Cationic compounds with activity against multidrug-resistant bacteria: interest of a new compound compared with two older antiseptics, hexamidine and chlorhexidine

Stenotrophomonas maltophilia: An Urgent Threat with Increasing Antibiotic Resistance

Stenotrophomonas maltophilia is a Gram-negative opportunistic pathogen that can cause many infections, such as chronic pulmonary infections in patients with cystic fibrosis and infections in immunocompromised patients with hematology-oncology diseases. Because of its remarkable and increasing antimicrobial resistance, the treatment of S. maltophilia infections is quite challenging. Meanwhile, the prevalence of S. maltophilia infections is increasing in recent decades. S. maltophilia is usually considered to be of low virulence but has numerous virulence factors involved in the pathogenesis of infections caused by S. maltophilia. By revealing its pathogenesis associated with virulence factors and molecular mechanisms of antimicrobial resistance, many existing or potential therapeutic strategies have been developed. However, because of the limited treatment options, new strategies are urgently needed. Here, we review the recent progresses in research on S. maltophilia which may help to develop more effective treatments against this increasing threat.

Functionalized Calixarenes as Promising Antibacterial Drugs to Face Antimicrobial Resistance

Since the discovery of polyphenolic resins 150 years ago, the study of polymeric compounds named calix[n]arene has continued to progress, and those skilled in the art perfectly know now how to modulate this phenolic ring. Consequently, calix[n]arenes are now used in a large range of applications and notably in therapeutic fields. In particular, the calix[4]arene exhibits multiple possibilities for regioselective polyfunctionalization on both of its rims and offers researchers the possibility of precisely tuning the geometry of their structures. Thus, in the crucial research of new antibacterial active ingredients, the design of calixarenes finds its place perfectly. This review provides an overview of the work carried out in this aim towards the development of intrinsically active prodrogues or metallic calixarene complexes. Out of all the work of the community, there are some excellent activities emerging that could potentially place these original structures in a very good position for the development of new active ingredients.

Hydrophilic nanoparticles that kill bacteria while sparing mammalian cells reveal the antibiotic role of nanostructures

To dissect the antibiotic role of nanostructures from chemical moieties belligerent to both bacterial and mammalian cells, here we show the antimicrobial activity and cytotoxicity of nanoparticle-pinched polymer brushes (NPPBs) consisting of chemically inert silica nanospheres of systematically varied diameters covalently grafted with hydrophilic polymer brushes that are non-toxic and non-bactericidal. Assembly of the hydrophilic polymers into nanostructured NPPBs doesn't alter their amicability with mammalian cells, but it incurs a transformation of their antimicrobial potential against bacteria, including clinical multidrug-resistant strains, that depends critically on the nanoparticle sizes. The acquired antimicrobial potency intensifies with small nanoparticles but subsides quickly with large ones. We identify a threshold size (d_silica ~ 50 nm) only beneath which NPPBs remodel bacteria-mimicking membrane into 2D columnar phase, the epitome of membrane pore formation. This study illuminates nanoengineering as a viable approach to develop nanoantibiotics that kill bacteria upon contact yet remain nontoxic when engulfed by mammalian cells.

In Vitro Antimicrobial Activity of a New Ophthalmic Solution Containing Hexamidine Diisethionate 0.05% (Keratosept)

PURPOSE

To assess the in vitro antimicrobial activity of a new commercial ophthalmic solution containing hexamidine diisethionate 0.05% (Keratosept).

METHODS

Staphylococcus aureus American Type Culture Collection (ATCC 43300), Pseudomonas aeruginosa ATCC 27853, 3 ocular bacterial isolates (1 Staphylococcus epidermidis, 1 S. aureus, and 1 P. aeruginosa), and 5 Candida species were used. The bacterial and fungal isolates were cultured on Columbia blood agar base and Sabouraud-dextrose agar plates, respectively, and incubated overnight at 37°C. Suspensions were prepared in a sterile saline solution with optical density equal to 0.5 McFarland standard (∼10 CFU/mL). Isolate suspensions were made in Keratosept solution to obtain a concentration of 10 CFU/mL. The suspensions were then distributed in conical tubes with a final volume of 1 mL and incubated at 37°C. After 1, 5, 10, 15, 20, 25, 30 minutes, and 24 hours, 10 μL of each suspension was removed, seeded on Columbia blood agar base and Sabouraud-dextrose agar plates and then incubated for 24 hours at 37°C.

RESULTS

After 1-minute incubation, there was no growth on the plates seeded with S. aureus ATCC 43300, S. aureus clinical isolate, S. epidermidis clinical isolate, and all 5 Candida species tested. Conversely, Keratosept solution failed to kill the Pseudomonas isolates after 30 minutes exposure and needed 24 hours to eradicate the organisms.

CONCLUSIONS

Keratosept ophthalmic solution showed in vitro antimicrobial activity against S. epidermidis, S. aureus, and Candida species. Results suggest that it may be a potential candidate for the treatment of staphylococcal and Candida infections of the ocular surface and have some role in antimicrobial prophylaxis before intravitreal injections.

Antimicrobial resistance trends of non-fermenter Gram negative bacteria in Saudi Arabia: A six-year national study

BACKGROUND

Antimicrobial resistance (AMR) of non-fermenting Gram-negative bacteria (NFGNB) is increasingly recognized as urgent healthcare threat. Trend data on AMR of NFGNB in Saudi Arabia are either old or limited. The objective was to estimate the prevalence and resistance trends of isolated NFGNB in Saudi Arabia.

