5-Aminolevulinic acid induced photodynamic inactivation on Staphylococcus aureus and Pseudomonas aeruginosa

5-aminolevulinic acid photodynamic therapy for chronic wound infection in rats with diabetes

Recent research indicated that ulcers and peripheral vascular disease resulting from drug-resistant bacterial infections are the main causes of delayed healing in chronic diabetic wounds. 5-Aminolevulinic acid (ALA) is a second-generation endogenous photosensitizer. The therapeutic effect and mechanism of ALA-mediated photodynamic therapy (ALA-PDT) on methicillin-resistant Staphylococcus aureus (MRSA)-infected wounds in diabetic rats were investigated in this study. The results revealed the promising antibacterial effects of ALA-PDT MRSA in vitro, with a minimum inhibitory concentration and minimum bactericidal concentration of 250 and 500 μM, respectively. ALA-PDT also changed the permeability and structural integrity of bacterial cell membranes by producing reactive oxygen species. Meanwhile, ALA-PDT accelerated wound healing in MRSA-infected diabetic rats, with 5 % ALA-PDT achieving complete sterilization in 14 days and wound closure in 21 days. Treatment with 5 % ALA-PDT additionally improved the histopathological appearance of skin tissue, as well as fibrosis, inflammatory cytokine release, and angiogenesis-related protein expression. These findings indicated that ALA-PDT significantly promoted the healing of MRSA-infected wounds in diabetic rats by eliminating bacteria, inhibiting inflammation, generating granulation tissues, promoting neovascularization, and restoring damaged nerves. In addition, the healing mechanism was related to the activation of inflammatory and angiogenesis pathways through the regulation of tumor necrosis factor-alpha and interleukin-6 expression and upregulation of CD206, CD31, and VEGF. These findings underscored the potential role of ALA-PDT in promoting the healing of chronic diabetic wounds.

Enhanced Antibacterial Activity against Escherichia coli Based on Cationic Carbon Dots Assembling with 5-Aminolevulinic Acid

Carbon dots (CDs) with positive surface charges are considered one of the encouraging nanomedications for antibacterial applications. However, due to the distinctive membrane structure of Gram-negative bacteria, cationic CDs with relatively high concentrations are usually required for effective treatment, which might bring out serious safety issues at high doses. Therefore, it is of substantial significance to improve the killing efficiency of cationic CDs on Gram-negative bacteria at appropriately low concentrations. In this work, optimized cationic CDs (bPEI25 000-CDs) were prepared via a hydrothermal method with citric acid and branched PEI25000, which offered a positive surface potential, elimination abilities against Escherichia coli, and relatively high biosafety. The optimized bPEI25 000-CDs can further assemble with the clinical photodynamic therapy (PDT) drug 5-aminolevulinic acid (5-ALA) through electrostatic interaction. Moreover, compared with bPEI25 000-CDs and 5-ALA, the bacterial survival rate was significantly reduced by the ALA-bPEI25 000-CD-induced PDT effect. Even when the dose of bPEI25 000-CD carrier was halved, the bacterial survival could be reduced by 44.4% after light exposure compared to those incubated in the dark. The investigation of the bacterial morphology, membrane potential, and intracellular ROS production suggested that the enhanced antibacterial activity may be due to the membrane dysfunction and cell damage resulting from the high interaction between positively charged ALA-bPEI25 000-CDs and the bacterial cell membrane. Meanwhile, the cationic ALA-bPEI25 000-CDs may facilitate the cellular uptake of 5-ALA, resulting in a more efficient PDT effect. In summary, the antibacterial strategy proposed in this study will provide a novel approach for expanding the application of CD-based nanomedications.

Drug repurposing to overcome microbial resistance

Infections are a growing global threat, and the number of resistant species of microbial pathogens is alarming. However, the rapid development of cross-resistant or multidrug-resistant strains and the development of so-called 'superbugs' are in stark contrast to the number of newly launched anti-infectives on the market. In this review, I summarize the causes of antimicrobial resistance, briefly discuss different approaches to the discovery and development of new anti-infective drugs, and focus on drug repurposing strategy, which is discussed from all possible perspectives. A comprehensive overview of drugs of other indications tested for their in vitro antimicrobial activity to support existing anti-infective therapeutics is provided, including several critical remarks on this strategy of repurposing non-antibiotics to antibacterial drugs.

