QAC

Clinical isolates of Enterobacter cloacae, Citrobacter freundii, Pseudomonas aeruginosa, and Stenotrophomonas maltophilia were tested
for
resistance to antibiotics and to the antiseptics benzalkonium chloride and cetyltrimethylammonium bromide. Furthermore, they were
examined for the presence of the resistance genes qacE and qacEv1. qacEv1 was detected by PCR in 10% of all (n = 103) and in 81% of
multiply antibiotic-resistant strains (n = 15). qacE was found in only one of 37 P. aeruginosa strains. The minimum inhibitory
concentrations
of benzalkonium chloride, cetyltrimethylammonium bromide, and ethidium bromide were not significantly different for
qacEv1/qacEpositive
or -negative strains. Our data indicate that multiply antibiotic-resistant Gram-negative bacteria are not necessarily more resistant to
quaternary ammonium compounds than antibiotic-sensitive strains even though qacE or qacEv1 is present. ß 2000 Federation of
European Microbiological Societies. Published by Elsevier Science B.V. All rights reserved.
Keywords: qac; Antiseptic resistance; Benzalkonium chloride; Multiple antibiotic resistance; Integron
1. Introduction
Several antibiotic resistance genes found in clinical isolates
of Gram-negative bacteria are located in genetic
units, so-called integrons (for review see [1]). These units
are composed of two conserved regions: the 3P- and the 5P-
conserved segments (3P-CS and 5P-CS) and a variable region
containing one or more resistance genes integrated as
cassettes in between. Several cassettes were characterized
by specifying di¡erent resistance determinants to antibiotics
such as aminoglycosides, penicillin, chloramphenicol or
trimethoprim. So far four classes of integrons have been
described [2,3]. Class I integrons are most commonly isolated
from antibiotic-resistant clinical isolates of members
of the families Enterobacteriaceae and Pseudomonaceae.
The 3P-CS of class I integrons includes the sulI sulfonamide
resistance determinant and qacEv1. Paulsen et al.
[4] described qacEv1 as a defective version of qacE, a gene
said to encode resistance to quaternary ammonium compounds
(QAC) and dyes like ethidium bromide. qacE was
also found as part of the 3P-CS in some integrons in
Gram-negative bacteria [4]. This could mean that bacteria
harboring integrons are also resistant to disinfectants like
QACs.
QACs, which contain benzalkonium chloride as the
most widely used agent, are employed as wound and
skin antiseptics and as disinfectants in hospitals. Since
problems concerning therapy of infections with multiply
antibiotic-resistant bacteria have increased dramatically in
recent years, the use of antiseptics and disinfectants has
largely increased, not only in disinfection practice but also
in local wound and skin antisepsis. Since little is known
about the occurrence of qacE/Ev1 and no data exist about
real resistance to QACs, the correlation of qacE/Ev1 with
QAC resistance and a possible linkage between antiseptic
and antibiotic resistance in clinical isolates was studied.