METHODS

A retrospective multicenter study involving seven tertiary care hospitals in Saudi Arabia was conducted between 2011 and 2016. Susceptibility testing for non-duplicate isolates was performed according to the Clinical and Laboratory Standards Institute (CLSI) guidelines in College of American Pathologists accredited diagnostic microbiology laboratories in the participating hospitals.

RESULTS

Out of 461,274 isolates, 100,132 (21.7%) were NFGNB which represented 30% of gram-negative pathogens. Pseudomonas aeruginosa was the most common (73.6%), followed by Acinetobacter baumannii (21.0%) and Stenotrophomonas maltophilia (5.3%). Resistance trends of P. aeruginosa were increasing for aztreonam (absolute increase during the study was 17.3%), imipenem (12.3%), and meropenem (11.6%). A. baumannii was fully resistant to several beta lactam drugs, and resistance trends were increasing for potential treatments such as tigecycline (25.1%) and tobramycin (15.5%). S. maltophilia was >90% resistant to trimethoprim/ sulfamethoxazole and ciprofloxacin by the end of the study.

CONCLUSION

We are reporting high and/or increasing resistance of NFGNB to common treatment options. The current findings call for urgent actions to combat the increasing resistance of NFGNB. Large scale sharing of AMR data collected at different hospitals with the Saudi AMR committee would be critical to set priorities and monitor progress.

Binding Affinity and Driving Forces for the Interaction of Calixarene-Based Micellar Aggregates With Model Antibiotics in Neutral Aqueous Solution

The search for novel surfactants or drug delivery systems able to improve the performance of old-generation antibiotics is a topic of great interest. Self-assembling amphiphilic calix[4]arene derivatives provide well-defined nanostructured systems that exhibit promising features for antibiotics delivery. In this work, we investigated the capability of two micellar polycationic calix[4]arene derivatives to recognize and host ofloxacin, chloramphenicol, or tetracycline in neutral aqueous solution. The formation of the nanoaggregates and the host–guest equilibria were examined by nano-isothermal titration calorimetry, dynamic light scattering, and mono- and bi-dimensional NMR. The thermodynamic characterization revealed that the calix[4]arene-based micellar aggregates are able to effectively entrap the model antibiotics and enabled the determination of both the species and the driving forces for the molecular recognition process. Indeed, the formation of the chloramphenicol–micelle adduct was found to be enthalpy driven, whereas entropy drives the formation of the adducts with both ofloxacin and tetracycline. NMR spectra corroborated ITC data about the positioning of the antibiotics in the calixarene nanoaggregates.

Thiacalixarene based quaternary ammonium salts as promising antibacterial agents

The search for new antibacterial and antiseptic drugs is an urgent problem due to the resistance of microorganisms to existing drugs. In this work, for the first time, the design of antibacterial and bactericidal agents based on quaternary ammonium compounds on thiacalixarene macrocyclic platform was proposed and implemented. A series of tetrasubstituted quaternary ammonium salts with different nature and length of the substituent (-N⁺(CH₃)₂R, R = CH₂Ph, C_nH_2n+1, n = 1, 4, 8, 10) based on p-tert-butylthiacalix[4]arene in cone and 1,3-alternate conformations was obtained with excellent yields. The obtained compounds have a high antibacterial effect against Gram-positive (S. aureus, S. epidermidis, B. subtilis) bacteria comparable with commercial antiseptics chlorhexidine, miramistin and benzalkonium chloride. It was found that quaternary ammonium derivatives of thiacalix[4]arene in 1,3-alternate conformation more effectively inhibit the growth of the tested bacterial strains in comparison with compounds in cone conformation. Cytotoxicity studies on human skin fibroblast (HSF) cells demonstrated that all compounds were less toxic compared to reference drugs. The different type of interaction of the studied compounds with model DPPC lipid membranes explains different antibacterial activity and cytotoxicity of compounds. The compounds in cone conformation are adsorbed on the DPPC vesicles membrane surface, while the incorporation of lipophilic alkyl fragments of macrocycles in 1,3-alternate conformation into the membrane leads to "clumping" of DPPC vesicles. It was shown the saving of antibacterial activity of thiacalixarene derivatives in 1,3-alternate conformation on Gram-positive clinical strains. The obtained results allow viewing the described thiacalixarene based quaternary ammonium compounds as promising molecules in the development of the new antibacterial agents.

Antimicrobial Activity of Calixarenes and Related Macrocycles

Calixarenes and related macrocycles have been shown to have antimicrobial effects since the 1950s. This review highlights the antimicrobial properties of almost 200 calixarenes, resorcinarenes, and pillararenes acting as prodrugs, drug delivery agents, and inhibitors of biofilm formation. A particularly important development in recent years has been the use of macrocycles with substituents terminating in sugars as biofilm inhibitors through their interactions with lectins. Although many examples exist where calixarenes encapsulate, or incorporate, antimicrobial drugs, one of the main factors to emerge is the ability of functionalized macrocycles to engage in multivalent interactions with proteins, and thus inhibit cellular aggregation.

Small Molecules with Membrane-Active Antibacterial Activity

This spotlight on application provides a brief overview of our research exploration, focusing on the research of small molecules with membrane-active antibacterial activity that mimic host-defense peptides (HDPs). The development of antimicrobial HDP agents is an emerging research area as they circumvent the potential disadvantages of HDPs. The small molecules are preferable for development due to their low production cost and potential of more practical applications. In recent years, we conducted research on the design of antibacterial agents based on small molecules including hydantoins, acylated reduced amides, biscyclic guanidines, and dimeric alkylamides of lysines. We herein sketch our journey on the exploration of the antimicrobial activity of these few classes of molecules and hopefully share our insight in the future design of small-molecular-weight antibiotic agents with membrane-active activity that mimic HDPs.

