Bacteria efflux pumps extruded antiseptics
| Family of efflux pump | Efflux pump | Species | Gene location | Antiseptic | References |
|---|---|---|---|---|---|
| MFS | EmrAB | S. enterica | chromosome | triclosan | (Rensch et al. 2014) |
| LmrS | S. aureus | chromosome | benzalkonium chloride | (Kernberger-Fischer et al. 2018) | |
| MdeA | S. aureus | chromosome | benzalkonium chloride | (Huang et al. 2004) | |
| MdrL | L. monocytogenes | chromosome | benzethonium chloride | (Romanova et al. 2006) | |
| NorA | S. aureus, S. epidermidis | chromosome | benzalkonium chloride, cetrimide, acriflavine | (Furi et al. 2013; Qingzhong et al. 2015; Costa et al. 2018) | |
| NorB | S. aureus | chromosome | cetrimide | (Qingzhong et al. 2015) | |
| QacA | S. aureus | plasmid | chlorhexidine, benzethonium chloride | (Noguchi et al. 1999) | |
| QacB | S. aureus | plasmid | chlorhexidine | (Furi et al. 2013) | |
| SmvA | P. aeruginosa, K. pneumoniae | chromosome | chlorhexidine, octenidine | (Wand et al. 2019; Bock et al. 2021) | |
| ABC | EfrAB | E. faecalis, E. faecium | chromosome | chlorhexidine, triclosan | (Lerma et al. 2014) |
| PatAB | S. pneumoniae, S.pseudopneumoniae | chromosome | acriflavine | (Robertson et al. 2005; Alvarado et al. 2017) | |
| RND | AdeABC | A. baumannii | chromosome | chlorhexidine, octenidine, benzalkonium chloride | (Meyer et al. 2022) |
| AcrAB-TolC | S. enterica, E. coli, K. pneumoniae | chromosome | chlorhexidine, triclosan | (Mcmurry et al. 1998; Webber et al. 2008; Curiao et al. 2015) | |
| AcrEF | S. enterica | chromosome | triclosan | (Rensch et al. 2014) | |
| MexAB-OprM | P. aeruginosa | chromosome | chlorhexidine1, triclosan | (Schweizer 1998; Hashemi et al. 2019) | |
| MexCD-OprJ | P. aeruginosa | chromosome | chlorhexidine, benzalkonium chloride, triclosan | (Chuanchuen et al. 2001; Morita et al. 2003) | |
| MexEF-OprN | P. aeruginosa | chromosome | triclosan | (Chuanchuen et al. 2001) | |
| MexXY | P. aeruginosa | chromosome | chlorhexidine2 | (Tag ElDein et al. 2021) | |
| OqxAB | E. coli | plasmid | benzalkonium chloride, triclosan | (Hansen et al. 2007) | |
| SdeAB | S. marcescens | chromosome | chlorhexidine, benzalkonium chloride | (Maseda et al. 2009) | |
| SmeDEF | S. maltophilia | chromosome | triclosan | (Hernández et al. 2011) | |
| TriABC-OpmH | P. aeruginosa | chromosome | triclosan | (Fabre et al. 2021) | |
| SMR | EmrE | E. coli | plasmid | benzalkonium chloride, acriflavine | (Nishino and Yamaguchi 2001) |
| KpnEF | K. pneumoniae | chromosome | chlorhexidine, triclosan, benzalkonium chloride | (Srinivasan and Rajamohan 2013) | |
| QacG | Staphylococcus spp. | plasmid | benzalkonium chloride, | (Heir et al. 1999) | |
| QacH | S. saprophyticus | plasmid | benzalkonium chloride | (Heir et al. 1998) | |
| QacJ | S. aureus, S. simulans, S. intermedius | plasmid | benzalkonium chloride | (Bjorland et al. 2003) | |
| QacZ | E. faecalis | plasmid | benzalkonium chloride | (Braga et al. 2010) | |
| Smr | S. aureus | plasmid | chlorhexidine, benzalkonium chloride | (Noguchi et al. 1999) | |
| MATE | AbeM | A. baumannii | chromosome | triclosan, acriflavine | (Su et al. 2005) |
| MepA | S. aureus | chromosome | chlorhexidine, benzalkonium chloride, cetrimide | (Costa et al. 2013) | |
| PACE | AceI | A. baumannii | chromosome | chlorhexidine | (Hassan et al. 2015) |
Selected antiseptic products available on Polish market, and their indications
| Commercially available products | Active ingredients | Concentration | Product type | Indications |
|---|---|---|---|---|
| Products with chlorhexidine as a main ingredient | ||||
| Aseptall | chlorhexidini digluconatis | 0.12% | oral spray | for gum inflammations, post-dental procedures, canker sores, chapped corners of the mouth |
