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Zhang Y, Han Y, Huang Z, Huang Y, Kong J, Sun Y, Cao J, Zhou T. Restoring Colistin Sensitivity and Combating Biofilm Formation: Synergistic Effects of Colistin and Usnic Acid against Colistin-Resistant Enterobacteriaceae. ACS Infect Dis 2023; 9:2457-2470. [PMID: 37944020 DOI: 10.1021/acsinfecdis.3c00315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2023]
Abstract
Colistin (COL), the last line of defense in clinical medicine, is an important therapeutic option against multidrug-resistant Gram-negative bacteria. In this context, the emergence of colistin-resistant (COL-R) bacteria mediated by broad-spectrum efflux pumps, mobile genetic elements, and biofilm formation poses a significant public health concern. In response to this challenge, a novel approach of combining COL with usnic acid (UA) has been proposed in this study. UA is a secondary metabolite derived from lichens and is well-known for its anti-inflammatory properties. This study aimed to investigate the synergistic effects of UA and COL against COL-R Enterobacteriaceae both in vitro and in vivo. The exceptional synergistic antibacterial activity exhibited by the combination of COL and UA was demonstrated by performing a comprehensive set of assays, including the checkerboard assay, time-dependent killing assay, and Live/Dead bacterial cell viability assay. Furthermore, crystal violet staining and scanning electron microscopy assays revealed the inhibitory effect of this combination on the biofilm formation. Mechanistically, the combination of UA and COL exacerbated cell membrane rupture, induced DNA damage, and generated a significant amount of reactive oxygen species, which ultimately resulted in bacterial cell death. In addition, erythrocyte hemolysis and cell viability tests confirmed the biocompatibility of the combination. The evaluation of the COL/UA combination in vivo using Galleria mellonella larvae and a mouse infection model showed a significant improvement in the survival rate of the infected larvae as well as a reduction in the bacterial load in the mouse thigh muscle. These findings, for the first time, provide strong evidence for the potential application of COL/UA as an effective alternative therapeutic option to combat infections caused by COL-R Enterobacteriaceae strains.
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Affiliation(s)
- Yi Zhang
- Department of Clinical Laboratory, The First Affiliated Hospital of Wenzhou Medical University; Key Laboratory of Clinical Laboratory Diagnosis and Translational Research of Zhejiang Province, Wenzhou, Zhejiang Province 325000, China
- Department of Medical Lab Science, School of Laboratory Medicine and Life Science, Wenzhou Medical University, Wenzhou, Zhejiang Province 32500, China
| | - Yijia Han
- Department of Medical Lab Science, School of Laboratory Medicine and Life Science, Wenzhou Medical University, Wenzhou, Zhejiang Province 32500, China
| | - Zeyu Huang
- Department of Clinical Laboratory, The First Affiliated Hospital of Wenzhou Medical University; Key Laboratory of Clinical Laboratory Diagnosis and Translational Research of Zhejiang Province, Wenzhou, Zhejiang Province 325000, China
| | - Yali Huang
- Department of Clinical Laboratory, The First Affiliated Hospital of Wenzhou Medical University; Key Laboratory of Clinical Laboratory Diagnosis and Translational Research of Zhejiang Province, Wenzhou, Zhejiang Province 325000, China
| | - Jingchun Kong
- Department of Medical Lab Science, School of Laboratory Medicine and Life Science, Wenzhou Medical University, Wenzhou, Zhejiang Province 32500, China
| | - Yao Sun
- Department of Clinical Laboratory, The First Affiliated Hospital of Wenzhou Medical University; Key Laboratory of Clinical Laboratory Diagnosis and Translational Research of Zhejiang Province, Wenzhou, Zhejiang Province 325000, China
| | - Jianming Cao
- Department of Medical Lab Science, School of Laboratory Medicine and Life Science, Wenzhou Medical University, Wenzhou, Zhejiang Province 32500, China
| | - Tieli Zhou
- Department of Clinical Laboratory, The First Affiliated Hospital of Wenzhou Medical University; Key Laboratory of Clinical Laboratory Diagnosis and Translational Research of Zhejiang Province, Wenzhou, Zhejiang Province 325000, China