Permanent Antimicrobial Poly(vinylidene fluoride) Prepared by Chemical Bonding with Poly(hexamethylene guanidine)

Biofouling is one of the major obstacles in the application of poly(vinylidene fluoride) (PVDF) membrane in water and wastewater treatment. Developing antimicrobial PVDF could kill the attached microbe in the initial stage, thus theoretically inhibiting the formation of biofilm and delaying the occurrence of biofouling. However, the leaching of the antimicrobial component and deterioration of antimicrobial properties remain a concern. In this work, an antimicrobial PVDF (PVDF-g-AGE-PHMG) was developed by chemical bonding PVDF with poly(hexamethylene guanidine hydrochloride) (PHMG). The obtained PVDF-g-AGE-PHMG was blended with pristine PVDF to prepare an antimicrobial PVDF membrane. The results of Fourier transform infrared spectroscopy (FT-IR) and X-ray photoelectron spectroscopy (XPS) confirmed that PHMG was successfully grafted into the PVDF membrane. The morphologies, membrane porosity, water contact angles, antimicrobial properties, mechanical properties, and thermostability of the as-prepared membranes were investigated. When the content of PVDF-g-AGE-PHMG reached 10.0 wt %, the inhibition rates of both antimicrobial PVDF membrane against Escherichia coli and Staphylococcus aureus were above 99.99%. Due to the increased hydrophilicity, excellent antimicrobial activity, nonleaching of antimicrobial component, good mechanical properties, and thermostability, the as-prepared PVDF membrane has promising applications in the field of water treatment.

Environmentally Benign Nanoantibiotics with a Built-in Deactivation Switch Responsive to Natural Habitats

The massive use of antibiotics in healthcare and agriculture has led to their artificial accumulation in natural habitats, which risks the structure and function of the microbial communities in ecosystems, threatens food and water security, and accelerates the development of resistome. Ideally, antibiotics should remain fully active in clinical services while becoming deactivated rapidly once released into the environment, but none of the current antibiotics meet this criterion. Here, we show a nanoantibiotic design that epitomizes the concept of carrying a built-in "OFF" switch responsive to natural stimuli. The environmentally benign nanoantibiotics consist of cellulose backbones covalently grafted with hydrophilic polymer brushes that by themselves are antimicrobially inactive. In their nanostructured forms in services, these cellulose-based polymer molecular brushes are potent killers for both Gram-positive and Gram-negative bacteria, including clinical multidrug-resistant strains; after services and being discharged into the environment, they are shredded into antimicrobially inactive pieces by cellulases that do not exist in the human body but are abundant in natural habitats. This study illuminates a new concept of mitigating the environmental footprints of antibiotics with rationally designed nanoantibiotics that can be dismantled and disabled by bioorthogonal chemistry occurring exclusively in natural habitats.

Calix[4]API-s: fully functionalized calix[4]arene-based facial active pharmaceutical ingredients

This mini-review covers 25 fully functionalized facial calix[4]arene-based symmetrical and conical cyclic tetramers with significant (comparable to established therapeutic agents) anticancer and anti-infective activities. The main role of the calixarene scaffold in these calix[4]arene-based active pharmaceutical ingredients (calix[4]API-s) is to replicate embedded phenolic units in the cyclic tetramers. So, probably owing to the multivalency, facial, conical structures of calix[4]API-s and synergistic effect of their four replicated units, they can be considered as effective bioactive agents.

A pilot study of the in vitro antimicrobial activity and in vivo residual activity of chlorhexidine and acetic acid/boric acid impregnated cleansing wipes

BACKGROUND

Topical antimicrobials are recommended for first line treatment of surface and superficial infections in dogs. This is especially important given the increasing prevalence of antimicrobial resistant infections. Antimicrobial wipes have become popular, but there are a lack of controlled studies assessing their in vitro antimicrobial and in vivo residual activity. We aimed to assess the antimicrobial efficacy of two commercial antimicrobial wipes against frequently isolated pathogens. Ten clinical and one reference isolate each of meticillin-susceptible Staphylococcus pseudintermedius (MSSP), meticillin-resistant S. pseudintermedius (MRSP), Escherichia coli (EC), extended spectrum beta-lactamase (ESBL) producing E. coli (ESBL-EC), Pseudomonas aeruginosa (PA) and Malassezia pachydermatis (MP) were tested using a modified Kirby-Bauer technique. Each isolate was tested against 6 mm discs of chlorhexidine (CHX) and acetic acid/boric acid (AABA) wipes, and positive and negative controls either overnight (bacteria) or for 3 days (Malassezia). Healthy dogs were treated with the wipes and distilled water on a randomised flank (n = 5 each). Hair samples (1 cm; 0.1 g) taken at days 0, 1 and 3 were inoculated with an isolate of each organism. Zones of inhibition (ZI) were measured.