Searching for antimicrobial photosensitizers among a panel of BODIPYs

In recent years, antimicrobial Photodynamic Therapy (aPDT) gained increasing attention for its potential to inhibit the growth and spread of microorganisms, both as free-living cells and/or embedded in biofilm communities. In this scenario, compounds belonging to the family of boron-dipyrromethenes (BODIPYs) represent a very promising class of photosensitizers for applications in antimicrobial field. In this study, twelve non-ionic and three cationic BODIPYs were assayed for the inactivation of Staphylococcus aureus, Pseudomonas aeruginosa and Candida albicans. As expected, S. aureus showed to be very sensitive to BODIPYs and mild conditions were sufficient to reach good rates of photoinactivation with both neutral and monocationic ones. Surprisingly, one neutral compound (named B9 in this study) resulted the best BODIPY to photoinactivate P. aeruginosa PAO1. The photoinactivation of C. albicans was reached with both neutral and mono-cationic BODIPYs. Furthermore, biofilms of the three model microorganisms were challenged with BODIPYs in light-based antimicrobial technique. S. aureus biofilms were successfully inhibited with milder conditions than those applied to P. aeruginosa and C. albicans. Notably, it was possible to eradicate 24-h-old biofilms of both S. aureus and P. aeruginosa. In conclusion, this study supports the potential of neutral BODIPYs as pan-antimicrobial PSs.

Ultra-high irradiance (UHI) blue light: highlighting the potential of a novel LED-based device for short antifungal treatments of food contact surfaces

Microbial food spoilage is an important cause of health and economic issues and can occur via resilient contamination of food surfaces. Novel technologies, such as the use of visible light, have seen the light of day to overcome the drawbacks associated with surface disinfection treatments. However, most studies report that photo-inactivation of microorganisms with visible light requires long time treatments. In the present study, a novel light electroluminescent diode (LED)-based device was designed to generate irradiation at an ultra-high power density (901.1 mW/cm²). The efficacy of this technology was investigated with the inactivation of the yeast S. cerevisiae. Short-time treatments (below 10 min) at 405 nm induced a ~4.5 log reduction rate of the cultivable yeast population. The rate of inactivation was positively correlated to the overall energy received by the sample and, at a similar energy, to the power density dispatched by the lamp. A successful disinfection of several food contact surfaces (stainless steel, glass, polypropylene, polyethylene) was achieved as S. cerevisiae was completely inactivated within 5 min of treatments. The disinfection of stainless steel was particularly effective with a complete inactivation of the yeast after 2 min of treatment. This ultra-high irradiance technology could represent a novel cost- and time-effective candidate for microbial inactivation of food surfaces. These treatments could see applications beyond the food industry, in segments such as healthcare or public transport. KEY POINTS : • A novel LED-based device was designed to emit ultra-high irradiance blue light • Short time treatments induced high rate of inhibition of S. cerevisiae • Multiple food contact surfaces were entirely disinfected with 5-min treatments.

Copper sulfide with morphology-dependent photodynamic and photothermal antibacterial activities

Metal chalcogenides have been intensively investigated as antibacterial agents due to their unique structures and superior photoactivities. Herein, various structures of copper sulfide (CuS), a metal chalcogenide, such as microspheres (MSs), nanosheets (NSs), and nanoparticles (NPs), were developed in this work for antibacterial applications. A hydrothermal process was utilized to synthesize CuS MSs, CuS NSs, and CuS NPs. Under simulated solar light and near-infrared (NIR) light irradiation, the antibacterial behaviors, reactive oxygen species (ROS) production, and light-driven antibacterial mechanisms of CuS MSs, CuS NSs, and CuS NPs were demonstrated with the bacterium Escherichia coli (E. coli). Bacterial growth curves and ROS generation tests indicated that CuS NSs and CuS NPs had higher light-driven antibacterial activities than that of CuS MSs. ROS of hydroxyl (·OH) and superoxide anion radicals (O₂^-) were investigated via an electron spin resonance (ESR) spectroscopic analysis by respectively incubating CuS MSs, CuS NSs, and CuS NPs with E. coli under simulated solar light irradiation. Furthermore, E. coli incubated with CuS NPs and CuS NSs showed substantial bacterial degradation after NIR laser irradiation, which was attributed to their photothermal killing effects. Light-driven antibacterial mechanisms of CuS NSs and CuS NPs were investigated, and we discovered that under simulated solar and NIR light irradiation, CuS NSs and CuS NPs produced photoinduced electrons, and the copper ions and photoinduced electrons then reacted with atmospheric moisture to produce hydroxide and superoxide anion radicals and heat, resulting in bacterial mortality.

