1
|
Coles VE, Puri L, Bhandari M, Wood TJ, Burrows LL. The effects of chlorhexidine, povidone-iodine, and vancomycin on growth and biofilms of pathogens that cause prosthetic joint infections: an in vitro model. J Hosp Infect 2024:S0195-6701(24)00230-5. [PMID: 38992843 DOI: 10.1016/j.jhin.2024.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2024] [Revised: 06/11/2024] [Accepted: 06/23/2024] [Indexed: 07/13/2024]
Abstract
BACKGROUND Chlorhexidine gluconate (CHG) and povidone-iodine (PI) are commonly used to prevent prosthetic joint infection (PJI) during total joint replacement; however, their effective concentrations and impact on biofilms are not well defined. AIM To determine: (1) the in vitro minimum inhibitory concentration of CHG and PI against model PJI-causing organisms and clinical isolates; (2) their impact on biofilm formation; (3) if there is a synergistic benefit to combining the two solutions; and (4) if adding the antibiotic vancomycin impacts antiseptic activity. METHODS We measured in vitro growth and biofilm formation of Staphylococcus epidermidis, methicillin-sensitive and methicillin-resistant S. aureus, Escherichia coli, Pseudomonas aeruginosa, and Candida albicans, as well as recent clinical isolates, in the presence of increasing concentrations of CHG and/or PI. Checkerboard assays were used to measure potential synergy of the solutions together and with vancomycin. FINDINGS CHG and PI inhibited growth and biofilm formation of all model organisms tested at concentrations of 0.0004% and 0.33% or lower, respectively; highly dilute concentrations paradoxically increased biofilm formation. The solutions did not synergize with one another and acted independently of vancomycin. CONCLUSION CHG and PI are effective at lower concentrations than typically used, establishing baselines to support further clinical trials aimed at optimizing wound disinfection. There is no synergistic advantage to using both in combination. Vancomycin is effective at inhibiting the growth of S. epidermidis and S. aureus; however, it stimulates P. aeruginosa biofilm production, suggesting in the rare case of P. aeruginosa PJI, it could exacerbate infection.
Collapse
Affiliation(s)
- Victoria E Coles
- Department of Biochemistry and Biomedical Sciences, McMaster University, Hamilton, Canada; Michael G. DeGroote Institute for Infectious Disease Research, McMaster University, Hamilton, Canada
| | - Laura Puri
- Hamilton Arthroplasty Group, Hamilton Health Sciences Juravinski Hospital, Hamilton, Canada
| | - Mohit Bhandari
- Department of Orthopaedic Surgery, McMaster University, Hamilton, Canada
| | - Thomas J Wood
- Hamilton Arthroplasty Group, Hamilton Health Sciences Juravinski Hospital, Hamilton, Canada; Department of Orthopaedic Surgery, McMaster University, Hamilton, Canada
| | - Lori L Burrows
- Department of Biochemistry and Biomedical Sciences, McMaster University, Hamilton, Canada; Michael G. DeGroote Institute for Infectious Disease Research, McMaster University, Hamilton, Canada.
| |
Collapse
|
2
|
Biguanides drugs: Past success stories and promising future for drug discovery. Eur J Med Chem 2021; 224:113726. [PMID: 34364161 DOI: 10.1016/j.ejmech.2021.113726] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 07/27/2021] [Accepted: 07/27/2021] [Indexed: 12/13/2022]
Abstract
Biguanides have attracted much attention a century ago and showed resurgent interest in recent years after a long period of dormancy. They constitute an important class of therapeutic agents suitable for the treatment of a wide spectrum of diseases. Therapeutic indications of biguanides include antidiabetic, antimalarial, antiviral, antiplaque, and bactericidal applications. This review presents an extensive overview of the biological activity of biguanides and different mechanisms of action of currently marketed biguanide-containing drugs, as well as their pharmacological properties when applicable. We highlight the recent developments in research on biguanide compounds, with a primary focus on studies on metformin in the field of oncology. We aim to provide a critical overview of all main bioactive biguanide compounds and discuss future perspectives for the design of new drugs based on the biguanide fragment.
