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The impact of the <jats:italic>qacA\/B<\/jats:italic> and <jats:italic>smr<\/jats:italic> chlorhexidine tolerance genes on the outcome of methicillin-resistant <jats:italic>Staphylococcus aureus<\/jats:italic> (MRSA) infections is unclear. We evaluated the prevalence and clinical impact of, and microbiological risk factors for, <jats:italic>qacA\/B<\/jats:italic> tolerance in MRSA bacteremia. MRSA bacteremia that occurred more than two days after intensive care unit admission between January 2009 and December 2018 was identified from a prospective cohort of <jats:italic>S. aureus<\/jats:italic> bacteremia in a tertiary-care hospital from South Korea. A total of 183 MRSA blood isolates was identified, and the major genotype found was ST5-MRSA-II (87.4%). The prevalences of <jats:italic>qacA\/B<\/jats:italic> and <jats:italic>smr<\/jats:italic> were 67.2% and 3.8%, respectively. <jats:italic>qacA\/B<\/jats:italic>-positive isolates were predominantly ST5-MRSA-II (96.7% [119\/123]), the dominant hospital clone. In a homogenous ST5-MRSA-II background, <jats:italic>qacA\/B<\/jats:italic> positivity was independently associated with septic shock (aOR, 4.85), gentamicin resistance (aOR, 74.43), and non-t002 <jats:italic>spa<\/jats:italic> type (aOR, 74.12). <jats:italic>qacA\/B<\/jats:italic> positivity was found to have decreased significantly in ST5-MRSA-II in association with a decline in <jats:italic>qacA\/B<\/jats:italic>-positive t2460, despite the increasing use of chlorhexidine since 2010 (<jats:italic>P<\/jats:italic>\u2009&lt;\u20090.001 for trend). Continuous surveillance of the <jats:italic>qac<\/jats:italic> genes, and molecular characterization of their plasmids, are needed to understand their role in MRSA epidemiology.<\/jats:p>","DOI":"10.1038\/s41598-022-15546-3","type":"journal-article","created":{"date-parts":[[2022,7,6]],"date-time":"2022-07-06T10:03:29Z","timestamp":1657101809000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Clinical impact of and microbiological risk factors for qacA\/B positivity in ICU-acquired ST5-methicillin-resistant SCCmec type II Staphylococcus aureus bacteremia"],"prefix":"10.1038","volume":"12","author":[{"given":"Haein","family":"Kim","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sunghee","family":"Park","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hyeonji","family":"Seo","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hyemin","family":"Chung","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Eun Sil","family":"Kim","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Heungsup","family":"Sung","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mi-Na","family":"Kim","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Seongman","family":"Bae","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jiwon","family":"Jung","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Min Jae","family":"Kim","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sung-Han","family":"Kim","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sang-Oh","family":"Lee","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sang-Ho","family":"Choi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yang Soo","family":"Kim","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yong Pil","family":"Chong","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2022,7,6]]},"reference":[{"key":"15546_CR1","doi-asserted-by":"publisher","first-page":"1868","DOI":"10.1093\/cid\/ciz112","volume":"69","author":"M Souli","year":"2019","unstructured":"Souli, M. et al. 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