Effects of a sub-minimum inhibitory concentration of chlorhexidine gluconate on the development of in vitro multi-species biofilms

Subminimum Inhibitory Concentrations Tetracycline Antibiotics Induce Biofilm Formation in Minocycline-Resistant Klebsiella pneumonia by Affecting Bacterial Physical and Chemical Properties and Associated Genes Expression

Biofilm formation of Klebsiella pneumoniae can protect bacteria from antibiotics and is difficult to eradicate. Thus, the influence of subinhibitory concentrations of antibiotics on bacteria is becoming increasingly important. Our study showed that subminimum inhibitory concentrations (sub-MICs) of tetracycline antibiotics can increase biofilm formation in minocycline-resistant Klebsiella pneumoniae clinical strains. However, in the bacterial adhesion and invasion experiments, the adhesion and invasion ability decreased and the survival rate of Galleria mellonella increased. Under sub-MICs of tetracycline antibiotics treatment, abnormal stretching of bacteria was observed by scanning electron microscopy. Treatment with sub-MICs of tetracyclines leads to increased surface hydrophobicity and eDNA content and decreased outer membrane permeability. The expression levels of the fimA, luxS, qseB, and qseC genes decreased, the expression level of mrkA increased, and the expression level of acrA was inconsistent under different tetracycline antibiotics treatments. Together, our results suggested that the increase in Klebsiella pneumoniae biofilm formation caused by sub-MICs of tetracycline antibiotics may occur by affecting bacterial physical and chemical properties and associated genes expression.

Anti-oral streptococci and anti-biofilm properties of Etlingera pavieana essential oil and its bioactive compounds proposed for an alternative herbal mouthwash

Oral streptococci are the major group of bacteria in the oral cavity. Some of their species cause oral diseases that may lead to tooth loss and quality-of-life reduction, such as dental caries. One of prevention techniques to promote oral health is rinsing mouthwash after toothbrushing. This study aimed to determine the potential uses of local food, also remedy, plant in Thailand called Reaw-Horm or Etlingera pavieana for alternative herbal mouthwash. The essential oil from E. pavieana rhizome (Eo) is used for anti-streptococci including Streptococcus mutans and Streptococcus sobrinus and anti-biofilm activities. The main components of Eo are methyl chavicol (MC) and trans-anethole (TA). The disk diffusion method showed the inhibition zone of Eo in a dose-dependent manner. The minimum inhibitory concentration (MIC) of Eo and TA was >1.6 % v/v, and 0.4 % v/v of MC. Regarding anti-biofilm activities, MC showed nearly equal anti-biofilm formation of S. mutans and S. sobrinus, whereas Eo and TA acted toward S. sobrinus more than S. mutans biofilm. Sub-MIC killing effects on cells under biofilm were observed in Eo and MC. Therefore, MC was recommended as an active compound for anti-streptococci activities. Biocompatibility of Eo and MC were shown to be safe for epidermal cell lines. Herbal mouthwashes containing Eo were developed and had antioxidant and antimicrobial actions with established for 3 months. This study provides in vitro support on the use of herbal mouthwash with antioxidant and antimicrobial activities for dental caries prevention and well-being of individuals.

Preparation of Citrus reticulata peel nano-encapsulated essential oil and in vitro assessment of its biological properties

Dental caries is the most common biofilm-dependent oral disease. Streptococcus mutans is among the main microorganisms responsible for the development of dental caries. Nano-suspension of Citrus reticulata (tangerine) peel essential oil in 0.5% (v/v) concentration was prepared and its antibacterial effect on S. mutans in planktonic and biofilm forms as well as its cytotoxic and antioxidant effects were assessed and compared with chlorhexidine (CHX). The minimum inhibitory concentration (MIC) of free essential oil, nano-encapsulated essential oil, and CHX was 5.6% (v/v), 0.0005% (v/v), and 0.0002% (w/v), respectively. The percentage of biofilm inhibition by the free essential oil, nano-encapsulated essential oil, and CHX at half-MIC was 67.3%, 24%, and 90.6%, respectively. The nano-encapsulated essential oil had no cytotoxicity and showed significant antioxidant effects in different concentrations. Nano-encapsulation of tangerine peel essential oil significantly enhanced its biological activities in much lower concentrations than the free essential oil (11,000 times diluted). It also showed lower cytotoxicity and higher antibiofilm effects in sub-MICs compared with CHX, indicating the optimal potential of tangerine nano-encapsulated essential oil for incorporation in the composition of organic antibacterial and antioxidant mouth rinses.

Bacterial sensitivity to chlorhexidine and povidone-iodine antiseptics over time: a systematic review and meta-analysis of human-derived data

Surgical site infection (SSI) is the most common complication of surgery, increasing healthcare costs and hospital stay. Chlorhexidine (CHX) and povidone-iodine (PVI) are used for skin antisepsis, minimising SSIs. There is concern that  resistance to topical biocides may be emergeing, although the potential clinical implications remain unclear. The objective of this systematic review was to determine whether the minimum bactericidal concentration (MBC) of topical preparations of CHX or PVI have changed over time, in microbes relevant to SSI. We included studies reporting the MBC of laboratory and clinical isolates of common microbes to CHX and PVI. We excluded studies using non-human samples and antimicrobial solvents or mixtures with other active substances. MBC was pooled in random effects meta-analyses and the change in MBC over time was explored using meta-regression. Seventy-nine studies were included, analysing 6218 microbes over 45 years. Most studies investigated CHX (93%), with insufficient data for meta-analysis of PVI. There was no change in the MBC of CHX to Staphylococci or Streptococci over time. Overall, we find no evidence of reduced susceptibility of common SSI-causing microbes to CHX over time. This provides reassurance and confidence in the worldwide guidance that CHX should remain the first-choice agent for surgical skin antisepsis.