Collapse
|
3
|
Yoo MS, Jin HJ, Lee SY. Synergistic Antibacterial Efficacies of Chlorhexidine Digluconate or Protamine Sulfate Combined with Laminaria japonica or Rosmarinus officinalis Extracts against Streptococcus mutans. Biocontrol Sci 2020; 25:41-44. [PMID: 32173666 DOI: 10.4265/bio.25.41] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
Chlorhexidine digluconate inhibits oral bacteria and the formation of dental plaque. Protamine sulfate, a polycationic protein, exerts antibacterial activity by altering the cell wall of bacteria. Extracts of Laminaria japonica and Rosmarinus officinalis display antimicrobial effects against oral pathogens. The purpose of this study was to investigate the synergistic effect of chlorhexidine digluconate and protamine sulfate on the inhibitory activity of L. japonica and R. officinalis extracts against Streptococcus mutans, a major etiological agent for dental caries. Minimal inhibitory concentrations (MICs) of chlorhexidine digluconate, protamine sulfate, and L. japonica and R. officinalis extracts were determined by broth dilution method. Synergistic effect of chlorhexidine digluconate or protamine sulfate and extracts of L. japonica or R. officinalis was determined by fractional inhibitory concentration index (FIC). FIC demonstrated the synergistic effects of the different combinations of antibacterial agents. In this study, the use of sub-MIC of chlorhexidine digluconate or protamine sulfate with sub-MIC of L. japonica and R. officinalis extracts resulted in synergistic inhibitory effects of these antibacterial agents except for chlorhexidine digluconate and L. japonica combination.
Collapse
Affiliation(s)
- Min Seok Yoo
- Department of Oral Microbiology, College of Dentistry, Research Institute of Oral Science, Gangneung-Wonju National University
| | - Hyung-Joo Jin
- Department of Marine Molecular Biotechnology, College of Life Sciences, Gangneung-Wonju National University
| | - Si Young Lee
- Department of Oral Microbiology, College of Dentistry, Research Institute of Oral Science, Gangneung-Wonju National University
| |
Collapse
|
4
|
Zancan RF, Calefi PHS, Borges MMB, Lopes MRM, Andrade FB, Vivan RR, Duarte MAH. Antimicrobial activity of intracanal medications against both
Enterococcus faecalis
and
Candida albicans
biofilm. Microsc Res Tech 2018; 82:494-500. [DOI: 10.1002/jemt.23192] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Revised: 10/18/2018] [Accepted: 11/20/2018] [Indexed: 01/09/2023]
Affiliation(s)
- Rafaela Fernandes Zancan
- Department of Restorative Dentistry, Dental Materials and EndodonticsBauru Dental School, University of São Paulo Bauru São Paulo Brazil
| | - Pedro Henrique Souza Calefi
- Department of Restorative Dentistry, Dental Materials and EndodonticsBauru Dental School, University of São Paulo Bauru São Paulo Brazil
| | - Mariana Maciel Batista Borges
- Department of Restorative Dentistry, Dental Materials and EndodonticsBauru Dental School, University of São Paulo Bauru São Paulo Brazil
| | - Marcelo Ribeiro Milanda Lopes
- Department of Restorative Dentistry, Dental Materials and EndodonticsBauru Dental School, University of São Paulo Bauru São Paulo Brazil
| | - Flaviana Bombarda Andrade
- Department of Restorative Dentistry, Dental Materials and EndodonticsBauru Dental School, University of São Paulo Bauru São Paulo Brazil
| | - Rodrigo Ricci Vivan
- Department of Restorative Dentistry, Dental Materials and EndodonticsBauru Dental School, University of São Paulo Bauru São Paulo Brazil
| | - Marco Antonio Hungaro Duarte
- Department of Restorative Dentistry, Dental Materials and EndodonticsBauru Dental School, University of São Paulo Bauru São Paulo Brazil
| |
Collapse
|
5
|
Carey B, Lambourne J, Porter S, Hodgson T. Chronic mucocutaneous candidiasis due to gain-of-function mutation in STAT1. Oral Dis 2018; 25:684-692. [PMID: 29702748 DOI: 10.1111/odi.12881] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Revised: 01/06/2018] [Accepted: 02/20/2018] [Indexed: 12/26/2022]
Abstract
Chronic mucocutaneous candidiasis (CMC) is a heterogenous group of primary immunodeficiency diseases characterised by susceptibility to chronic or recurrent superficial Candida infection of skin, nails and mucous membranes. Gain-of-function mutations in the STAT1 gene (STAT1-GOF) are the most common genetic aetiology for CMC, and mutation analysis should be considered. These mutations lead to defective responses in Type 1 and Type 17 helper T cells (Th1 and Th17), which, depending on the mutation, also predispose to infection with Staphylococci, Mycobacteria and Herpesviridae. We describe the clinical and genetic findings for three patients with CMC due to gain-of-function mutations in the STAT1 gene.