RESULTS

All isolates produced confluent growth with AABA and control wipes, except for the cleansing wipes and MP (median ZI 12 mm; 95% CI 8.2-15.8). The median (95% CI) CHX wipe ZIs (mm) were: MP 48.0 (47.0-49.0), MSSP 15.6 (14.2-17.0), MRSP 14.0 (13.6-14.4), EC 13.6 (12.0-15.2) and ESBL-EC 10.0 (9.4-10.6). PA showed confluent growth. The differences between the bacterial isolates was significant (Kruskal-Wallis p < 0.0001; post-tests MSSP = MRSP = EC > EBSL-EC > PA). Confluent growth was visible with all the hair samples.

CONCLUSION

CHX but not AABA showed in vitro efficacy against MSSP, MRSP, EC and MP. ESBL-EC were less susceptible and there was no activity against PA. There was no residual activity on hair. Additional studies are required to determine efficacy of these products in clinically affected patients.

Oropharyngeal Bacterial Colonization after Chlorhexidine Mouthwash in Mechanically Ventilated Critically Ill Patients

WHAT WE ALREADY KNOW ABOUT THIS TOPIC

WHAT THIS ARTICLE TELLS US THAT IS NEW: BACKGROUND:: Oropharyngeal care with chlorhexidine to prevent ventilator-associated pneumonia is currently questioned, and exhaustive microbiologic data assessing its efficacy are lacking. The authors therefore aimed to study the effect of chlorhexidine mouthwash on oropharyngeal bacterial growth, to determine chlorhexidine susceptibility of these bacteria, and to measure chlorhexidine salivary concentration after an oropharyngeal care.

METHODS

This observational, prospective, single-center study enrolled 30 critically ill patients under mechanical ventilation for over 48 h. Oropharyngeal contamination was assessed by swabbing the gingivobuccal sulcus immediately before applying 0.12% chlorhexidine with soaked swabs, and subsequently at 15, 60, 120, 240, and 360 min after. Bacterial growth and identification were performed, and chlorhexidine minimal inhibitory concentration of recovered pathogens was determined. Saliva was collected in 10 patients, at every timepoint, with an additional timepoint after 30 min, to measure chlorhexidine concentration.

RESULTS

Two hundred fifty bacterial samples were analyzed and identified 48 pathogens including Streptococci (27.1%) and Enterobacteriaceae (20.8%). Oropharyngeal contamination before chlorhexidine mouthwash ranged from 10 to 10 colony-forming units (CFU)/ml in the 30 patients (median contamination level: 2.5·10 CFU/ml), and remained between 8·10 (lowest) and 3·10 CFU/ml (highest count) after chlorhexidine exposure. These bacterial counts did not decrease overtime after chlorhexidine mouthwash (each minute increase in time resulted in a multiplication of bacterial count by a coefficient of 1.001, P = 0.83). Viridans group streptococci isolates had the lowest chlorhexidine minimal inhibitory concentration (4 [4 to 8] mg/l); Enterobacteriaceae isolates had the highest ones (32 [16 to 32] mg/l). Chlorhexidine salivary concentration rapidly decreased, reaching 7.6 [1.8 to 31] mg/l as early as 60 min after mouthwash.

CONCLUSIONS

Chlorhexidine oropharyngeal care does not seem to reduce bacterial oropharyngeal colonization in critically ill ventilated patients. Variable chlorhexidine minimal inhibitory concentrations along with low chlorhexidine salivary concentrations after mouthwash could explain this ineffectiveness, and thus question the use of chlorhexidine for ventilator-associated pneumonia prevention.

Bis-Cyclic Guanidines as a Novel Class of Compounds Potent against Clostridium difficile

Clostridium difficile infection (CDI) symptoms range from diarrhea to severe toxic megacolon and even death. Due to its rapid acquisition of resistance, C. difficile is listed as an urgent antibiotic-resistant threat, and has surpassed methicillin-resistant Staphylococcus aureus (MRSA) as the most common hospital-acquired infection in the USA. To combat this pathogen, a new structural class of pseudo-peptides that exhibit antimicrobial activities could play an important role. Herein we report a set of bis-cyclic guanidine compounds that show potent antibacterial activity against C. difficile with decent selectivity. Eight compounds showed high in vitro potency against C. difficile UK6 with MIC values of 1.0 μg mL^-1 , and cytotoxic selectivity index (SI) values up to 37. Moreover, the most selective compound is also effective in the treatment of C. difficile-induced disease in a mouse model of CDI, and appears to be a very promising new candidate for the treatment of CDI.

Novel bis-cyclic guanidines as potent membrane-active antibacterial agents with therapeutic potential

We designed a class of small dimeric cyclic guanidine derivatives which display potent antibacterial activity against both multidrug-resistant Gram-negative and Gram-positive bacteria. They could compromise bacterial membranes without developing resistance, inhibit biofilms formed by E. coli, and exhibit excellent in vivo activity in the MRSA-infected thigh burden mouse model.

Design, synthesis and antibacterial evaluation of a polycationic calix[4]arene derivative alone and in combination with antibiotics

The growing antibiotic resistance phenomenon continues to stimulate the search for new compounds and strategies to combat bacterial infections. In this study, we designed and synthesized a new polycationic macrocyclic compound (2) bearing four N-methyldiethanol ammonium groups clustered and circularly organized by a calix[4]arene scaffold. The in vitro activity of compound 2, alone and in combination with known antibiotics (ofloxacin, chloramphenicol or tetracycline), was assessed against strains of Staphylococcus aureus (ATCC 6538 and methicillin-resistant isolate 15), S. epidermidis (ATCC 35984 and methicillin-resistant isolate 57), and Pseudomonas aeruginosa (ATCC 9027 and antibiotic-resistant isolate 1). Calix[4]arene derivative 2 showed significant antibacterial activity against ATCC and methicillin-resistant Gram positive Staphylococci, improved the stability of tetracycline in water, and in combination with antibiotics enhanced the antibiotic efficacy against Gram negative P. aeruginosa by an additive effect.