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Popovici V, Matei E, Cozaru GC, Bucur L, Gîrd CE, Schröder V, Ozon EA, Karampelas O, Musuc AM, Atkinson I, Rusu A, Petrescu S, Mitran RA, Anastasescu M, Caraiane A, Lupuliasa D, Aschie M, Badea V. Evaluation of Usnea barbata (L.) Weber ex F.H. Wigg Extract in Canola Oil Loaded in Bioadhesive Oral Films for Potential Applications in Oral Cavity Infections and Malignancy. Antioxidants (Basel) 2022; 11:antiox11081601. [PMID: 36009320 PMCID: PMC9404812 DOI: 10.3390/antiox11081601] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 08/11/2022] [Accepted: 08/17/2022] [Indexed: 12/16/2022] Open
Abstract
Usnea lichens are known for their beneficial pharmacological effects with potential applications in oral medicine. This study aims to investigate the extract of Usnea barbata (L.) Weber ex F.H. Wigg from the Călimani Mountains in canola oil as an oral pharmaceutical formulation. In the present work, bioadhesive oral films (F-UBO) with U. barbata extract in canola oil (UBO) were formulated, characterized, and evaluated, evidencing their pharmacological potential. The UBO-loaded films were analyzed using standard methods regarding physicochemical and pharmacotechnical characteristics to verify their suitability for topical administration on the oral mucosa. F-UBO suitability confirmation allowed for the investigation of antimicrobial and anticancer potential. The antimicrobial properties against Staphylococcus aureus ATCC 25923, Pseudomonas aeruginosa ATCC 27353, Candida albicans ATCC 10231, and Candida parapsilosis ATCC 22019 were evaluated by a resazurin-based 96-well plate microdilution method. The brine shrimp lethality assay (BSL assay) was the animal model cytotoxicity prescreen, followed by flow cytometry analyses on normal blood cells and oral epithelial squamous cell carcinoma CLS-354 cell line, determining cellular apoptosis, caspase-3/7 activity, nuclear condensation and lysosomal activity, oxidative stress, cell cycle, and cell proliferation. The results indicate that a UBO-loaded bioadhesive film’s weight is 63 ± 1.79 mg. It contains 315 µg UBO, has a pH = 6.97 ± 0.01, a disintegration time of 124 ± 3.67 s, and a bioadhesion time of 86 ± 4.12 min, being suitable for topical administration on the oral mucosa. F-UBO showed moderate dose-dependent inhibitory effects on the growth of both bacterial and fungal strains. Moreover, in CLS-354 tumor cells, F-UBO increased oxidative stress, diminished DNA synthesis, and induced cell cycle arrest in G0/G1. All these properties led to considering UBO-loaded bioadhesive oral films as a suitable phytotherapeutic formulation with potential application in oral infections and neoplasia.
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Affiliation(s)
- Violeta Popovici
- Department of Microbiology and Immunology, Faculty of Dental Medicine, Ovidius University of Constanta, 7 Ilarie Voronca Street, 900684 Constanta, Romania
| | - Elena Matei
- Center for Research and Development of the Morphological and Genetic Studies of Malignant Pathology, Ovidius University of Constanta, CEDMOG, 145 Tomis Blvd., 900591 Constanta, Romania
- Correspondence: (E.M.); (V.S.); (E.A.O.); (O.K.); (A.M.M.)
| | - Georgeta Camelia Cozaru
- Center for Research and Development of the Morphological and Genetic Studies of Malignant Pathology, Ovidius University of Constanta, CEDMOG, 145 Tomis Blvd., 900591 Constanta, Romania
- Clinical Service of Pathology, Sf. Apostol Andrei Emergency County Hospital, 145 Tomis Blvd., 900591 Constanta, Romania
| | - Laura Bucur
- Department of Pharmacognosy, Faculty of Pharmacy, Ovidius University of Constanta, 6 Capitan Al. Serbanescu Street, 900001 Constanta, Romania
| | - Cerasela Elena Gîrd
- Department of Pharmacognosy, Phytochemistry, and Phytotherapy, Faculty of Pharmacy, Carol Davila University of Medicine and Pharmacy, 6 Traian Vuia Street, 020956 Bucharest, Romania
| | - Verginica Schröder
- Department of Cellular and Molecular Biology, Faculty of Pharmacy, Ovidius University of Constanta, 6 Capitan Al. Serbanescu Street, 900001 Constanta, Romania
- Correspondence: (E.M.); (V.S.); (E.A.O.); (O.K.); (A.M.M.)