Collapse
Affiliation(s)
- Barbara Carey
- Oral Medicine Unit, UCLH NHS Foundation Trust, Eastman Dental Hospital, UCL Eastman Dental Institute, London, UK
| | - Jonathan Lambourne
- Department of Microbiology and Infectious Diseases, Barts Health NHS Trust, London, UK
| | - Stephen Porter
- Oral Medicine Unit, UCLH NHS Foundation Trust, Eastman Dental Hospital, UCL Eastman Dental Institute, London, UK
| | - Tim Hodgson
- Oral Medicine Unit, UCLH NHS Foundation Trust, Eastman Dental Hospital, UCL Eastman Dental Institute, London, UK
| |
Collapse
|
6
|
Effect of Chlorhexidine Bathing Every Other Day on Prevention of Hospital-Acquired Infections in the Surgical ICU: A Single-Center, Randomized Controlled Trial. Crit Care Med 2017; 44:1822-32. [PMID: 27428384 DOI: 10.1097/ccm.0000000000001820] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To test the hypothesis that compared with daily soap and water bathing, 2% chlorhexidine gluconate bathing every other day for up to 28 days decreases the risk of hospital-acquired catheter-associated urinary tract infection, ventilator-associated pneumonia, incisional surgical site infection, and primary bloodstream infection in surgical ICU patients. DESIGN This was a single-center, pragmatic, randomized trial. Patients and clinicians were aware of treatment-group assignment; investigators who determined outcomes were blinded. SETTING Twenty-four-bed surgical ICU at a quaternary academic medical center. PATIENTS Adults admitted to the surgical ICU from July 2012 to May 2013 with an anticipated surgical ICU stay for 48 hours or more were included. INTERVENTIONS Patients were randomized to bathing with 2% chlorhexidine every other day alternating with soap and water every other day (treatment arm) or to bathing with soap and water daily (control arm). MEASUREMENTS AND MAIN RESULTS The primary endpoint was a composite outcome of catheter-associated urinary tract infection, ventilator-associated pneumonia, incisional surgical site infection, and primary bloodstream infection. Of 350 patients randomized, 24 were excluded due to prior enrollment in this trial and one withdrew consent. Therefore, 325 were analyzed (164 soap and water versus 161 chlorhexidine). Patients acquired 53 infections. Compared with soap and water bathing, chlorhexidine bathing every other day decreased the risk of acquiring infections (hazard ratio = 0.555; 95% CI, 0.309-0.997; p = 0.049). For patients bathed with soap and water versus chlorhexidine, counts of incident hospital-acquired infections were 14 versus 7 for catheter-associated urinary tract infection, 13 versus 8 for ventilator-associated pneumonia, 6 versus 3 for incisional surgical site infections, and 2 versus 0 for primary bloodstream infection; the effect was consistent across all infections. The absolute risk reduction for acquiring a hospital-acquired infection was 9.0% (95% CI, 1.5-16.4%; p = 0.019). Incidences of adverse skin occurrences were similar (18.9% soap and water vs 18.6% chlorhexidine; p = 0.95). CONCLUSIONS Compared with soap and water, chlorhexidine bathing every other day decreased the risk of acquiring infections by 44.5% in surgical ICU patients.
Collapse
|
7
|
Gadea R, Glibota N, Pérez Pulido R, Gálvez A, Ortega E. Adaptation to Biocides Cetrimide and Chlorhexidine in Bacteria from Organic Foods: Association with Tolerance to Other Antimicrobials and Physical Stresses. JOURNAL OF AGRICULTURAL AND FOOD CHEMISTRY 2017; 65:1758-1770. [PMID: 28177232 DOI: 10.1021/acs.jafc.6b04650] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Chlorhexidine (CH) and quaternary ammonium compounds (QAC), such as cetrimide (CE), are widely used as disinfectants because of their broad antimicrobial spectrum. However, their frequent use for disinfection in different settings may promote bacterial drug resistance against both biocides and clinically relevant antibiotics. This study analyzes the effects of stepwise exposure to cetrimide (CE) and chlorhexidine (CH) of bacteria from organic foods and previously classified as biocide-sensitive. Gradual exposure of these strains to biocides resulted in mainly transient decreased antimicrobial susceptibility to other antibiotics and to biocides. Biocide-adapted bacteria also exhibit alterations in physiological characteristics, mainly decreased heat tolerance, or gastric acid tolerance in CE-adapted strains, while bile resistance does not seem to be influenced by biocide adaptation. Results from this study suggest that changes in membrane fluidity may be the main mechanism responsible for the acquisition of stable tolerance to biocides.