Photodynamic inactivation and its application in food preservation

Food incidents caused by various foodborne pathogenic bacteria are posing a major threat to human health. The traditional thermal and chemical-based procedures applied for microbial control in the food industry cause adverse effects on food quality and bacterial resistance. As a new means of innovative sterilization technology, photodynamic inactivation (PDI) has gained significant attention due to excellent sterilization effect, environmental friendliness, safety, and low cost. This review analyses new developments in recent years for PDI systems applied to the food preservation. The fundamentals of photosensitization mechanism, the development of photosensitizers and light source selection are discussed. The application of PDI in food preservation are presented, with the main emphasis on the natural photosensitizers and its application to inactivate in vitro and in vivo microorganisms in food matrixes such as fresh vegetable, fruits, seafood, and poultry. The challenges and future research directions facing the application of this technology to food systems have been proposed. This review will provide reference for combating microbial contamination in food industry.

In Vitro and In Vivo Demonstration of Ultraefficient and Broad-Spectrum Antibacterial Agents for Photodynamic Antibacterial Chemotherapy

Increasing threats from both pathogenic infections and antibiotic resistance highlight the pressing demand for nonantibiotic agents and alternative therapies. Herein, we report several new phenothiazinium-based derivatives, which could be readily synthesized via fragment-based assembly, which exhibited remarkable bactericidal activities both in vitro and in vivo. Importantly, in contrast to numerous clinically and preclinically used antibacterial photosensitizers, these compounds were able to eliminate various types of microorganisms, including Gram-(+) Staphylococcus aureus (S. aureus), Gram-(-) Escherichia coli, multidrug-resistant S. aureus, and their associated biofilms, at low drug and light dosages (e.g., 0.21 ng/mL in vitro and 1.63 ng/cm² in vivo to eradicate S. aureus at 30 J/cm²). This study thus unveils the potential of these novel phenothiaziniums as potent antimicrobial agents for highly efficient photodynamic antibacterial chemotherapy.

Inactivation of specific spoilage organism (Pseudomonas) of sturgeon by curcumin-mediated photodynamic inactivation

The present study aimed to measure the inactivation effect and mechanism of curcumin-mediated photodynamic inactivation (PDI) on the specific spoilage organism (Pseudomonas) of the sturgeon. The conditions of PDI used were as follows: 30 μM curcumin, 15 W LED light (470 nm) power and 90 s irradiation time. Under these conditions, the high-throughput sequencing was used to study the microbiota of sturgeon. The method of aerobic plate colony count (APC) was used to determine the viability of Pseudomonas after PDI. Sodium dodecyl sulphate polyacrylamide gel electrophoresis (SDS-PAGE), the propidium iodide (PI) single staining method, and agarose gel electrophoresis were used to study the inactivation mechanism of PDI on Pseudomonas. The results showed that Pseudomonas was the specific spoilage organism of sturgeon, and PDI significantly inhibited the growth of Pseudomonas. The in-vitro inactivation rate of Pseudomonas was 99.9% with counts decreased by 3.19 ± 0.15 log₁₀ CFU/mL. The mechanism of PDI to inactivate Pseudomonas is as follows. Firstly, the high-level structure of membrane protein was destroyed, and the cell membrane permeability was increased, which caused leakage of cellular content. Then the nucleic acid inside the cell was destroyed, which eventually caused the death of bacteria. These findings demonstrate that curcumin-mediated PDI can be utilized as an effective way to inactivate the specific spoilage organism (Pseudomonas) of the sturgeon.