Interactions of Biocidal Polyhexamethylene Guanidine Hydrochloride and Its Analogs with POPC Model Membranes

The bacterial membrane-targeted polyhexamethylene guanidine hydrochloride (PHGH) and its novel analog polyoctamethylene guanidine hydrochloride (POGH) had excellent antimicrobial activities against antibiotics-resistant bacteria. However, the biocompatibility aspects of PHGH and POGH on the phospholipid membrane of the eukaryotic cell have not yet been considered. Four chemically synthesized cationic oligoguanidine polymers containing alkyl group with different carbon chain lengths, including PHGH, POGH, and their two analogs, were used to determine their interactions with zwitterionic 1-palmitoyl-2-oleoyl-sn-glycero-3-phosphocholine (POPC) phospholipids vesicles mimicking the eukaryotic cell membrane. Characterization was conducted by using bactericidal dynamics, hemolysis testing, calcein dye leakage, and isothermal titration calorimetry. Results showed that the gradually lengthened alkyl carbon chain of four oligoguanidine polymers increased the biocidal activity of the polymer, accompanied with the increased hemolytic activity, calcein dye leakage rate and the increased absolute value of the exothermic effect of polymer-POPC membrane interaction. The thermodynamic curve of the polymer-POPC membrane interaction exhibited a very weak exothermic effect and a poorly unsaturated titration curve, which indicated that four guanidine polymers had weak affinity for zwitterionic POPC vesicles. Generally, PHGH of four guanidine polymers had high biocidal activity and relatively high biocompatibility. This study emphasized that appropriate amphiphilicity balanced by the alkyl chain length, and the positive charge is important factor for the biocompatibility of cationic antimicrobial guanidine polymer. Both PHGH and POGH exhibited destructive power to phospholipid membrane of eukaryotic cell, which should be considered in their industry applications.

Microscopic Examination of Polymeric Monoguanidine, Hydrochloride-Induced Cell Membrane Damage in Multidrug-Resistant Pseudomonas aeruginosa

Advances in antimicrobial activities of molecule-containing, multiple guanidinium groups against antibiotics-resistant bacteria should be noted. The synthesized polyoctamethylene monoguanidine hydrochloride (POGH), carrying cationic amphiphilic moieties, display excellent activity against multidrug-resistant Pseudomonas aeruginosa (MDR-PA) and other antibiotics-resistant bacteria. The membrane damage effects of POGH on MDR-PA were clarified using beta-lactamase activity assay, confocal fluorescence microscopy, scanning electron microscopy, and transmission electron microscopy. The results showed that POGH disrupted both the outer and inner membranes and the intracellular structure of MDR-PA to different extents depending on the dose. All concentrations of POGH within 3–23 μg/mL increased the outer membrane permeability, which facilitated the release of beta-lactamase across the inner membrane. A median dose (10 μg/mL) of POGH led to the separation of the inner and outer membrane, an increase in the membrane gap, and outer membrane structure damage with still maintained overall cytoskeletal structures. The application of a 30 μg/mL dose of POGH led to the collapse of the outer membrane, cellular wrinkling, and shrinkage, and the formation of local membrane holes. The disruption of the outer and inner membranes and the formation of the local membrane holes by a relative high dose were probably the main bactericidal mechanism of POGH. The microscopic evidence explained the strong outer-membrane permeation ability of guanidine-based antimicrobial polymers, which could be considered for the molecular design of novel guanidine-based polymers, as well as the damaged membrane structure and intracellular structure of MDR-PA.

The Two-Component System ChtRS Contributes to Chlorhexidine Tolerance in Enterococcus faecium

Enterococcus faecium is one of the primary causes of nosocomial infections. Disinfectants are commonly used to prevent infections with multidrug-resistant E. faecium in hospitals. Worryingly, E. faecium strains that exhibit tolerance to disinfectants have already been described. We aimed to identify and characterize E. faecium genes that contribute to tolerance to the disinfectant chlorhexidine (CHX). We used a transposon mutant library, constructed in a multidrug-resistant E. faecium bloodstream isolate, to perform a genome-wide screen to identify genetic determinants involved in tolerance to CHX. We identified a putative two-component system (2CS), composed of a putative sensor histidine kinase (ChtS) and a cognate DNA-binding response regulator (ChtR), which contributed to CHX tolerance in E. faecium Targeted chtR and chtS deletion mutants exhibited compromised growth in the presence of CHX. Growth of the chtR and chtS mutants was also affected in the presence of the antibiotic bacitracin. The CHX- and bacitracin-tolerant phenotype of E. faecium E1162 was linked to a unique, nonsynonymous single nucleotide polymorphism in chtR Transmission electron microscopy showed that upon challenge with CHX, the ΔchtR and ΔchtS mutants failed to divide properly and formed long chains. Normal growth and cell morphology were restored when the mutations were complemented in trans Morphological abnormalities were also observed upon exposure of the ΔchtR and ΔchtS mutants to bacitracin. The tolerance to both chlorhexidine and bacitracin provided by ChtRS in E. faecium highlights the overlap between responses to disinfectants and antibiotics and the potential for the development of cross-tolerance for these classes of antimicrobials.