Collapse
Affiliation(s)
- Rebeca Gadea
- Área de Microbiología, Departamento de Ciencias de la Salud, Facultad de Ciencias Experimentales, Universidad de Jaén , 23071-Jaén, Spain
| | - Nicolás Glibota
- Área de Microbiología, Departamento de Ciencias de la Salud, Facultad de Ciencias Experimentales, Universidad de Jaén , 23071-Jaén, Spain
| | - Rubén Pérez Pulido
- Área de Microbiología, Departamento de Ciencias de la Salud, Facultad de Ciencias Experimentales, Universidad de Jaén , 23071-Jaén, Spain
| | - Antonio Gálvez
- Área de Microbiología, Departamento de Ciencias de la Salud, Facultad de Ciencias Experimentales, Universidad de Jaén , 23071-Jaén, Spain
| | - Elena Ortega
- Área de Microbiología, Departamento de Ciencias de la Salud, Facultad de Ciencias Experimentales, Universidad de Jaén , 23071-Jaén, Spain
| |
Collapse
|
8
|
Ioannidis A, Thurnheer T, Hofer D, Sahrmann P, Guggenheim B, Schmidlin PR. Mechanical and hydrodynamic homecare devices to clean rough implant surfaces - an in vitro polyspecies biofilm study. Clin Oral Implants Res 2014; 26:523-8. [PMID: 24944072 DOI: 10.1111/clr.12436] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/17/2014] [Indexed: 02/02/2023]
Abstract
OBJECTIVES To investigate the cleaning efficacy of a mechanical and a hydrodynamic homecare device on biofilm-coated titanium surfaces with and without chlorhexidine. MATERIAL AND METHODS Six-species biofilms were grown on 108 SLA-titanium discs, which were cleaned as follows: sonic toothbrush alone (i) or in combination with either a 0.2% chlorhexidine (ii) or a placebo gel (iii) and oral irrigator (hydrodynamic action) with water (iv) or combined with 0.2% chlorhexidine solution (v). Untreated samples served as control (vi). Biofilms were then harvested either immediately after treatment (study part A) or after a regrowth phase of 24 h (study part B) and colony-forming units (CFU) were assessed. Results were analysed using Whitney U-tests between the treatment groups. After the Bonferroni correction, the significance level was set at α = 0.0033. RESULTS The median CFU counts directly after instrumentation accounted - in ascending order (P-values in comparison with the control group A6 were <0.001 for all groups except for A3: P = 0.014) - 2.0E1 (A5), 1.1E5 (A4), 3.6E5 (A2), 3.3E5 (A1) and 6.8E6 (A3), respectively. The untreated control group showed the highest CFU counts: 1.8E7 (A6). After regrowth, the following CFU counts were measured in ascending order (all P-values <0.001 when compared to the control group B6 = 2.0E8): 1.6E2 (B5), 1.9E5 (B2), 1.4E7 (B4), 3.1E7 (B1) and 3.9E7 (B3). CONCLUSIONS An oral irrigator combined with 0.2% chlorhexidine is effective in reducing biofilms attached to rough titanium surfaces immediately after cleaning. Following a regrowth phase of 24 h, micro-organisms could be equally effective removed with a sonic toothbrush combined with 0.2% chlorhexidine and an oral irrigator with 0.2% chlorhexidine.
Collapse
Affiliation(s)
- Alexis Ioannidis
- Clinic of Fixed Prosthodontics and Dental Material Science, Center of Dental Medicine, University of Zurich, Zurich, Switzerland
| | | | | | | | | | | |
Collapse
|
9
|
Chlorhexidine is a highly effective topical broad-spectrum agent against Candida spp. Int J Antimicrob Agents 2013; 41:65-9. [DOI: 10.1016/j.ijantimicag.2012.08.014] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2012] [Revised: 08/08/2012] [Accepted: 08/24/2012] [Indexed: 11/20/2022]
|
10
|
Carvalhinho S, Costa AM, Coelho AC, Martins E, Sampaio A. Susceptibilities of Candida albicans mouth isolates to antifungal agents, essentials oils and mouth rinses. Mycopathologia 2012; 174:69-76. [PMID: 22246961 DOI: 10.1007/s11046-012-9520-4] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2011] [Accepted: 01/02/2012] [Indexed: 10/14/2022]
Abstract
Forty Candida albicans strains isolated from patient's mouth with fixed orthodontic appliances were analyzed to their susceptibilities to antifungal agents, mouth rinses and essential oils. Susceptibility to fluconazole, econazole, miconazole and ketoconazole, amphotericin B and nystatin was assessed by the disk diffusion (DD) method based on the Clinical and Laboratory Standards Institute M44-A protocol, and by Etest (fluconazole and amphotericin B). The susceptibilities to mouth rinses and essential oils were also determined by the DD technique. All isolates tested were susceptible (S) to amphotericin B, nystatin and fluconazole. The overall concordance between the DD and the Etest was 100% for amphotericin and fluconazole. One isolate was resistant to econazole (2.5%) and the other to ketoconazole (2.5%). Econazole and ketoconazole had the highest percentages of susceptible dose dependent (SDD), 55 and 95%, respectively. Regarding to the susceptibility isolates profile, seven phenotypes were detected, and the 3 more represented (90% of the isolates) of them were SDD to one, two or three azoles. The study of mouth rinses showed a high variability of efficacy against C. albicans. The results showed that the isolates susceptibility to essential oils differed (P < 0.05). The profile activity was: cinnamon > laurel > mint > eucalyptus > rosemary > lemon > myrrh > tangerine. The main finding was that the susceptibility to cinnamon and laurel varied among the three more representative antifungal phenotypes (P < 0.05). The susceptibility of econazole-SDD isolates to cinnamon and lemon was higher than those of the econazole-S yeasts (P < 0.05). In contrast, econazole-SDD isolates were less affected by laurel than econazole-S counterparts (P < 0.05).