Photodynamic inactivation mediated by 5-aminolevulinic acid of bacteria in planktonic and biofilm forms

Bacterial photodynamic inactivation (PDI) employing endogenous production of porphyrins from 5-aminolevulinic acid (ALA) - named ALA-PDI-, is a new promising tool to achieve bacteria control in non-spread infections. The technique combines the action of the porphyrins acting as photosensitisers with light, to produce reactive oxygen species to target the pathogen. To date, some clinical applications of ALA-PDI have been reported although variable responses ranging from total eradication to absence of photokilling were found. ALA-PDI conducted at suboptimal conditions may lead to misleading results and the complexity of haem synthesis in bacteria hinders the optimization of the treatment. The present work aimed to gain insight on the variables affecting ALA-PDI in Gram-positives and Gram-negatives bacteria growing on planktonic and biofilm cultures and to correlate the degree of the response with the amount and type of porphyrin synthesised. Staphylococcus epidermidis and Escherichia coli clinical isolates and Pseudomonas aeruginosa ATCC27853 and Staphylococcus aureus ATCC25923 strains were utilised, and the optimal conditions of concentration and time exposure of ALA, and light dose were set. In both Gram-positive species analysed, a peak of porphyrin synthesis was observed at 1-2 mM ALA in biofilm and planktonic cultures, which fairly correlated with the decrease in the number of CFU after PDI (5 to 7 logs) and porphyrin content was in the same order of magnitude. In addition, ALA-PDI was similarly effective for planktonic and biofilm S. aureus cultures, and more effective in S. epidermidis planktonic cultures at low light doses. Beyond a certain light dose, it was not possible to achieve further photosensitization. Similarly, a plateau of cell death was attained at a certain ALA incubation time. Accumulation of hydrophilic porphyrins at longer incubation periods was observed. The proportion of porphyrins changed as a function of ALA concentration and incubation time in the Gram-positive bacteria, though we did not find a clear correlation between the porphyrin type and PDI response. As a salient feature was the presence of isococroporphyrin isoforms in both Gram-positive and Gram-negative bacteria. Gram-negative bacteria were quite refractory to the treatment: P. aeruginosa was slightly inactivated (4-logs reduction) at 40 mM ALA, whereas E. coli was not inactivated at all. These species accumulated high ALA quantities and the amount of porphyrins did not correlate with the degree of photoinactivation. Our microscopy studies show that porphyrins are not located in the envelopes of Gram-negative bacteria, reinforcing the hypothesis that endogenous porphyrins fail to attack these structures.

Effects of a novel gel containing 5-aminolevulinic acid and red LED against bacteria involved in peri-implantitis and other oral infections

Antibiotic resistance is a major public health problem worldwide and the finding of alternative methods for eliminating bacteria is one of the prerogatives of medical research. The indiscriminate use of antibiotics in dentistry, especially for the treatment of peri-implantitis, could lead to superinfections. Alternative methods, like photodynamic therapy mediated by the use of aminolevulinic acid and a red light has been largely described, especially in dentistry, but results were encouraging against Gram-positive bacteria, but limited against Gram-negative. The effectiveness of photodynamic therapy mediated by a novel product containing aminolevulinic acid, Aladent (ALAD) has been tested in this in vitro study, against different types of bacteria particularly involved in the infections of the oral cavity and peri-implantitis. The novelty of ALAD is the marked hydrophilicity that should increase the passage of the molecule through the membrane pores of Gram-negative bacteria. Considering the novelty of the product a preliminary experiment permitted to test the effectiveness against Enterococcus faecalis after 1 h of ALAD incubation at different concentrations, with or without different timings of LED irradiation. The count of CFUs and the live/dead observation with fluorescent microscopy showed a significant reduction and killing of bacterium. Then, in the second stage, that could meet the necessity of effectiveness and the clinician's requests to reduce the timing of treatment, ALAD, with and without irradiation, was tested on Staphylococcus aureus, Enterococcus faecalis, Escherichia coli, Veillonella parvula and Porphyromonas gingivalis. In particular, the efficiency of different concentrations of the product after a 25 min incubation was tested with and without the adjunctive LED irradiation for 5 min. A slight ALAD bactericidal effect was reported for all bacteria, also without LED irradiation, however, the most effective treatment was 25 min of 50% ALAD incubation followed by 5 min of a red LED. The in vitro tests demonstrated that ALAD gel with LED irradiation exerts a potent antibacterial activity on different bacteria, both Gram-positive and Gram-negative.

Antimicrobial photodynamic therapy on Staphylococcus aureus and Escherichia coli using malachite green encapsulated mesoporous silica nanoparticles: an in vitro study

BACKGROUND

Rise in the number of healthcare associated or hospital acquired infections is a major problem affecting the global healthcare sector. We evaluated superior antibacterial and antibiofilm photodynamic therapy (aPDT) using malachite green encapsulated mesoporous silica nanoparticles (MG-MSN) against Staphylococcus aureus and Escherichia coli, which are known to be major causative agents of nosocomial infections.

