ddcP, pstB, and excess D-lactate impact synergism between vancomycin and chlorhexidine against Enterococcus faecium 1,231,410

PLoS One. 2021 Apr 8;16(4):e0249631. doi: 10.1371/journal.pone.0249631. eCollection 2021.

Abstract

Vancomycin-resistant enterococci (VRE) are important nosocomial pathogens that cause life-threatening infections. To control hospital-associated infections, skin antisepsis and bathing utilizing chlorhexidine is recommended for VRE patients in acute care hospitals. Previously, we reported that exposure to inhibitory chlorhexidine levels induced the expression of vancomycin resistance genes in VanA-type Enterococcus faecium. However, vancomycin susceptibility actually increased for VanA-type E. faecium in the presence of chlorhexidine. Hence, a synergistic effect of the two antimicrobials was observed. In this study, we used multiple approaches to investigate the mechanism of synergism between chlorhexidine and vancomycin in the VanA-type VRE strain E. faecium 1,231,410. We generated clean deletions of 7 of 11 pbp, transpeptidase, and carboxypeptidase genes in this strain (ponA, pbpF, pbpZ, pbpA, ddcP, ldtfm, and vanY). Deletion of ddcP, encoding a membrane-bound carboxypeptidase, altered the synergism phenotype. Furthermore, using in vitro evolution, we isolated a spontaneous synergy escaper mutant and utilized whole genome sequencing to determine that a mutation in pstB, encoding an ATPase of phosphate-specific transporters, also altered synergism. Finally, addition of excess D-lactate, but not D-alanine, enhanced synergism to reduce vancomycin MIC levels. Overall, our work identified factors that alter chlorhexidine and vancomycin synergism in a model VanA-type VRE strain.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • ATP-Binding Cassette Transporters / genetics
  • ATP-Binding Cassette Transporters / metabolism*
  • Adenosine Triphosphatases / genetics
  • Adenosine Triphosphatases / metabolism*
  • Anti-Bacterial Agents / pharmacology
  • Anti-Infective Agents, Local / pharmacology
  • Bacterial Proteins / genetics
  • Bacterial Proteins / metabolism*
  • Chlorhexidine / pharmacology*
  • Drug Synergism*
  • Enterococcus faecium / drug effects*
  • Gram-Positive Bacterial Infections / drug therapy*
  • Gram-Positive Bacterial Infections / genetics
  • Gram-Positive Bacterial Infections / microbiology
  • Humans
  • Lactic Acid / metabolism*
  • Vancomycin / pharmacology*

Substances

  • ATP-Binding Cassette Transporters
  • Anti-Bacterial Agents
  • Anti-Infective Agents, Local
  • Bacterial Proteins
  • Lactic Acid
  • Vancomycin
  • Adenosine Triphosphatases
  • phosphate import ATP-binding protein, Bacteria
  • Chlorhexidine

Grants and funding

This work was supported by start-up funds from the University of Texas at Dallas and the Cecil H. and Ida Green Chair in Systems Biology Science to K.L.P.