Collapse
Affiliation(s)
- Sara Carvalhinho
- Department of Biology and Environment, University of Trás-os-Montes and Alto Douro (UTAD), PO Box 1013, 5001-911, Vila Real, Portugal
| | | | | | | | | |
Collapse
|
11
|
Haapasalo M, Endal U, Zandi H, Coil JM. Eradication of endodontic infection by instrumentation and irrigation solutions. ACTA ACUST UNITED AC 2005. [DOI: 10.1111/j.1601-1546.2005.00135.x] [Citation(s) in RCA: 285] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
12
|
Kampf G, Kramer A. Epidemiologic background of hand hygiene and evaluation of the most important agents for scrubs and rubs. Clin Microbiol Rev 2004; 17:863-93, table of contents. [PMID: 15489352 PMCID: PMC523567 DOI: 10.1128/cmr.17.4.863-893.2004] [Citation(s) in RCA: 416] [Impact Index Per Article: 20.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
The etiology of nosocomial infections, the frequency of contaminated hands with the different nosocomial pathogens, and the role of health care workers' hands during outbreaks suggest that a hand hygiene preparation should at least have activity against bacteria, yeasts, and coated viruses. The importance of efficacy in choosing the right hand hygiene product is reflected in the new Centers for Disease Control and Prevention guideline on hand hygiene (J. M. Boyce and D. Pittet, Morb. Mortal. Wkly. Rep. 51:1-45, 2002). The best antimicrobial efficacy can be achieved with ethanol (60 to 85%), isopropanol (60 to 80%), and n-propanol (60 to 80%). The activity is broad and immediate. Ethanol at high concentrations (e.g., 95%) is the most effective treatment against naked viruses, whereas n-propanol seems to be more effective against the resident bacterial flora. The combination of alcohols may have a synergistic effect. The antimicrobial efficacy of chlorhexidine (2 to 4%) and triclosan (1 to 2%) is both lower and slower. Additionally, both agents have a risk of bacterial resistance, which is higher for chlorhexidine than triclosan. Their activity is often supported by the mechanical removal of pathogens during hand washing. Taking the antimicrobial efficacy and the mechanical removal together, they are still less effective than the alcohols. Plain soap and water has the lowest efficacy of all. In the new Centers for Disease Control and Prevention guideline, promotion of alcohol-based hand rubs containing various emollients instead of irritating soaps and detergents is one strategy to reduce skin damage, dryness, and irritation. Irritant contact dermatitis is highest with preparations containing 4% chlorhexidine gluconate, less frequent with nonantimicrobial soaps and preparations containing lower concentrations of chlorhexidine gluconate, and lowest with well-formulated alcohol-based hand rubs containing emollients and other skin conditioners. Too few published data from comparative trials are available to reliably rank triclosan. Personnel should be reminded that it is neither necessary nor recommended to routinely wash hands after each application of an alcohol-based hand rub. Long-lasting improvement of compliance with hand hygiene protocols can be successful if an effective and accessible alcohol-based hand rub with a proven dermal tolerance and an excellent user acceptability is supplied, accompanied by education of health care workers and promotion of the use of the product.
Collapse
Affiliation(s)
- Günter Kampf
- Bode Chemie GmbH & Co., Scientific Affairs, Melanchthonstrasse 27, 22525 Hamburg, Germany.
| | | |
Collapse
|
13
|
Epstein JB, Hancock PJ, Nantel S. Oral candidiasis in hematopoietic cell transplantation patients: an outcome-based analysis. ORAL SURGERY, ORAL MEDICINE, ORAL PATHOLOGY, ORAL RADIOLOGY, AND ENDODONTICS 2003; 96:154-63. [PMID: 12931087 DOI: 10.1016/s1079-2104(03)00296-8] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Despite aggressive antifungal prophylaxis, the increased risk for systemic fungal infection in recipients of hematopoietic cell transplants (HCT) continues to be a significant concern because Candida infection can cause morbidity and mortality in these patients. The objectives of this study were to examine the relationship of oral colonization by Candida species to systemic infection, mortality, and the impact of antifungal treatment on a population of recipients of HCT. STUDY DESIGN One hundred and fifteen consecutive patients undergoing hematopoietic cell transplantation were evaluated. Oral examinations and cultures for Candida were completed before transplantation and on a weekly basis until discharge. The oral complications were assessed, and the level of mucositis was scored by using the National Cancer Institute grade. Systemic antifungal prophylaxis was provided to all patients. Chlorhexidine oral rinses were also routinely provided. RESULTS Colonization by Candida species was identified in 31% of patients. Fifty-six percent of patients with colonization had clinical evidence of oral candidiasis. Significantly decreased Candida colonization was seen in patients using chlorhexidine alone compared with those using chlorhexidine and nystatin together (P <.046). Twenty-five patients died in the immediate posttransplantation period, 17 of whom were Candida-positive. The length of hospital stay ranged from 15 to 153 days; increased stay was also associated with Candida colonization (P =.04). Seventy-four percent of all patients developed ulcerative mucositis. More severe mucositis was seen in patients undergoing chemotherapy and radiation therapy. There was no significant difference between Candida colonization and the presence or severity of mucositis. CONCLUSIONS Despite systemic and topical antifungal prophylaxis, oropharyngeal colonization by Candida species was common in patients who had received HCT. Candidiasis was commonly present in those who did not survive the early transplant period. Of the 25 patients who died early after the transplantation, 92% had ulcerative mucositis in comparison with 70% of those who survived, reflecting the association of oral mucositis with the toxicity of HCT. There was a significant relationship among allogeneic and autologous HCT, length of stay, and colonization of Candida. In patients undergoing systemic antifungal prophylaxis, chlorhexidine rinse was statistically more effective in reducing colonization by Candida than chlorhexidine and nystatin combined (P =.046).