| ChloraPrep | chlorhexidini digluconatis, 2-propanolum | 2% v/v | skin antiseptic applicator | for skin disinfection before surgical procedures |
| Chlorhexidin puder | chlorhexidini digluconatis | 1% | powder | for care and protection of skin areas exposed to infection, supporting the regeneration of irritated or damaged skin |
| Curaprox Perio Plus+ Focus | chlorhexidini digluconatis | 0.5% | toothpaste | helps maintain gum health and regenerates them, prevents tartar formation, eliminates dental plaque, for local use |
| Curasept ADS DNA 205 | chlorhexidini digluconatis | 0.05% | mouthwash | especially recommended for people wearing orthodontic appliances or implants, it inhibits the development of dental plaque |
| Decontaman Pre Wipes | chlorhexidini digluconatis | 2% | body wash wipes | for skin disinfection before surgical procedures |
| ELGYDIUM Perioblock PRO | chlorhexidini digluconatis | 0.12% | toothpaste | for irritated, sensitive, or bleeding gums and dental plaque |
| Eludril Classic | chlorhexidini digluconatis, alcohol | 0.1% | mouthwash | for adjunctive treatment for periodontics and implantology, for patients with prosthetic restorations or implants |
| Eludril Extra | chlorhexidini digluconatis | 0.2% | mouthwash | for individuals with sensitive oral mucosa, for irritated and bleeding gums, before and after dental procedures, supplementary use during dental treatment |
| Elugel | chlorhexidini digluconatis | 0.2% | dental gel | for patients wearing orthodontic braces, supplementary use after periodontic procedures, implant and surgical procedures |
| GUM Butler ParoeX | chlorhexidini digluconatis | 0.06% | toothpaste | for use with implants, dentures, orthodontic appliances, protects delicate gums, reduces gum inflammation, helps prevent plaque build-up, provides long-term protection against gum disease |
| Gum Paroex | chlorhexidini digluconatis | 0.12% | mouthwash | for reduction of dental plaque accumulation, relief of sensitive gums, maintenance of gum tissue health |
| Hydrex S | chlorhexidini digluconatis | 4% | solution | for washing hands, for disinfecting the skin of hands and skin before surgery |
| Manusan | chlorhexidini digluconatis | 4% | solution | for hygienic and surgical hand washing, body and hair |
| MEDISEPT Velodes Soft | chlorhexidini digluconatis, 2-propanolum | (0.5g + 60g)/100g | solution | for hygienic and surgical hand disinfection |
| OrthoKIN Mint | chlorhexidini digluconatis | 0.06% | mouthwash | for people wearing orthodontic braces |
| Spirytusu Hibitanowego 0,5% ATS | chlorhexidini digluconatis | 0.5% | solution | for disinfecting the hands of medical personnel before and after contact with patients, for disinfecting the skin of patients before injections and surgical procedures, for disinfecting the surgical field |
| Spitaderm | chlorhexidini digluconatis, 2-propanolum, hydrogenii peroxidum 30 per centum | (70g + 0.5g + 1.5g)/100g | solution | for hygienic and surgical hand disinfection before punctures, surgeries, injections |
| Products with octenidine as a main ingredient | ||||
| Octaseptal | octenidinum dihydrochloridum, phenoxyethanol | (0.1g + 2g)/100g | aerosol | for antiseptic treatment of not very extensive wounds and disinfection of the skin, mucous membranes, oral cavity, in the treatment of minor burn and ulcerative wounds, in children (including for the care of the umbilical stump) |
| Octeangin | octenidinum dihydrochloridum | 2.6 mg/tabl. | lozenges | for use in short-term adjuvant treatment of inflammation of the oral cavity and throat mucosa |