| | - Emma Adriana Ozon
- Department of Pharmaceutical Technology and Biopharmacy, Faculty of Pharmacy, Carol Davila University of Medicine and Pharmacy, 6 Traian Vuia Street, 020956 Bucharest, Romania
- Correspondence: (E.M.); (V.S.); (E.A.O.); (O.K.); (A.M.M.)
| | - Oana Karampelas
- Department of Pharmaceutical Technology and Biopharmacy, Faculty of Pharmacy, Carol Davila University of Medicine and Pharmacy, 6 Traian Vuia Street, 020956 Bucharest, Romania
- Correspondence: (E.M.); (V.S.); (E.A.O.); (O.K.); (A.M.M.)
| | - Adina Magdalena Musuc
- “Ilie Murgulescu” Institute of Physical Chemistry, Romanian Academy, 202 Spl. Independentei, 060021 Bucharest, Romania
- Correspondence: (E.M.); (V.S.); (E.A.O.); (O.K.); (A.M.M.)
| | - Irina Atkinson
- “Ilie Murgulescu” Institute of Physical Chemistry, Romanian Academy, 202 Spl. Independentei, 060021 Bucharest, Romania
| | - Adriana Rusu
- “Ilie Murgulescu” Institute of Physical Chemistry, Romanian Academy, 202 Spl. Independentei, 060021 Bucharest, Romania
| | - Simona Petrescu
- “Ilie Murgulescu” Institute of Physical Chemistry, Romanian Academy, 202 Spl. Independentei, 060021 Bucharest, Romania
| | - Raul-Augustin Mitran
- “Ilie Murgulescu” Institute of Physical Chemistry, Romanian Academy, 202 Spl. Independentei, 060021 Bucharest, Romania
| | - Mihai Anastasescu
- “Ilie Murgulescu” Institute of Physical Chemistry, Romanian Academy, 202 Spl. Independentei, 060021 Bucharest, Romania
| | - Aureliana Caraiane
- Department of Oral Rehabilitation, Faculty of Dental Medicine, Ovidius University of Constanta, 7 Ilarie Voronca Street, 900684 Constanta, Romania
| | - Dumitru Lupuliasa
- Department of Pharmaceutical Technology and Biopharmacy, Faculty of Pharmacy, Carol Davila University of Medicine and Pharmacy, 6 Traian Vuia Street, 020956 Bucharest, Romania
| | - Mariana Aschie
- Center for Research and Development of the Morphological and Genetic Studies of Malignant Pathology, Ovidius University of Constanta, CEDMOG, 145 Tomis Blvd., 900591 Constanta, Romania
- Clinical Service of Pathology, Sf. Apostol Andrei Emergency County Hospital, 145 Tomis Blvd., 900591 Constanta, Romania
| | - Victoria Badea
- Department of Microbiology and Immunology, Faculty of Dental Medicine, Ovidius University of Constanta, 7 Ilarie Voronca Street, 900684 Constanta, Romania
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Li J, Feng S, Liu X, Jia X, Qiao F, Guo J, Deng S. Effects of Traditional Chinese Medicine and its Active Ingredients on Drug-Resistant Bacteria. Front Pharmacol 2022; 13:837907. [PMID: 35721131 PMCID: PMC9204478 DOI: 10.3389/fphar.2022.837907] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 04/25/2022] [Indexed: 11/13/2022] Open
Abstract
The increasing and widespread application of antibacterial drugs makes antibiotic resistance a prominent and growing concern in clinical practice. The emergence of multidrug-resistant bacteria presents a global threat. However, the development and use of novel antibacterial agents involves time-consuming and costly challenges that may lead to yet further drug resistance. More recently, researchers have turned to traditional Chinese medicine to stem the rise of antibiotic resistance in pathogens. Many studies have shown traditional Chinese medicines to have significant bacteriostatic and bactericidal effects, with the advantage of low drug resistance. Some of which when combined with antibiotics, have also demonstrated antibacterial activity by synergistic effect. Traditional Chinese medicine has a variety of active components, including flavonoids, alkaloids, phenols, and quinones, which can inhibit the growth of drug-resistant bacteria and be used in combination with a variety of antibiotics to treat various drug-resistant bacterial infections. We reviewed the interaction between the active ingredients of traditional Chinese medicines and antibiotic-resistant bacteria. At present, flavonoids and alkaloids are the active ingredients that have been most widely studied, with significant synergistic activity demonstrated when used in combination with antibiotics against drug-resistant bacteria. The reviewed studies show that traditional Chinese medicine and its active ingredients have antimicrobial activity on antibiotic-resistant bacteria, which may enhance the susceptibility of antibiotic-resistant bacteria, potentially reduce the required dosage of antibacterial agents and the rate of drug resistance. Our results provide direction for finding and developing alternative methods to counteract drug-resistant bacteria, offering a new therapeutic strategy for tackling antibiotic resistance.