Collapse
Affiliation(s)
- Joel B Epstein
- Department of Oral Medicine and Diagnostic Sciences, University of Illinois, Chicago, USA.
| | | | | |
Collapse
|
14
|
Suci PA, Tyler BJ. A method for discrimination of subpopulations of Candida albicans biofilm cells that exhibit relative levels of phenotypic resistance to chlorhexidine. J Microbiol Methods 2003; 53:313-25. [PMID: 12689709 DOI: 10.1016/s0167-7012(02)00247-6] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Microbes in biofilms are generally found to be resistant to antimicrobial agents. One set of hypotheses attributes biofilm resistance to acquisition of special physiological traits (phenotypic resistance). Methods are presented that allow discrimination of subpopulations of Candida albicans cells that exhibit relative levels of phenotypic resistance to chlorhexidine. The assay for phenotypic resistance is based on microscopic detection of the rate of penetration of propidium iodide (PI) into single cells as their membranes become disrupted by chlorhexidine. Using the assay, it was found that batch cultures became progressively more resistant to the action of chlorhexidine during the transition from exponential growth to early stationary phase. Results are presented demonstrating that the methods can be used to characterize relative levels of phenotypic resistance exhibited by cells at the base of a C. albicans biofilm.
Collapse
Affiliation(s)
- Peter A Suci
- Center for Biofilm Engineering and Microbiology Department, Montana State University, Bozeman 59717-3980, USA.
| | | |
Collapse
|
15
|
Suci PA, Tyler BJ. Action of chlorhexidine digluconate against yeast and filamentous forms in an early-stage Candida albicans biofilm. Antimicrob Agents Chemother 2002; 46:3522-31. [PMID: 12384360 PMCID: PMC128749 DOI: 10.1128/aac.46.11.3522-3531.2002] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
An in situ method for sensitive detection of differences in the action of chlorhexidine against subpopulations of cells in Candida albicans biofilms is described. Detection relies on monitoring the kinetics of propidium iodide (PI) penetration into the cytoplasm of individual cells during dosing with chlorhexidine. Accurate estimation of the time for delivery of the dosing concentration to the substratum was facilitated by using a flow cell system for which transport to the interfacial region was previously characterized. A model was developed to quantify rates of PI penetration based on the shape of the kinetic data curves. Yeast were seeded onto the substratum, and biofilm formation was monitored microscopically for 3 h. During this period a portion of the yeast germinated, producing filamentous forms (both hyphae and pseudohyphae). When the population was subdivided on the basis of cell morphology, rates of PI penetration into filamentous forms appeared to be substantially higher than for yeast forms. Based on the model, rates of penetration were assigned to individual cells. These data indicated that the difference in rates between the two subpopulations was statistically significant (unpaired t test, P < 0.0001). A histogram of rates and analysis of variance indicated that rates were approximately equally distributed among different filamentous forms and between apical and subapical segments of filamentous forms.
