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Active efflux is regarded as a common mechanism for antibiotic and biocide resistance. However, the role of many drug efflux pumps in biocide resistance in  Acinetobacter baumannii  remains unknown. Using biocide-resistant  A. baumannii  clinical isolates, we investigated the incidence of 11 known/putative antimicrobial resistance efflux pump genes ( adeB, adeG, adeJ, adeT1, adeT2, amvA, abeD, abeM, qacE, qacE Δ 1 , and  aceI ) and triclosan target gene  fabI  through PCR and DNA sequencing. Reverse transcriptase quantitative PCR was conducted to assess the correlation between the efflux pump gene expression and the reduced susceptibility to triclosan or chlorhexidine. The  A. baumannii  isolates displayed high levels of reduced susceptibility to triclosan, chlorhexidine, benzalkonium, hydrogen peroxide, and ethanol. Most tested isolates were resistant to multiple antibiotics. Efflux resistance genes were widely distributed and generally expressed in  A. baumannii . Although no clear relation was established between efflux pump gene expression and antibiotic resistance or reduced biocide susceptibility, triclosan non-susceptible isolates displayed relatively increased expression of  adeB  and  adeJ  whereas chlorhexidine non-susceptible isolates had increased  abeM  and  fabI  gene expression. Increased expression of  adeJ  and  abeM  was also demonstrated in multiple antibiotic resistant isolates. Exposure of isolates to subinhibitory concentrations of triclosan or chlorhexidine induced gene expression of  adeB, adeG, adeJ  and f abI , and  adeB , respectively. A point mutation in FabI, Gly95Ser, was observed in only one triclosan-resistant isolate. Multiple sequence types with the major clone complex, CC92, were identified in high level triclosan-resistant isolates. Overall, this study showed the high prevalence of antibiotic and biocide resistance as well as the complexity of intertwined resistance mechanisms in clinical isolates of  A. baumannii , which highlights the importance of antimicrobial stewardship and resistance surveillance in clinics.

Molecular Characterization of Reduced Susceptibility to Biocides in Clinical Isolates of Acinetobacter baumannii