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Affiliation(s)
- Jimin Li
- Chongqing Key Laboratory of Sichuan-Chongqing Co-construction for Diagnosis and Treatment of Infectious Diseases Integrated Traditional Chinese and Western Medicine, College of Medical Technology, Chengdu University of Traditional Chinese Medicine, Chengdu, China.,Non-Coding RNA and Drug Discovery Key Laboratory of Sichuan Province, Chengdu Medical College, Chengdu, China
| | - Shanshan Feng
- Chongqing Key Laboratory of Sichuan-Chongqing Co-construction for Diagnosis and Treatment of Infectious Diseases Integrated Traditional Chinese and Western Medicine, College of Medical Technology, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Xin Liu
- School of Public Health, Chengdu Medical College, Chengdu, China
| | - Xu Jia
- Non-Coding RNA and Drug Discovery Key Laboratory of Sichuan Province, Chengdu Medical College, Chengdu, China.,School of Basic Medical Sciences, Chengdu Medical College, Chengdu, China
| | - Fengling Qiao
- Chongqing Key Laboratory of Sichuan-Chongqing Co-construction for Diagnosis and Treatment of Infectious Diseases Integrated Traditional Chinese and Western Medicine, College of Medical Technology, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Jinlin Guo
- Chongqing Key Laboratory of Sichuan-Chongqing Co-construction for Diagnosis and Treatment of Infectious Diseases Integrated Traditional Chinese and Western Medicine, College of Medical Technology, Chengdu University of Traditional Chinese Medicine, Chengdu, China.,Key Laboratory of Systematic Research of Distinctive Chinese Medicine Resources in Southwest China, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Shanshan Deng
- Non-Coding RNA and Drug Discovery Key Laboratory of Sichuan Province, Chengdu Medical College, Chengdu, China.,School of Basic Medical Sciences, Chengdu Medical College, Chengdu, China
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Synergism between metallic nanoparticles and antibiotics. Appl Microbiol Biotechnol 2022; 106:3973-3984. [PMID: 35670851 DOI: 10.1007/s00253-022-12001-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 03/28/2022] [Accepted: 05/27/2022] [Indexed: 11/02/2022]
Abstract
The discovery of antibiotics in the twentieth century made it possible to treat bacterial infections and revolutionized modern medicine. However, gradually, it is possible to perceive a decrease in the effectiveness of antimicrobial agents against pathogenic isolates, which, together with the low investment in the discovery and/or development of new antibiotics by large pharmaceutical companies since the 1960s, makes it increasingly difficult to treatment of infections caused by these microorganisms. The search for strategies capable of potentiating the effect of existing drugs through the development of new therapeutic approaches, which also have the potential to circumvent bacterial resistance to antibiotics, has become indispensable. In this context, metallic nanoparticles stand out, as they could be used to act synergistically with drugs. Thus, the objective of this review was to present the latest information on the synergistic activity of antibiotics with metallic nanoparticles, pointing out this association as a promising alternative for the preservation of bacterial sensitivity to these drugs. The different metallic nanoparticles can present different benefits in the treatment of bacterial infections, with this being able to potentiate the bacterial activity of antibiotics that are widely used in the clinic, being able to increase the susceptibility in multiresistant microorganisms. KEY POINTS: • Metallic nanoparticles increased the antimicrobial action of drugs; • Metallic nanoparticles compromise the action of bacterial efflux pumps; • Biofilm formation was inhibited after treatment with metallic nanoparticles.