Collapse
Affiliation(s)
- Peter A Suci
- Center for Biofilm Engineering and Microbiology Department, Montana State University, Bozeman, Montana 59717-3980, USA.
| | | |
Collapse
|
16
|
Patel MP, Cruchley AT, Coleman DC, Swai H, Braden M, Williams DM. A polymeric system for the intra-oral delivery of an anti-fungal agent. Biomaterials 2001; 22:2319-24. [PMID: 11511028 DOI: 10.1016/s0142-9612(00)00367-7] [Citation(s) in RCA: 42] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Oral candidal infections are often persistent and intractable and thus the aim of this study was to develop a polymeric sustained release device to improve the topical treatment of these infections. A self curing system based on poly(ethyl methacrylate) and tetrahydrofurfuryl methacrylate (PEM/THFM) was used with chlorhexidine diacetate (CX) added at levels between 0 and 12% w/w. Water uptake by the device was assessed gravimetrically and CX release measured by UV spectrometry. Anti candidal activity was established by culturing azole sensitive and resistant strains of Candida albicans in the presence of the polymeric delivery device with and without CX. Candidal growth was measured by turbidimetry or surviving colony-forming unit (CFU) formation. There was an initial high release of CX over 24 h followed by a slow diffusion up to 7 days. CX inhibited candidal growth and survival markedly in vitro, with the test samples showing less than 0.5 x 10(-7) CFU/ml compared to controls (3-4 x 10(-7) CFU/ml). These results indicate the potential of a chlorhexidine containing PEM/THFM polymeric system in the treatment of persistent candidal infections.
Collapse
Affiliation(s)
- M P Patel
- Department of Biomaterials in Relation to Dentistry, St Bartholomew's and the Royal London School of Medicine and Dentistry, Queen Mary and Westfield College, London, UK.
| | | | | | | | | | | |
Collapse
|
17
|
Meiller TF, Kelley JI, Jabra-Rizk MA, Depaola LG, Baqui AA, Falkler WA. In vitro studies of the efficacy of antimicrobials against fungi. ORAL SURGERY, ORAL MEDICINE, ORAL PATHOLOGY, ORAL RADIOLOGY, AND ENDODONTICS 2001; 91:663-70. [PMID: 11402279 DOI: 10.1067/moe.2001.113550] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The purpose of this study was to compare the efficacy of Listerine Antiseptic, Tartar Control Listerine Antiseptic, and Peridex mouthrinses and a 0.2% chlorhexidine digluconate solution against known pathogenic fungi. STUDY DESIGN Standardized methods were used to compare the antimicrobial efficacy of the above agents versus representative fungal species. Minimum inhibitory concentration-minimum fungicidal concentrations in macrobroth dilutions, suspension kill-time, and effectiveness against an artificial biofilm-attached population were studied. RESULTS All antimicrobials tested were effective against the fungal species under investigation at the concentration available commercially. Listerine Antiseptic showed a greater efficacy against attached artificial biofilm populations than the other antimicrobials tested. CONCLUSIONS Listerine Antiseptic, Tartar Control Listerine Antiseptic, and Peridex mouthrinses show promise as a means to control the pathogenic fungal species under investigation and may have applications to reduce oral colonization.
Collapse
Affiliation(s)
- T F Meiller
- Department of Oral Medicine and Diagnostic Sciences, Unversity of Maryland Dental School, Balitmore, Md 21201, USA.
| | | | | | | | | | | |
Collapse
|
18
|
Waltimo TM, Orstavik D, Sirén EK, Haapasalo MP. In vitro susceptibility of Candida albicans to four disinfectants and their combinations. Int Endod J 1999; 32:421-9. [PMID: 10709489 DOI: 10.1046/j.1365-2591.1999.00237.x] [Citation(s) in RCA: 131] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
AIM The aim of this study was to evaluate the susceptibility of seven strains of Candida albicans to four disinfectants: iodine potassium iodide, chlorhexidine acetate, sodium hypochlorite and calcium hydroxide. In addition, all possible pairs of the disinfectants were tested in order to compare the effect of the combination and its components. METHODOLOGY Filter paper discs were immersed in standardized yeast suspensions and then transferred to disinfectant solutions of different concentrations and incubated at 37 degrees C for 30 s, 5 min, 1 h and 24 h. After incubation the filter paper discs were transferred to vials with PBS and glass beads that were then vigorously shaken for dispersal of the yeast cells. PBS with resuspended yeasts was serially diluted 10-fold. Droplets of 25 microL from each dilution were inoculated on TSB agar plates and incubated in air at 37 degrees C for 24 h. The number of colony-forming units was then calculated from appropriate dilutions. RESULTS C. albicans cells were highly resistant to calcium hydroxide. Sodium hypochlorite (5% and 0.5%) and iodine (2%) potassium iodide (4%) killed all yeast cells within 30 s, whilst chlorhexidine acetate (0.5%) showed complete killing after 5 min. Combinations of disinfectants were equally or less effective than the more effective component. All C. albicans strains tested showed similar susceptibility to the medicaments tested. CONCLUSIONS This study indicates that sodium hypochlorite, iodine potassium iodide and chlorhexidine acetate are more effective than calcium hydroxide against C. albicans in vitro. However, combining calcium hydroxide with sodium hypochlorite or chlorhexidine may provide a wide-spectrum antimicrobial preparation with a long-lasting effect.
