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Updated: Feb 14, 2026

Targeting Biofilm Associated Staphylococcus aureus Using Resazurin Based Drug-susceptibility Assay
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Antiseptic Susceptibility and Sub-Inhibitory Concentration-Induced Biofilm Response in Staphylococcus epidermidis

Pinjia Wang1,2,3, Ruomei Wang1, Ruolan Guo1

  • 1School of Laboratory Medicine, Chengdu Medical College, Chengdu, China.

Surgical Infections
|February 12, 2026
PubMed
Abstract

Insights

Methicillin-resistant Staphylococcus epidermidis (MRSE) and efflux genes contribute to antiseptic tolerance in surgical site infections. Low antiseptic concentrations may increase biofilm formation in resistant strains, necessitating improved decolonization strategies.

Area of Science:

  • Microbiology
  • Infectious Diseases
  • Clinical Science

Background:

  • Staphylococcus epidermidis is a key pathogen in surgical site infections (SSIs).
  • This study investigated clinical isolates from abdominal operations to inform decolonization therapy.

Purpose of the Study:

  • To characterize clinical isolates of S. epidermidis from gynecological procedures.
  • To assess the prevalence of methicillin resistance and antiseptic resistance genes.
  • To evaluate the impact of antiseptics on biofilm formation.

Main Methods:

  • Analyzed 146 S. epidermidis isolates from pre-operative skin swabs.
  • Utilized PCR to detect mecA, efflux pump genes (qacA/B, smr), and biofilm genes (icaA-D, aap).
  • Determined susceptibility to benzalkonium chloride (BAC) and chlorhexidine digluconate (CHG) using broth microdilution; assessed biofilm formation with and without sub-inhibitory antiseptic exposure.

Main Results:

  • 49.3% of isolates were Methicillin-resistant S. epidermidis (MRSE); 63.0% and 29.5% carried qacA/B and smr genes, respectively.
  • MRSE isolates exhibited higher minimum inhibitory concentrations (MIC50) for BAC and CHG.
  • Biofilm-forming isolates showed significantly increased BAC MIC50; sub-inhibitory antiseptic exposure induced biofilm formation in non-producers, particularly in qac-positive and MRSE strains.

Conclusions:

  • High prevalence of MRSE and efflux genes contributes to antiseptic tolerance.
  • Sub-inhibitory antiseptic concentrations may promote biofilm formation in resistant S. epidermidis strains.
  • Optimized decolonization tactics are crucial for preventing SSIs.
Keywords:
Staphylococcus epidermidisantisepticsbiofilmresistanceskin

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