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Battista S, Köber M, Bellio P, Celenza G, Galantini L, Vargas-Nadal G, Fagnani L, Veciana J, Ventosa N, Giansanti L. Quatsomes Formulated with l-Prolinol-Derived Surfactants as Antibacterial Nanocarriers of (+)-Usnic Acid with Antioxidant Activity. ACS APPLIED NANO MATERIALS 2022; 5:6140-6148. [PMID: 35655931 PMCID: PMC9150064 DOI: 10.1021/acsanm.1c04365] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 03/21/2022] [Indexed: 06/15/2023]
Abstract
The efficacy of the treatment of bacterial infection is seriously reduced because of antibiotic resistance; thus, therapeutic solutions against drug-resistant microbes are necessary. Nanoparticle-based solutions are particularly promising for meeting this challenge because they can offer intrinsic antimicrobial activity and sustained drug release at the target site. Herein, we present a newly developed nanovesicle system of the quatsome family, composed of l-prolinol-derived surfactants and cholesterol, which has noticeable antibacterial activity even on Gram-negative strains, demonstrating great potential for the treatment of bacterial infections. We optimized the vesicle stability and antibacterial activity by tuning the surfactant chain length and headgroup charge (cationic or zwitterionic) and show that these quatsomes can furthermore serve as nanocarriers of pharmaceutical actives, demonstrated here by the encapsulation of (+)-usnic acid, a natural substance with many pharmacological properties.
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Affiliation(s)
- Sara Battista
- Dipartimento
di Scienze Fisiche e Chimiche, Università
degli Studi dell’Aquila, Via Vetoio, 67010 Coppito, L’Aquila, Italy
| | - Mariana Köber
- Institut
de Ciència de Materials de Barcelona (ICMAB-CSIC), Esfera Universitat Autónoma de Barcelona (UAB); Campus UAB s/n, E-08193 Cerdanyola del Vallès, Spain
- Networking
Research Center on Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Campus Universitari de Bellaterra, E-08193 Cerdanyola, Spain
| | - Pierangelo Bellio
- Dipartimento
di Scienze Cliniche Applicate e Biotecnologie, Università degli Studi dell’Aquila, Via Vetoio, 67010 Coppito, L’Aquila, Italy
| | - Giuseppe Celenza
- Dipartimento
di Scienze Cliniche Applicate e Biotecnologie, Università degli Studi dell’Aquila, Via Vetoio, 67010 Coppito, L’Aquila, Italy
| | - Luciano Galantini
- Dipartimento
di Chimica, Università di Roma “Sapienza”, Piazzale Aldo Moro 5, 00185 Roma, Italy
| | - Guillem Vargas-Nadal
- Institut
de Ciència de Materials de Barcelona (ICMAB-CSIC), Esfera Universitat Autónoma de Barcelona (UAB); Campus UAB s/n, E-08193 Cerdanyola del Vallès, Spain
- Networking
Research Center on Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Campus Universitari de Bellaterra, E-08193 Cerdanyola, Spain
| | - Lorenza Fagnani
- Dipartimento
di Scienze Cliniche Applicate e Biotecnologie, Università degli Studi dell’Aquila, Via Vetoio, 67010 Coppito, L’Aquila, Italy
| | - Jaume Veciana
- Institut
de Ciència de Materials de Barcelona (ICMAB-CSIC), Esfera Universitat Autónoma de Barcelona (UAB); Campus UAB s/n, E-08193 Cerdanyola del Vallès, Spain
- Networking
Research Center on Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Campus Universitari de Bellaterra, E-08193 Cerdanyola, Spain
| | - Nora Ventosa
- Institut
de Ciència de Materials de Barcelona (ICMAB-CSIC), Esfera Universitat Autónoma de Barcelona (UAB); Campus UAB s/n, E-08193 Cerdanyola del Vallès, Spain
- Networking
Research Center on Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Campus Universitari de Bellaterra, E-08193 Cerdanyola, Spain
| | - Luisa Giansanti
- Dipartimento
