Defining and combating the mechanisms of triclosan resistance in clinical isolates of Staphylococcus aureus

The MICs of triclosan for 31 clinical isolates of Staphylococcus aureus were 0.016 mug/ml (24 strains), 1 to 2 mug/ml (6 strains), and 0.25 mug/ml (1 strain). All the strains for which triclosan MICs were elevated (>0.016 mug/ml) showed three- to fivefold increases in their levels of enoyl-acyl carrier protein (ACP) reductase (FabI) production. Furthermore, strains for which triclosan MICs were 1 to 2 mug/ml overexpressed FabI with an F204C alteration. Binding studies with radiolabeled NAD(+) demonstrated that this change prevents. the formation of the stable triclosan-NAD(+)-FabI complex, and both this alteration and its overexpression contributed to achieving MICs of 1 to 2 mug/ml for these strains. Three novel, potent inhibitors of FabI (50% inhibitory concentrations, less than or equal to64 nM) demonstrated up to 1,000-fold better activity than triclosan against the strains for which triclosan MICs were elevated. None of the compounds tested from this series formed a stable complex with NAD(+)-FabI. Consequently, although the overexpression of wild-type FabI gave rise to an increase in the MICs, as expected, overexpression of FabI with an F204C alteration did not cause an additional increase in resistance. Therefore, this work identifies the mechanisms of triclosan resistance in S. aureus, and we present three compounds from a novel chemical series of FabI inhibitors which have excellent activities against both triclosan-resistant and -sensitive clinical isolates of S. aureus.