Distribution of Biocide Resistance Genes and Association with Clonal Complex Genotypes in Staphylococcus aureus Isolated from School-Age Children in Guangzhou

Chlorhexidine and mupirocin are often prescribed to children in affected communities to prevent colonization and transmission of , but this has led to an increasing rate of biocide resistance. In this study, we aimed to determine the distribution of biocide resistance genes among isolates from school-age children in Guangzhou, investigate chlorhexidine gluconate and mupirocin susceptibility and clonal complex (CC) genotypes in strains carrying biocide-resistance genes, and further explore the role of biofilms in this resistance. Antibiotic resistance and multilocus sequence genotyping were performed on 722 isolates from previous study. The distribution of nine biocide genes ( ) was determined by PCR. Isolates carrying or genes were further tested for susceptibility to chlorhexidine gluconate (CHG) and mupirocin and biofilm formation abilities. The most prevalent of the nine biocide resistance genes were (95.57%), followed by (78.81%), (77.01%), and (58.17%). The gene was not detected. Distribution of was significantly decreased in CC30 and CC45 genotypes, and presence of was associated with resistance to antibiotics such as CLI, ERY, TCY, SXT, CIP, and LVX. In addition, 64 (94.1%, n=68) + isolates showed CHG resistance, 12 (100.0%, n=12) + isolates were mupirocin resistant, and 4 (80%, n=5) and 5 (100%, n=5) + + isolates were CHG and mupirocin resistant, respectively. Of these 85 isolates, 98.8% (n=84) had different degrees of biofilm-forming abilities, which were positively associated with CHG and mupirocin resistance. The distribution of biocide resistance genes was associated with special CCs. The and genes are highly associated with resistance to CHG and mupirocin, and biofilm formation was found to contribute to this biocide resistance.