di Scienze Fisiche e Chimiche, Università
degli Studi dell’Aquila, Via Vetoio, 67010 Coppito, L’Aquila, Italy
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(+)-Usnic Acid as a Promising Candidate for a Safe and Stable Topical Photoprotective Agent. Molecules 2021; 26:molecules26175224. [PMID: 34500657 PMCID: PMC8433837 DOI: 10.3390/molecules26175224] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 08/19/2021] [Accepted: 08/26/2021] [Indexed: 12/04/2022] Open
Abstract
The study aimed to examine whether usnic acid—a lichen compound with UV-absorbing properties—can be considered as a prospective photoprotective agent in cosmetic products. Moreover, a comparison of two usnic acid enantiomers was performed to preselect the more effective compound. To meet this aim, an in vitro model was created, comprising the determination of skin-penetrating properties via skin-PAMPA assay, safety assessment to normal human skin cells (keratinocytes, melanocytes, fibroblasts), and examination of photostability and photoprotective properties. Both enantiomers revealed comparable good skin-penetrating properties. Left-handed usnic acid was slightly more toxic to keratinocytes (IC50 80.82 and 40.12 µg/mL, after 48 and 72 h, respectively) than its right-handed counterpart. The latter enantiomer, in a cosmetic formulation, was characterized by good photoprotective properties and photostability, comparable to the UV filter octocrylene. Perhaps most interestingly, (+)-usnic acid combined with octocrylene in one formulation revealed enhanced photoprotection and photostability. Thus, the strategy can be considered for the potential use of (+)-usnic acid as a UV filter in cosmetic products. Moreover, the proposed model may be useful for the evaluation of candidates for UV filters.
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Overexpression of the adeB Efflux Pump Gene in Tigecycline-Resistant Acinetobacter baumannii Clinical Isolates and Its Inhibition by (+)Usnic Acid as an Adjuvant. Antibiotics (Basel) 2021; 10:antibiotics10091037. [PMID: 34572620 PMCID: PMC8472003 DOI: 10.3390/antibiotics10091037] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 08/19/2021] [Accepted: 08/20/2021] [Indexed: 12/11/2022] Open
Abstract
Acinetobacter species are among the most life-threatening Gram-negative bacilli, causing hospital-acquired infections, and they are associated with high morbidity and mortality. They show multidrug resistance that acts via various mechanisms. In Acinetobacter baumannii, efflux pump-mediated resistance to many antimicrobial compounds, including tigecycline, has been widely reported. Natural compounds have been used for their various pharmacological properties, including anti-efflux pump activity. The present study aimed to evaluate the efflux pump-mediated resistance mechanism of Acinetobacter baumannii and the effect of (+)Usnic acid as an efflux pump inhibitor with tigecycline. For detecting the efflux pump activity of tigecycline-resistant Acinetobacter baumannii isolates, microbroth dilution method and real-time quantitative reverse transcription–polymerase chain reaction was used. (+)Usnic acid was added to tigecycline and tested by the checkerboard method to evaluate its efficacy as an efflux pump inhibitor. qRT-PCR analysis was carried out to show the downregulation of the efflux pump in the isolates. Out of 42 tigecycline-resistant Acinetobacter baumannii isolates, 19 showed efflux pump activity. All 19 strains expressed the adeB gene. (+)Usnic acid as an adjuvant showed better efficacy in lowering the minimum inhibitory concentration compared with the conventional efflux pump inhibitor, carbonyl cyanide phenylhydrazone.