Collapse
Affiliation(s)
- T M Waltimo
- NIOM, Scandinavivan Institute of Dental Materials, Haslum, Norway.
| | | | | | | |
Collapse
|
19
|
McDonnell G, Russell AD. Antiseptics and disinfectants: activity, action, and resistance. Clin Microbiol Rev 1999; 12:147-79. [PMID: 9880479 PMCID: PMC88911 DOI: 10.1128/cmr.12.1.147] [Citation(s) in RCA: 2643] [Impact Index Per Article: 105.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Antiseptics and disinfectants are extensively used in hospitals and other health care settings for a variety of topical and hard-surface applications. A wide variety of active chemical agents (biocides) are found in these products, many of which have been used for hundreds of years, including alcohols, phenols, iodine, and chlorine. Most of these active agents demonstrate broad-spectrum antimicrobial activity; however, little is known about the mode of action of these agents in comparison to antibiotics. This review considers what is known about the mode of action and spectrum of activity of antiseptics and disinfectants. The widespread use of these products has prompted some speculation on the development of microbial resistance, in particular whether antibiotic resistance is induced by antiseptics or disinfectants. Known mechanisms of microbial resistance (both intrinsic and acquired) to biocides are reviewed, with emphasis on the clinical implications of these reports.
Collapse
Affiliation(s)
- G McDonnell
- STERIS Corporation, St. Louis Operations, St. Louis, Missouri 63166, USA.
| | | |
Collapse
|
20
|
Giuliana G, Pizzo G, Milici ME, Giangreco R. In vitro activities of antimicrobial agents against Candida species. ORAL SURGERY, ORAL MEDICINE, ORAL PATHOLOGY, ORAL RADIOLOGY, AND ENDODONTICS 1999; 87:44-9. [PMID: 9927079 DOI: 10.1016/s1079-2104(99)70293-3] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Antimicrobial mouthrinses may represent a valid alternative to topical antifungal agents. However, the action of antimicrobials could be affected by the different ingredients incorporated into mouthrinse products. The purpose of the present study was to investigate the in vitro antifungal and fungicidal activities of antimicrobials alone. STUDY DESIGN A broth macrodilution method was used to determine the minimum inhibitory concentration of 4 antimicrobial agents against Candida species. Minimum fungicidal concentration was also determined. RESULTS All antimicrobials showed antifungal activity against all tested organisms, but cetylpyridinium chloride received significantly lower minimum inhibitory concentrations (P < .005). Cetylpyridinium chloride also showed a greater fungicidal activity than chlorhexidine digluconate and hexetidine (P< .005), whereas sanguinarine chloride appeared to be less fungicidal against most of the isolates tested. CONCLUSIONS These findings suggest that cetylpyridinium chloride may be used as a topical antifungal agent. Clinical trials are now required to assess its value in the management of oral candidosis.
Collapse
Affiliation(s)
- G Giuliana
- Department of Periodontology, School of Dentistry, University of Palermo, Italy
| | | | | | | |
Collapse
|
21
|
Hiom SJ, Furr JR, Russell AD. Uptake of 14C-chlorhexidine gluconate by Saccharomyces cerevisiae, Candida albicans and Candida glabrata. Lett Appl Microbiol 1995; 21:20-2. [PMID: 7662332 DOI: 10.1111/j.1472-765x.1995.tb00997.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Uptake of radiolabelled chlorhexidine gluconate (14C-CHG) to Saccharomyces cerevisiae, Candida albicans and C. glabrata was very rapid and near maximal within 30 s. The organism, S. cerevisiae, most sensitive to the lethal action of chlorhexidine, took up significantly more biocide than the other organisms. Cells from cultures of different ages took up different amounts of 14C-CHG.
Collapse
Affiliation(s)
- S J Hiom
- Welsh School of Pharmacy, University of Wales College of Cardiff, UK
| | | | | |
Collapse
|
22
|
Maillard JY, Hann AC, Beggs TS, Day MJ, Hudson RA, Russell AD. Energy dispersive analysis of X-rays study of the distribution of chlorhexidine diacetate and cetylpyridinium chloride on the Pseudomonas aeruginosa bacteriophage F116. Lett Appl Microbiol 1995; 20:357-60. [PMID: 7786501 DOI: 10.1111/j.1472-765x.1995.tb01320.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Using an energy dispersive analyser of X-rays fitted to a scanning electron microscope, chlorhexidine was shown not to bind onto F116 bacteriophage, unlike cetylpyridinium chloride, which possibly penetrated the phage. This could explain the difference in viricidal activity between the two compounds.
Collapse
Affiliation(s)
- J Y Maillard
- Welsh School of Pharmacy, Department of Applied Biology, University of Wales College of Cardiff, UK
| | | | | | | | | | | |
Collapse
|
23
|
Affiliation(s)
- A D Russell
- Welsh School of Pharmacy, University of Wales College of Cardiff
| | | |
Collapse
|
24
|
|