aureus / drug effects*
  • Staphylococcus aureus / pathogenicity


  • Anti-Infective Agents, Local
  • chlorhexidine gluconate
  • Chlorhexidine