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Lu Q, Zhu HH, Li GH, Qi TT, Ye LJ, Teng XQ, Qu Q, He GF, Qu J. A Comparative Study of the Microbiological Efficacy of Polymyxin B on Different Carbapenem-Resistant Gram-Negative Bacteria Infections. Front Med (Lausanne) 2021; 8:620885. [PMID: 33634151 PMCID: PMC7902010 DOI: 10.3389/fmed.2021.620885] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 01/15/2021] [Indexed: 12/14/2022] Open
Abstract
Objective: The emergence of carbapenem-resistant gram-negative bacteria (CR-GNB) has brought great challenges to clinical anti-infection treatment around the world. Polymyxins are often considered as the last line of defense in the treatment of CR-GNB infections. In this study, we explored the microbiological efficacy of Polymyxin B (PMB) on different CR-GNB infections as well as the factors influencing microbiological efficacy. Methods: CR-GNB infected patients with PMB-based regimens were enrolled. Clinical and microbiological data were collected from the medical electronic record system of the Second Xiangya hospital. The efficacy of PMB on different CR-GNB was evaluated by the clearance rate at 7-days and within the course of treatment, as well as the 30-day mortality rate. Results: A total of 294 CR-GNB infected patients were enrolled: 154 CR-Acinetobacter baumannii (CRAB), 55 CR-Klebsiella pneumoniae (CRKP), and 85 CR-Pseudomonas aeruginosa (CRPA). The CRAB group had the highest 7-day bacterial clearance rate [(CRAB: 39.0%) vs. (CRKP: 29.4%) vs. (CRPA: 14.5%), P = 0.003] and total bacterial clearance rate [(CRAB: 49.0%) vs. (CRKP: 39.8%) vs. (CRPA: 18.2%), P < 0.001] among the three groups, while the bacterial clearance rate of the CRPA group was the lowest. Multivariate logistic regression showed that the differences among the three groups were multiple CR-GNB infections (P = 0.004), respiratory infections (P = 0.001), PMB resistance (P < 0.001), and the combination of tigecycline (P < 0.001). Binary logistic regression showed that multiple CR-GNB infection [(7-day bacterial clearance: P = 0.004) & (total bacterial clearance: P = 0.011)] and bacterial species [(7-day bacterial clearance: P < 0.001) & (total bacterial clearance: P < 0.001)] were independent risk factors for microbiological efficacy. Conclusion: PMB exhibited differential microbiological efficacy on different types of CR-GNB infections; it had the best effect on CRAB, followed by CRKP and CRPA. Multiple CR-GNB infections and bacterial species were independent risk factors for microbiological efficacy.
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Affiliation(s)
- Qiong Lu
- Department of Pharmacy, The Second Xiangya Hospital, Central South University, Institute of Clinical Pharmacy, Central South University, Changsha, China
| | - Hai-Hong Zhu
- Department of Pharmacy, The Second Xiangya Hospital, Central South University, Institute of Clinical Pharmacy, Central South University, Changsha, China
| | - Guo-Hua Li
- Department of Pharmacy, The Second Xiangya Hospital, Central South University, Institute of Clinical Pharmacy, Central South University, Changsha, China
| | - Ting-Ting Qi
- Department of Pharmacy, The Second Xiangya Hospital, Central South University, Institute of Clinical Pharmacy, Central South University, Changsha, China
| | - Liang-Jun Ye
- Department of Pharmacy, Hunan Provincial Corps Hospital of Chinese People's Armed Police Force, Changsha, China
| | - Xin-Qi Teng
- Department of Pharmacy, The Second Xiangya Hospital, Central South University, Institute of Clinical Pharmacy, Central South University, Changsha, China
| | - Qiang Qu
- Department of Pharmacy, Xiangya Hospital, Central South University, Changsha, China
| | - Ge-Fei He
- Department of Pharmacy, The First Hospital of Changsha, Changsha, China
| | - Jian Qu
- Department of Pharmacy, The Second Xiangya Hospital, Central South University, Institute of Clinical Pharmacy, Central South University, Changsha, China
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