High Prevalence of Reduced Chlorhexidine Susceptibility in Organisms Causing Central Line–Associated Bloodstream Infections

In units that bathe patients daily with chlorhexidine gluconate (CHG), organisms causing central line–associated bloodstream infections (CLABSIs) were more likely to have reduced CHG susceptibility than organisms causing CLABSIs in units that do not bathe patients daily with CHG (86% vs 64%; P = .028). Surveillance is needed to detect reduced CHG susceptibility with widespread CHG use.

Infect Control Hosp Epidemiol 2014;35(9):1183-1186

The selective interactions of cationic tetra-p-guanidinoethylcalix[4]arene with lipid membranes: theoretical and experimental model studies

Behavior of cationic tetra-p-guanidinoethylcalix[4]arene (CX1) and its building block, p-guanidinoethylphenol (mCX1) in model monolayer lipid membranes was investigated using all atom molecular dynamics simulations and surface pressure measurements. Members of two classes of lipids were taken into account: zwitterionic 1,2-dimyristoyl-sn-glycero-3-phosphocholine (DMPC) and anionic 1,2-dimyristoyl-sn-glycero-3-phospho-l-serine sodium salt (DMPS) as models of eukaryotic and bacterial cell membranes, respectively. It was demonstrated that CX1 and mCX1 accumulate near the negatively charged DMPS monolayers. The adsorption to neutral monolayers was negligible. In contrast to mCX1, CX1 penetrated into the hydrophobic part of the monolayer. The latter effect, which is possible due to a flip-flop inversion of the CX1 orientation in the lipid layer compared to the aqueous phase, may be responsible for its antibacterial activity.

Preparation and characterisation of hexamidine salts

Hexamidine diisethionate (HEX D) has been used in the personal care industry and in a number of over-the-counter (OTC) drug products as an antimicrobial agent since the 1950's. Recently, the compound has also been investigated for its beneficial effects on skin health. Surprisingly, there is only limited information describing the physicochemical properties of this compound in the literature. The objective of this work was therefore to conduct a comprehensive programme of characterisation of HEX D as well as its dihydrochloride salt (HEX H). HEX H was prepared from HEX D by a simple acid addition reaction. Both salts were characterised using Nuclear Magnetic Resonance (NMR), Differential scanning calorimetry (DSC), and Thermogravimetric analysis (TGA). A new high performance liquid chromatographic method was developed and validated for both compounds. The pH in aqueous solution as well as respective distribution coefficients between octanol and pH 7.4 buffer were also determined. Finally, solubility and short term stability studies were conducted in a range of solvents. NMR analysis confirmed the preparation of HEX H from HEX D. Thermal analysis indicated the melting points of HEX D and HEX H were 225°C and 266°C respectively. HPLC analysis confirmed the purity of both salts. LogD values at pH 7.4 were -0.74 for HEX D and -0.70 for HEX H respectively. The physicochemical properties of two HEX salts have been established using a range of analytical approaches. Detailed solubility and stability data have also been collated. This information will be useful in the design of novel formulations for targeted delivery of these compounds to the skin.

Chlorhexidine daily bathing: impact on health care-associated infections caused by gram-negative bacteria

BACKGROUND

Health care-associated infections (HAIs) are a major cause of morbidity and mortality in intensive care unit (ICU) patients. Our objective was to evaluate the impact of daily bathing with chlorhexidine gluconate (CHG) on the incidence rates of HAIs, with a focus on their causative bacteria, in a French ICU.

METHODS

From March 2012-May 2013, we enrolled 325 patients with at least 1 episode of suspected sepsis in the ICU, during two 6-month periods. The intervention group was subjected daily to skin cleansing with 2% CHG-impregnated cloths, whereas the control group was bathed daily with soap and water. HAI included bloodstream infections, ventilator-associated pneumonia, and urinary tract infections. Incidence rates corresponded to the number of infections per 1,000 patient days.

RESULTS

Incidence of HAI was significantly decreased in the intervention group (29 vs 56; P = .01). After adjustment for baseline patient characteristics, the increased risk of HAI in the water and soap group was significant (odds ratio = 1.993; 95% confidence interval [CI], 1.132-3.508; P = .017). The incidence rate of clinical cultures positive for gram-negative bacteria, including Enterobacteriaceae and nonfermenting bacilli, decreased in the intervention group (risk ratio = 0.588; 95% CI, 0.346-0.978; P = .04).

CONCLUSIONS

CHG daily cleansing reduced the incidence rate of HAI caused by gram-negative bacteria, highlighting the role of the transient gram-negative bacteria skin colonization in the pathogenesis of HAI.

Polymorphic variation in susceptibility and metabolism of triclosan-resistant mutants of Escherichia coli and Klebsiella pneumoniae clinical strains obtained after exposure to biocides and antibiotics