| Octeniderm | octenidinum dihydrochloridum, 1-propanolum, 2-propanolum | (0.1g + 30g + 45g)/100g | solution | for skin disinfection before surgical procedures |
| Octenisept | octenidinum dihydrochloridum, phenoxyethanol | (0.1g + 2g)/100g | solution | for disinfection and supportive treatment of small, superficial wounds and pre-procedural skin disinfection for non-surgical procedures. |
| Septisse | octenidinum dihydrochloridum, phenoxyethanol | (0.1g + 2g)/100g | aerosol | for skin disinfection before surgical procedures, care of the umbilical stump, postoperative sutures, disinfection of the oral cavity |
| Products with iodophors as a main ingredient | ||||
| Betadine | povidonum iodinatum | 10% | ointment | for local treatment of burns, wounds, abrasions, trophic ulcers, skin infections |
| Betadine | povidonum iodinatum | 75 mg/ml | solution | for washing hands before surgery and hygienic disinfection of hands |
| Braunoderm | povidonum iodinatum, 2-propanolum | (1g + 50g)/100g | solution | for disinfection of intact skin before surgery, injections, punctures, catheterization |
| Jodi Gel | povidonum iodinatum | 10% | gel | for disinfecting wounds and skin before surgical procedures, in stomatitis, in primary and secondary local skin infections |
| PV Jod 10% | povidonum iodinatum | 100 mg/g | solution | for disinfecting wounds, especially superficial ones and after surgical procedures, as well as burns, scabs and ulcers, prevention and treatment of infections of the skin and mucous membranes |
| Products with alcohols as a main ingredient | ||||
| Desderman N | ethanolum (96%), 2-biphenylol | (79g + 0,1g)/100g | solution | for hygienic and surgical hand skin disinfection, the preparation is recommended for health service facilities |
| Kodan Tinktur Forte | 1-propanolum, 2-propanolum, 2-biphenylolum | (10g + 45g + 0.2g)/100g | solution | for skin disinfection before surgical procedures, blood collection, wound dressing, for hygienic hand disinfection, prevents skin fungal infections |
| Mikrozid AF liquid | ethanolum (94%), 1-propanolum | (25g + 35 g)/100g | solution | for disinfection of surfaces of medical devices |
| Mikrozid AF Wipes JUMBO | ethanolum 96%, 1-propanolum | (25g + 35g)/100g | wipes | for disinfection in medical clinics, hospitals (including neonatal and neonatal wards), public places |
| Primasept med | 1-propanolum 2-propanolum, 2-biphenylolum | (10g + 8g + 2g)/100g | solution | for disinfecting and washing hands and body |
| Promanum pure | ethanolum, 2-propanolum | (78.1g + 10g)/100g | solution | for hygienic and surgical disinfection of hands with sensitive skin |
| Sensivia | ethanolum, 2-propanolum, acidum lacticum | (45g + 28g + 0,3g)/100g | solution | for hygienic and surgical disinfection of hand skin |
| Septoderm | ethanolum, 2-propanolum | (45g + 30 g)/100g | gel | for hygienic and surgical hand disinfection |
| Sirafan Speed | 1-propanolum, 2-propanolum | (25g + 35g)/100g | solution | for disinfection of areas in contact with food (tables, slicers) |
| Skinman Soft | 2-propanolum, benzalkonii chloridum, acid undecylenicum | (60g + 0.3g + 0.1g)/100g | solution | for hygienic hand disinfection, for long-term use by people with sensitive skin, for versatile use in medical facilities |
| Skinsept color | ethanolum, alcohol benzylicus, 2-propanolum | (45.54g + 1g + 27g)/100g | solution | for skin disinfection before surgery, injections, punctures, blood collection and vaccinations |
| Skinsept Pur | ethanolum (96%), 2-propanolum, alcohol benzylicus | (46g + 27g + 1g)/100g | solution | for skin disinfection before surgeries, injections, punctures, vaccinations, blood collection, dressing changes. |
| Softa-man | ethanolum 96%, 1-propanolum | (47.9g + 18g)/100g | solution | for hygienic and surgical hand disinfection |
