<i>Staphylococcus epidermidis</i> Isolated in 1965 Are More Susceptible to Triclosan than Current Isolates

<div><p>Since its introduction to the market in the 1970s, the synthetic biocide triclosan has had widespread use in household and medical products. Although decreased triclosan susceptibility has been observed for several bacterial species, when exposed under laboratory settings, no <i>in vivo</i> studies have associated triclosan use with decreased triclosan susceptibility or cross-resistance to antibiotics. One major challenge of such studies is the lack of strains that with certainty have not been exposed to triclosan. Here we have overcome this challenge by comparing current isolates of the human opportunistic pathogen <i>Staphylococcus epidermidis</i> with isolates collected in the 1960s prior to introduction of triclosan to the market. Of 64 current <i>S. epidermidis</i> isolates 12.5% were found to have tolerance towards triclosan defined as MIC≥0.25 mg/l compared to none of 34 isolates obtained in the 1960s. When passaged in the laboratory in the presence of triclosan, old and current susceptible isolates could be adapted to the same triclosan MIC level as found in current tolerant isolates. DNA sequence analysis revealed that laboratory-adapted strains carried mutations in <i>fabI</i> encoding the enoyl-acyl carrier protein reductase isoform, FabI, that is the target of triclosan, and the expression of <i>fabI</i> was also increased. However, the majority of the tolerant current isolates carried no mutations in <i>fabI</i> or the putative promoter region. Thus, this study indicates that the widespread use of triclosan has resulted in the occurrence of <i>S. epidermidis</i> with tolerance towards triclosan and that the adaptation involves FabI as well as other factors. We suggest increased caution in the general application of triclosan as triclosan has not shown efficacy in reducing infections and is toxic to aquatic organisms.</p>