METHODS

Malachite green (MG) was encapsulated on mesoporous silica nanoparticles (MSN). Fourier-transform infrared spectroscopy, Transmission electron microscopy, and spectroscopic analysis were performed to characterize the MG-MSN. The antimicrobial efficacies of MSN, MG, and MG-MSN were investigated and the results were recorded.

RESULTS

MG-MSN was effective against both the tested bacteria. S. aureus was more phototoxic to MG-MSN compared to E. coli. The antibiofilm efficacy of MG-MSN on E. coli and S. aureus was also studied. Biofilm inhibition was 65.68 ± 2.62% in E. coli and 79.66 ± 3.82% in S. aureus. Cell viability assay, exopolysaccharides quantification, and confocal laser scanning microscopy studies also revealed the enhanced antibiofilm activity of MG-MSN when used as a potential photosensitizer for aPDT. This study can be extended to eradicate these strains from localized superficial infections and medical appliances, preventing nosocomial infections.

The Photomodulation Activity of Metformin Against Oral Microbiome

Periodontitis is one of the most common inflammatory diseases of the periodontium, which results in the inflammatory destruction of supporting structures around teeth and is closely associated with the development of systemic disease. Due to a wide variety of antibiotic resistance periodontopathic bacteria, photodynamic therapy (PDT) is a non-invasive adjunctive therapeutic modality that is capable of destroying the whole range of microbes. Metformin (Metf) is an antidiabetic drug, and recent studies suggest that cancer patients who receive Metf and are exposed to radiotherapy and chemotherapy show better outcomes. Our surveys in this review introduce Metf as a potent stimulus in increasing the efficacy of PDT in the induction of destruction in microbial cells.

Porphyrinoid photosensitizers mediated photodynamic inactivation against bacteria

The multi-drug resistant bacteria have become a serious problem complicating therapies to such a degree that often the term "post-antibiotic era" is applied to describe the situation. The infections with methicillin-resistant S. aureus, vancomycin-resistant E. faecium, third generation cephalosporin-resistant E. coli, third generation cephalosporin-resistant K. pneumoniae and carbapenem-resistant P. aeruginosa have become commonplace. Thus, the new strategies of infection treatment have been searched for, and one of the approaches is based on photodynamic antimicrobial chemotherapy. Photodynamic protocols require the interaction of photosensitizer, molecular oxygen and light. The aim of this review is to provide a comprehensive overview of photodynamic antimicrobial chemotherapy by porphyrinoid photosensitizers. In the first part of the review information on the mechanism of photodynamic action and the mechanism of the bacteria resistance to the photodynamic technique were described. In the second one, it was described porphyrinoids photosensitizers like: porphyrins, chlorins and phthalocyanines useable in photodynamic bacteria inactivation.

Photoinactivation of ESKAPE pathogens: overview of novel therapeutic strategy

The emergence of antimicrobial drug resistance requires development of alternative therapeutic options. Multidrug-resistant strains of Enterococcus spp., Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumanii, Pseudomonas aeruginosa and Enterobacter spp. are still the most commonly identified antimicrobial-resistant pathogens. These microorganisms are part of the so-called 'ESKAPE' pathogens to emphasize that they currently cause the majority of hospital acquired infections and effectively 'escape' the effects of antibacterial drugs. Thus, alternative, safer and more efficient antimicrobial strategies are urgently needed, especially against 'ESKAPE' superbugs. Antimicrobial photodynamic inactivation is a therapeutic option used in the treatment of infectious diseases. It is based on a combination of a photosensitizer, light and oxygen to remove highly metabolically active cells.

Photodynamic inactivation as an emergent strategy against foodborne pathogenic bacteria in planktonic and sessile states

Foodborne microbial diseases are still considered a growing public health problem worldwide despite the global continuous efforts to ensure food safety. The traditional chemical and thermal-based procedures applied for microbial growth control in the food industry can change the food matrix and lead to antimicrobial resistance. Moreover, currently applied disinfectants have limited efficiency against biofilms. Therefore, antimicrobial photodynamic therapy (aPDT) has become a novel alternative for controlling foodborne pathogenic bacteria in both planktonic and sessile states. The use of aPDT in the food sector is attractive as it is less likely to cause antimicrobial resistance and it does not promote undesirable nutritional and sensory changes in the food matrix. In this review, aspects on the antimicrobial photodynamic technology applied against foodborne pathogenic bacteria and studied in recent years are presented. The application of photodynamic inactivation as an antibiofilm strategy is also reviewed.