| Softasept N uncolored | ethanolum 96%, 2-propanolum | (78.83g + 10g)/100g | solution | for skin disinfection before surgical procedures, before venous injections and punctures |
| Sterillium | 1-propanolum, 2-propanolum | (45g + 30g)/100g | solution | for hand skin disinfection |
Bacterial and yeast mutants obtained by stepwise exposure to the following antiseptics: chlorhexidine, octenidine, povidone-iodine, and ethyl alcohol
| Microorganism | Antiseptic used for exposure | Changes in sensitivity to (x-fold increase in MIC value)a | Phenotypic/Genotypic changes in mutants | References | |
|---|---|---|---|---|---|
| Antiseptic | Antibiotics/Chemotherapeutics | ||||
| Citrobacter spp. | octenidine | 2-fold increase in MIC | 4-fold increase in MIC for ampicillin, piperacillin, ceftazidime, and chloramphenicol, 2- to 4-fold increase in MIC for ciprofloxacin and meropenem | no significant difference in the growth rates and biofilm formation, significant virulence reduction / mutations in marR and envZ | (Garratt et al. 2021) |
| Enterobacter spp. | octenidine | 2-fold increase in MIC | cross-resistance to ciprofloxacin, chloramphenicol, and ceftazidime | growth retardation, no significant difference in biofilm formation, no change in virulence / deletions SNPsb in malT and torA, D21E mutation in SmvA | (Garratt et al. 2021) |
| E. coli | chlorhexidine | 2- to 4-fold increase in MIC | no changes in antibiotic susceptibility | cell shape change: narrowing, reduced average cell length, more permeable membranes / changes in protein abundance levels: upregulation: GadE, NfsA, NfsB, MdfA, PmrB, LpxL, downregulation: CadA, Lon; changes in gene expression levels: upregulation: emrAB, ompX, ompA, gadE, mdtEF, gadABC, cadA, hdeABD, ydeN downregulation: mlaA, cdaR, rob, soxS, ompT, ompF | (Gregorchuk et al. 2021) |
| ethyl alcohol | no relevant MIC changes | no changes in antibiotic susceptibility | ntc / nt | (Shepherd and Parker 2023) | |
| K. pneumoniae | chlorhexidine | 16- to 32-fold increase in MIC | 128-fold increase in MIC for colistin | different growth capacities / 8.88 to 11.95-fold higher expression of efflux pump gene cepA, mutation Leu82Arg in PmrB | (Zhang et al. 2019) |
| 4-fold increase in MIC | 32-fold increase in MIC for colistin | nt / overexpressed gene smvA, high expression of the pmrD and pmrK, identification of PemI/PemK TA system, PemK toxin expression reduced biofilm formation | (Bleriot et al. 2020) | ||
| 4-fold increase in MIC | 8-fold increase in MIC for colistin | colonies of irregular shape and rough surfaces / nt | (Hashemi et al. 2019) | ||
| A. baumannii | chlorhexidine | 4-fold increase in MIC | 16-fold increase in MIC for colistin | colonies of irregular shape and rough surfaces / nt | (Hashemi et al. 2019) |
| P. aeruginosa | chlorhexidine | 8-fold increase in MIC | 32-fold increase in MIC for colistin | colonies of circular shape, slightly rough surface with undulating margins / increased expression of OprF, LptD, TolB, TolA, MurD, PagL, ClpB, SecG, SecB, SecA, ArcA, ArcB, ArcC, MexA, AceE, AceF, FadA, FabV, AcpP1, Pil proteins | (Hashemi et al. 2019) |
| 4- to 32-fold increase in MIC | decreased susceptibility to imipenem, meropenem, levofloxacin, ciprofloxacin, ceftazidime, cefepime, and tobramycin, cross-resistance to imipenem and ciprofloxacin | nt / upregulation of mexA, mexC, mexE, mexX, downregulation of oprD | (Zheng et al. 2022) | ||
| 2- to 22-fold increase in MIC | no changes in antibiotic susceptibility | nt / nt | (Karpiński et al. 2025) | ||