Prevalence of the fimbrial operon mrkABCD, mrkA expression, biofilm formation and effect of biocides on biofilm formation in carbapenemase-producing Klebsiella pneumoniae isolates belonging or not to high-risk clones

BACKGROUND

The role of mrkA adhesin expression, biofilm production, biofilm viability and biocides in the biofilms of carbapenemase-producing K. pneumoniae isolates was investigated.

METHODS

Seventeen isolates representing different sequence types and carbapenemases were investigated. mrkA expression was determined by real-time RT-PCR. Biofilm production (25°C and 37°C, with and without humidity) was determined by the crystal violet assay. The effect of isopropanol, povidone-iodine, sodium hypochlorite, chlorhexidine digluconate, benzalkonium chloride, ethanol and triclosan on biofilms was determined. The effect of povidone-iodine on biofilm biomass and thickness was also determined by Confocal Laser Scanning Microscopy (CLSM).

RESULTS

mrkA expression ranged 28.2-1.3 (high or intermediate-level; 64% of HR clones) and 21.5-1.3 (50% of non-HR clones). At 25°C biofilm formation was observed in 41% of isolates (absence of humidity) and 35% of isolates (presence of humidity), whereas at 37°C it was observed in 76% of isolates, with and without humidity. At 25°C biofilm producers were more frequently observed in HR clones (45% with humidity and 55% without humidity) than non-HR clones (17% with and without humidity). Biofilm viability from day 21 was higher at 25°C than 37°C. The greatest decrease in biofilm formation was observed with povidone iodine (29% decrease), which also decrease biofilm thickness.

CONCLUSIONS

Biofilm formation in carbapenemase-producing K. pneumoniae is related to mrkA expression. Biofilm formation is affected by temperature (37°C>25°C) whereas humidity has little effect. Biofilm viability is affected by temperature (25°C>37°C). At 25°C, HR clones are more frequently biofilm producers than non-HR clones. Povidone-iodine can decrease biofilm production and biofilm thickness.

Evidence on the Use of Mouthwash for the Control of Supragingival Biofilm and Its Potential Adverse Effects

Antimicrobial mouthwash improves supragingival biofilm control when used in conjunction with mechanical removal as part of an oral hygiene routine. Mouthwash is intended to suppress bacterial adhesion during biofilm formation processes and is not aimed at mature biofilms. The most common evidence-based effects of mouthwash on the subgingival biofilm include the inhibition of biofilm accumulation and its anti-gingivitis property, followed by its cariostatic activities. There has been no significant change in the strength of the evidence over the last decade. A strategy for biofilm control that relies on the elimination of bacteria may cause a variety of side effects. The exposure of mature oral biofilms to mouthwash is associated with several possible adverse reactions, such as the emergence of resistant strains, the effects of the residual structure, enhanced pathogenicity following retarded penetration, and ecological changes to the microbiota. These concerns require further elucidation. This review aims to reconfirm the intended effects of mouthwash on oral biofilm control by summarizing systematic reviews from the last decade and to discuss the limitations of mouthwash and potential adverse reactions to its use. In the future, the strategy for oral biofilm control may shift to reducing the biofilm by detaching it or modulating its quality, rather than eliminating it, to preserve the benefits of the normal resident oral microflora.

Adjunct use of mouth rinses with a sonic toothbrush accelerates the detachment of a Streptococcus mutans biofilm: an in vitro study

BACKGROUND

The aim of this in vitro study was to examine the possible enhancement of the biofilm peeling effect of a sonic toothbrush following the use of an antimicrobial mouth rinse.

METHODS

The biofilm at a noncontact site in the interdental area was treated by sound wave convection with the test solution or by immersion in the solution. The biofilm peeling effect was evaluated by determining the bacterial counts and performing morphological observations. A Streptococcus mutans biofilm was allowed to develop on composite resin discs by cultivation with stirring at 50 rpm for 72 h. The specimens were then placed in recesses located between plastic teeth and divided into an immersion group and a combination group. The immersion group was treated with phosphate buffer, chlorhexidine digluconate Peridex™ (CHX) mouth rinse or Listerine® Fresh Mint (EO) mouth rinse. The combination group was treated with CHX or EO and a sonic toothbrush.

RESULTS

The biofilm thickness was reduced by approximately one-half compared with the control group. The combination treatment produced a 1 log reduction in the number of bacteria compared to the EO immersion treatment. No significant difference was observed in the biofilm peeling effect of the immersion group compared to the control group.

CONCLUSIONS

The combined use of a sonic toothbrush and a mouth rinse enhanced the peeling of the biofilm that proliferates in places that are difficult to reach using mechanical stress.