Mineral Trioxide Aggregate Mixed with 5-Aminolevulinic Acid for the Photodynamic Antimicrobial Strategy in Hard Tissue Regeneration

Aminolevulinic acid (ALA) based photodynamic antimicrobial strategy can provide good antimicrobial effects and be used for medical applications. The aim of this study was to apply this strategy to Mineral Trioxide Aggregate (MTA), which is commonly used as a filling material for root endings and by doing so, to increase the bactericidal capability of MTA, as well as to investigate its characterization, cytocompatibility, and odontogenic differentiation potential. MTA is known to be a derivative of calcium silicate (CS). In this study, MTA specimens with or without ALA and light treatment were prepared. Diametral tensile strength values (DTS), setting durations, X-ray diffraction (XRD) spectra, apatite-mineralization, and antimicrobial abilities of the MTA, were also analyzed. Human dental pulp cells (hDPCs) can proliferate into the newly formed matrix and differentiate into odontoblasts to reinforce and strengthen the root. Levels of hDPCs proliferation and its odontogenic capabilities when cultured on MTA with ALA and light treatment, and the percentages of cells existing in the various cell cycle stages, were further evaluated in this study. The results indicated that MTA added ALA with light treatment had greater antibacterial ability and cytocompatibility, compared to MTA alone. A higher percentage S phase of the cells cultured on MTA added ALA with light treatment was observed. Furthermore, hDPCs cultured on MTA added ALA with light treatment had the highest expression levels of the odontoblastic differentiation markers. ALA has great antimicrobial efficiency and is a potential material for future medical applications. ALA-based photodynamic antibacterial strategy applied in the MTA has great antibacterial ability, cytocompatibility, and odontoblastic differentiation potential, and can facilitate the development of root canal treatment.

Immunochemical assay with monoclonal antibodies for detection of staphylococcal enterotoxin H

Staphylococcal enterotoxins cause food poisoning of various degrees of severity. For milk and meat products, there is a high probability of contamination with staphylococcal enterotoxin H (SEH). In this regard specific and sensitive methods are required to be developed for its detection and monitoring. In this work, the gene seh was expressed and a preparation of recombinant toxin was obtained. Using hybridoma technology, a panel of high-affinity monoclonal antibodies (mAbs) to SEH was produced. The antibodies were characterized and shown to have no cross-reactivity towards the main staphylococcal enterotoxins (A, B, C1, D, E, G and I). Based on these mAbs, a method for specific and quantitative detection of SEH was developed in the format of sandwich enzyme immunoassay (linear range, 0.2–3 ng/ml). All the mAbs produced revealed SEH by immunoblotting. Immunochemical analysis of the culture fluids of staphylococcal isolates obtained from the milk of mastitis-infected cows by immunoblotting and sandwich enzyme immunoassay demonstrated the conformity of these methods. Using the developed method, the toxin was revealed in blood serum and liquid food products practically to 100%. From non-liquid foods, it was shown to be extracted to a maximum with a buffer of pH 4.0–4.5.

Antibacterial photodynamic therapy: overview of a promising approach to fight antibiotic-resistant bacterial infections

Antibacterial photodynamic therapy (APDT) has drawn increasing attention from the scientific society for its potential to effectively kill multidrug-resistant pathogenic bacteria and for its low tendency to induce drug resistance that bacteria can rapidly develop against traditional antibiotic therapy. The review summarizes the mechanism of action of APDT, the photosensitizers, the barriers to PS localization, the targets, the in vitro-, in vivo-, and clinical evidence, the current developments in terms of treating Gram-positive and Gram-negative bacteria, the limitations, as well as future perspectives. Relevance for patients: A structured overview of all important aspects of APDT is provided in the context of resistant bacterial species. The information presented is relevant and accessible for scientists as well as clinicians, whose joint effort is required to ensure that this technology benefits patients in the post-antibiotic era.