Exposure to biocides may result in cross-resistance to other antimicrobials. Changes in biocide and antibiotic susceptibilities, metabolism, and fitness costs were studied here in biocide-selected Escherichia coli and Klebsiella pneumoniae mutants. E. coli and K. pneumoniae mutants with various degrees of triclosan susceptibility were obtained after exposure to triclosan (TRI), benzalkonium chloride (BKC), chlorhexidine (CHX) or sodium hypochlorite (SHC), and ampicillin or ciprofloxacin. Alterations in antimicrobial susceptibility and metabolism in mutants were tested using Phenotype MicroArrays. The expression of AcrAB pump and global regulators (SoxR, MarA, and RamA) was measured by quantitative reverse transcription-PCR (qRT-PCR), and the central part of the fabI gene was sequenced. The fitness costs of resistance were assessed by a comparison of relative growth rates. Triclosan-resistant (TRI(r)) and triclosan-hypersusceptible (TRI(hs)) mutants of E. coli and K. pneumoniae were obtained after selection with biocides and/or antibiotics. E. coli TRI(r) mutants, including those with mutations in the fabI gene or in the expression of acrB, acrF, and marA, exhibited changes in susceptibility to TRI, CHX, and antibiotics. TRI(r) mutants for which the TRI MIC was high presented improved metabolism of carboxylic acids, amino acids, and carbohydrates. In TRI(r) mutants, resistance to one antimicrobial provoked hypersusceptibility to another one(s). TRI(r) mutants had fitness costs, particularly marA-overexpressing (E. coli) or ramA-overexpressing (K. pneumoniae) mutants. TRI, BKC, and CIP exposure frequently yielded TRI(r) mutants exhibiting alterations in AraC-like global regulators (MarA, SoxR, and RamA), AcrAB-TolC, and/or FabI, and influencing antimicrobial susceptibility, fitness, and metabolism. These various phenotypes suggest a trade-off of different selective processes shaping the evolution toward antibiotic/biocide resistance and influencing other adaptive traits.

Insights into bacterial colonization of intensive care patients' skin: the effect of chlorhexidine daily bathing

Skin is a major reservoir of bacterial pathogens in intensive care unit (ICU) patients. The aim of this study was to assess the skin bacterial richness and diversity in ICU patients and the effect of CHG daily bathing on skin microbiota. Twenty ICU patients were included during an interventional period with CHG daily bathing (n = 10) and a control period (n = 10). At day seven of hospitalization, eight skin swab samples (nares, axillary vaults, inguinal creases, manubrium and back) were taken from each patient. The bacterial identification was performed by microbial culturomics. We used the Shannon index to compare the diversity. We obtained 5,000 colonies that yielded 61 bacterial species (9.15 ± 3.7 per patient), including 15 (24.5 %) that had never been cultured from non-pathological human skin before, and three (4.9 %) that had never been cultured from human samples before. Notably, Gram-negative bacteria were isolated from all sites. In the water-and-soap group, there was a higher risk of colonization with Gram-negative bacteria (OR = 6.05, 95 % CI [1.67-21.90]; P = 0.006). In the CHG group, we observed more patients colonized by sporulating bacteria (9/10 vs. 3/10; P = 0.019) with a reduced skin bacterial richness (P = 0.004) and lower diversity (0.37, 95 % CI [0.33; 0.42] vs. 0.50, 95 % CI [0.48; 0.52]). Gram-negative bacteria are frequent and disseminated components of the transient skin flora in ICU patients. CHG daily bathing is associated with a reduction in Gram-negative bacteria colonization together with substantial skin microbiota shifts.

Antibacterial activity of THAM Trisphenylguanide against methicillin-resistant Staphylococcus aureus

This study investigated the potential antibacterial activity of three series of compounds synthesized from 12 linear and branched polyamines with 2–8 amino groups, which were substituted to produce the corresponding guanides, biguanides, or phenylguanides, against Acinetobacter baumannii, Enterococcus faecalis, Escherichia coli, Pseudomonas aeruginosa and Staphylococcus aureus. Antibacterial activity was measured for each compound by determining the minimum inhibitory concentration against the bacteria, and the toxicity towards mammalian cells was determined. The most effective compound, THAM trisphenylguanide, was studied in time-to-kill and cytoplasmic leakage assays against methicillin-resistant Staphylococcus aureus (MRSA, USA300) in comparison to chlorhexidine. Preliminary toxicity and MRSA challenge studies in mice were also conducted on this compound. THAM trisphenylguanide showed significant antibacterial activity (MIC ∼1 mg/L) and selectivity against MRSA relative to all the other bacteria examined. In time-to-kill assays it showed increased antimicrobial activity against MRSA versus chlorhexidine. It induced leakage of cytoplasmic content at concentrations that did not reduce cell viability, suggesting the mechanism of action may involve membrane disruption. Using an intraperitoneal mouse model of invasive MRSA disease, THAM trisphenylguanide reduced bacterial burden locally and in deeper tissues. This study has identified a novel guanide compound with selective microbicidal activity against Staphylococcus aureus, including a methicillin-resistant (MRSA) strain.

Cationic quaternized aminocalix[4]arenes: cytotoxicity, haemolytic and antibacterial activities

This study reports the characterization of three cationic amphiphillic aminocalix[4]arenes as potential antimicrobial agents in vitro. In cytotoxicity tests on mouse macrophage RAW 264.7 cells aminocalix[4]arenes 1 and 3 showed no toxicity up to 200 and 100 μM concentrations, respectively, while 2 was non-toxic only up to 50 μM. With regard to the haemolytic activity on rabbit red blood cells, 1 was not active at concentrations up to 100 μM in contrast to the other two studied macrocycles. Compounds showed negligible ability to protect either mouse macrophage RAW 264.7 cells from anthrax lethal toxin of Bacillus anthracis (B. anthracis) or rabbit red blood cells from α-haemolysin of Staphylococcus aureus (S. aureus) in comparison to amino-β-cyclodextrins. However, all aminocalix[4]arenes showed potential as antimicrobials. Their minimum inhibitory concentrations (MIC) against Escherichia coli (E. coli) and S. aureus were in the 16-32 μg/ml concentration range, while minimum lethal concentrations (MLC) varied from 16 to 256 μg/ml depending on the bacteria and aminocalix[4]arene considered. Macrocycle 1 showed partial synergism against S. aureus in tandem with a model antibacterial drug, fusidic acid, at certain concentration combinations.