| ≥8-fold increase in MIC | 2- to 4-fold increase in MIC for amikacin, cefepime, and meropenem, 2-fold increase in MIC for ciprofloxacin, ceftazidime, and colistin | changes in membrane permeability / upregulation of mexX | (Tag ElDein et al. 2021) | ||
| octenidine | 16-fold increase in MIC | no changes in antibiotic susceptibility | no significant difference in the growth rates and biofilm formation, no change in virulence / mutations in smvR (TetR regulator) | (Garratt et al. 2021) | |
| 4- to 32-fold increase in MIC | 4-fold increase in MIC for gentamicin and colistin, 2-fold increase in MIC for amikacin and tobramycin | all mutants maintained unchanged virulence in the wax moth larvae G. mellonella model, three showed a decreased growth rate / nt | (Shepherd et al. 2018) | ||
| 3- to 12-fold increase in MIC | no changes in antibiotic susceptibility | nt / nt | (Karpiński et al. 2025) | ||
| povidoneiodine | 4-fold increase in MIC | no changes in antibiotic susceptibility | nt / nt | (Karpiński et al. 2025) | |
| ethyl alcohol | no relevant MIC changes | 15-fold increase in MIC for imipenem and aztreonam, 10-fold increase in MIC for gentamicin, 8-fold increase in MIC for ceftazidime | reduced growth / nt | (Shepherd and Parker 2023) | |
| E. hirae | ethyl alcohol | no relevant MIC changes | 4-fold increase in MIC for gentamicin | nt / nt | (Shepherd and Parker 2023) |
| S. aureus | chlorhexidine | 4- to 8-fold increase in MIC | 4- to 512-fold increase in MIC for tetracycline and amikacin, 2- to 512-fold increase in MIC for cefepime and gentamicin, 8- to 512-fold increase in MIC for meropenem, 2- to 64-fold increase in MIC for ciprofloxacin | nt / nt | (Wu et al. 2016) |
| 2- to 4-fold increase in MIC | no changes in antibiotic susceptibility | nt / mutations in mepA, purr, pldB, glpD, and mprF | (Renzoni and François et al. 2017) | ||
| povidoneiodine | 2-fold increase in MIC | nt | inhibition biofilm formation, reduced hemolytic activity / downregulation of icaA, icaD, eno, epbs, fib, hla | (Barakat et al. 2022) | |
| S. epidermidis | ethyl alcohol | no relevant MIC changes | no changes in antibiotic susceptibility | nt / nt | (Shepherd and Parker 2023) |
| S. oralis | chlorhexidine | 2-fold increase in MIC | decrease in susceptibility to erythromycin, increased MIC for clindamycin, amoxicillin, ampicillin | no significant difference in biofilm formation / nt | (Früh et al. 2022) |
| Streptococcus spp. | chlorhexidine | 2- to 8-fold increase in MIC | resistance to erythromycin and tetracycline, intermediate resistance to penicillin G and ampicillin, intermediate or resistance to cefuroxime and amoxicillin/clavulanic acid | increased biofilm formation / presence of ARGs: tetM, patA, patB, mefI, pbpX2, int, xis | (Auer et al. 2022) |
| G. adiacens | chlorhexidine | 4-fold increase in MIC | decreased susceptibility to erythromycin, clindamycin, increased MIC for penicillin G, tetracycline, cefuroxime, ciprofloxacin | slight increase in the ability to biofilm formation / nt | (Früh et al. 2022) |
| C. albicans | octenidine | no relevant MIC changes | no changes in antibiotic susceptibility | nt / nt | (Spettel et al. 2025) |
| chlorhexidine | no relevant MIC changes | no changes in antibiotic susceptibility | nt / nt | (Spettel et al. 2025) | |
| N. glabratus | octenidine | 2-fold increase in MIC | no changes in antibiotic susceptibility | nt / nt | (Spettel et al. 2025) |
| chlorhexidine | 4-fold increase in MIC | 64- to 256-fold increase in MIC for fluconazole, 4- to 128-fold increase in MIC for posaconazole, 32- to 125 increase in MIC for voriconazole, 8- to 64-fold increase in MIC for itraconazole, 32- to 512-fold increase in MIC for isavuconazole | nt / mutations in PDR1, mutations in PMA1, overexpression of CDR1 | (Spettel et al. 2025) | |