Advances in MRSA drug discovery: where are we and where do we need to be?

INTRODUCTION

Methicillin-resistant Staphylococcus aureus (MRSA) have been on the increase during the past decade, due to the steady growth of the elderly and immunocompromised patients, and the emergence of multidrug-resistant (MDR) bacterial strains. Although there are a limited number of anti-MRSA drugs available, a number of different combination antimicrobial drug regimens have been used to treat serious MRSA infections. Thus, the addition of several new antistaphylococcal drugs into clinical practice should broaden clinician's therapeutic options. As MRSA is one of the most common and problematic bacteria associated with increasing antimicrobial resistance, continuous efforts for the discovery of lead compounds as well as development of alternative therapies and faster diagnostics are required.

AREAS COVERED

This article summarizes the FDA-approved drugs to treat MRSA infections, the drugs in clinical trials, and the drug leads for MRSA and related Gram-positive bacterial infections. In addition, the article discusses the mode of action of antistaphylococcal molecules and the resistant mechanisms of some molecules.

EXPERT OPINION

The number of pipeline drugs presently undergoing clinical trials is not particularly encouraging. There are limited and rather expensive therapeutic options for MRSA infections in the critically ill. Further research efforts are required for effective phage therapy on MRSA infections in clinical use, which seem to be attractive therapeutic options for the future.

Antibacterial properties of cyclodextrin-antiseptics-complexes determined by microplate laser nephelometry and ATP bioluminescence assay

Cyclodextrins (CDs) are able to form inclusion complexes with other molecules, thereby, protecting these guest molecules from degradation, enhancing their biocompatibility or influencing their physiological distribution while retaining their activity. Here, antibacterial effects of CD-complexes with the antiseptics chlorhexidine diacetate (CHX), iodine (IOD) and polihexanide (PHMB) were determined using two different in vitro methods, microplate laser nephelometry and an ATP bioluminescence assay. Laser nephelometry is a direct method for monitoring and evaluating growth of micro-organisms by measurement of the turbidity of the solution. In contrast, the ATP bioluminescence assay determines specifically the amount of metabolic active bacterial cells. The antibacterial effects of CD-antiseptics-complexes were examined for Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa, Staphylococcus aureus and Staphylococcus epidermidis and the results of both methods were compared in respect of calculated means of half maximal inhibitory concentrations (IC50) and statistical evaluated Pearson's correlation coefficients (r). It could be demonstrated that both methods showed a high comparability although they differ in the parameters tested. This study revealed that CD-complexes with CHX and PHMB were most effective against E. coli and the tested staphylococci. While CD-IOD-complexes obtained high activity against K. pneumoniae, P. aeruginosa was distinctly more resistant compared to the other bacteria.

Environmental contamination with extended-spectrum β-lactamases: is there any difference between Escherichia coli and Klebsiella spp?

BACKGROUND

The hospital environment contributes to the spread of extended-spectrum β-lactamase (ESBL)-producing Enterobacteriaceae (ESBL-PE) during outbreaks. We aimed to assess the rate of environmental contamination in rooms occupied by ESBL carriers or infected children and to identify risk factors associated with contamination.

METHODS

Five environmental surface samples were systematically performed in rooms occupied by ESBL-PE carrier or infected children.

RESULTS

Forty-six Escherichia coli and 48 Klebsiella infected/carrier patients were included in the study. Nineteen (4%) of the 470 environmental samples performed yielded ESBL-PE. Klebsiella spp was the most frequent species isolated (16, 89%), whereas E coli and Citrobacter freundii were reported twice and once, respectively. Ten of the 19 (52%) isolates were identical to the corresponding strains isolated from children. Multivariate analysis highlighted ESBL-producing Klebsiella carriage/infection as the only risk factor significantly associated with surface contamination (P = .024).

CONCLUSION

Our data suggest that hospital environmental contamination is more frequent in instances of fecal carriage or infection with ESBL-producing Klebsiella than ESBL-producing E coli. Reinforcing hygiene measures around ESBL-producing Klebsiella might be necessary to reduce the spread of ESBL-PE in hospital environments.

Stenotrophomonas maltophilia: an emerging global opportunistic pathogen

Stenotrophomonas maltophilia is an emerging multidrug-resistant global opportunistic pathogen. The increasing incidence of nosocomial and community-acquired S. maltophilia infections is of particular concern for immunocompromised individuals, as this bacterial pathogen is associated with a significant fatality/case ratio. S. maltophilia is an environmental bacterium found in aqueous habitats, including plant rhizospheres, animals, foods, and water sources. Infections of S. maltophilia can occur in a range of organs and tissues; the organism is commonly found in respiratory tract infections. This review summarizes the current literature and presents S. maltophilia as an organism with various molecular mechanisms used for colonization and infection. S. maltophilia can be recovered from polymicrobial infections, most notably from the respiratory tract of cystic fibrosis patients, as a cocolonizer with Pseudomonas aeruginosa. Recent evidence of cell-cell communication between these pathogens has implications for the development of novel pharmacological therapies. Animal models of S. maltophilia infection have provided useful information about the type of host immune response induced by this opportunistic pathogen. Current and emerging treatments for patients infected with S. maltophilia are discussed.