Role of probiotics in preventing Clostridioides difficile infection in older adults: an integrative review.

Clostridioides difficile infection (CDI) is the leading cause of healthcare-associated diarrhea. This infection can particularly affect older adults, the most susceptible to CDI. Currently, the standard therapeutic measure is antibiotic therapy, which in turn increases the risk of recurrence of the infection by its collateral damage to the patient's microbiota. Probiotics are live microorganisms capable of maintaining balance in the intestinal microbiota. This study aims to perform an integrative review of the protective benefit of probiotics in CDI and diarrhea associated with C. difficile. The PubMed, Scopus, and Web of Science databases, the 10-year time cutoff, and the Prism Flow diagram were used for data collection. We observed no consensus among the studies; however, three of the seven evaluated studies demonstrated that the use of probiotics in older adults could contribute to reducing the incidence of hospital-onset CDI. We also found that the studies evaluated a wide variety of microorganisms, particularly Saccharomyces boulardii, associated with beneficial effects. More research is needed to understand the successful use of probiotics in the prevention of CDI in hospitalized older adults receiving antibiotics.

In Vitro Activity of Rifampin, Rifabutin, and Rifapentine against Enterococci and Streptococci from Periprosthetic Joint Infection.

After staphylococci, streptococci and enterococci are the most frequent causes of periprosthetic joint infection (PJI). MICs and minimum biofilm bactericidal concentrations of rifampin, rifabutin, and rifapentine were determined for 67 enterococcal and 59 streptococcal PJI isolates. Eighty-eight isolates had rifampin MICs of ≤1 µg/ml, among which rifabutin and rifapentine MICs were ≤ 8 and ≤4 µg/ml, respectively. There was low rifamycin in vitro antibiofilm activity except for a subset of Streptococcus mitis group isolates. IMPORTANCE Rifampin is an antibiotic with antistaphylococcal biofilm activity used in the management of staphylococcal periprosthetic joint infection with irrigation and debridement with component retention; some patients are unable to receive rifampin due to drug interactions or intolerance. We recently showed rifabutin and rifapentine to have in vitro activity against planktonic and biofilm states of rifampin-susceptible periprosthetic joint infection-associated staphylococci. After staphylococci, streptococci and enterococci combined are the most common causes of periprosthetic joint infection. Here, we investigated the in vitro antibiofilm activity of rifampin, rifabutin, and rifapentine against 126 Streptococcus and Enterococcus periprosthetic joint infection isolates. In contrast to our prior findings with staphylococcal biofilms, there was low antibiofilm activity of rifampin, rifabutin, and rifapentine against PJI-associated streptococci and enterococci, apart from some Streptococcus mitis group isolates.

Anti-biofilm activity of antibiotic-loaded Hylomate®.

INTRODUCTION: Antibiotic envelopes are being developed for cardiac implantable electronic device (CIED) wrapping to reduce the risk of infections. METHODS: Fifteen CIED infection-associated bacterial isolates of Staphylococcus aureus, Staphylococcus epidermidis and Cutibacterium acnes were used to assess in vitro biofilm formation on Hylomate® compared to titanium, silicone and polyurethane coupons pre-treated with vancomycin (400 µg/ml), bacitracin (1000 U/ml) or a combination of rifampin (80 µg/ml) plus minocycline (50 µg/ml). Scanning electron microscopy (SEM) was performed to visualize bacteria on Hylomate®. RESULTS: There was significantly less (p < 0.05) S. aureus and S. epidermidis on Hylomate® pre-treated with vancomycin, bacitracin or rifampin plus minocycline after 24 h of incubation (≤1.00 log10 CFU/cm2) compared with titanium, silicone or polyurethane pre-treated with vancomycin, bacitracin or rifampin plus minocycline. C. acnes biofilms were not detected (≤1.00 log10 CFU/cm2) on pre-treated Hylomate® coupons. CONCLUSIONS: This study showed that Hylomate® coupons pre-treated with antibiotics reduced staphylococcal and C. acnes biofilm formation in vitro.

In vitro activity of arbekacin against multidrug-resistant gram-negative bacilli.

BACKGROUND: Arbekacin is a broad-spectrum aminoglycoside with activity against some Gram-positive and Gram-negative bacteria. METHODS: Arbekacin minimum inhibitory concentration (MIC) values were determined for 296 drug-resistant Gram-negative bacilli, and compared to previously determined plazomicin, amikacin, gentamicin, and tobramycin MIC values. RESULTS: The MIC values required to inhibit 50% and 90% of isolates (MIC50 and MIC90, respectively) were 16 and >128 µg/ml, respectively. CONCLUSIONS: Arbekacin showed similar MIC50 values to amikacin and gentamicin, a lower MIC50 value than tobramycin, and a higher MIC50 value than plazomicin.

Novel Use of Rifabutin and Rifapentine to Treat Methicillin-Resistant Staphylococcus aureus in a Rat Model of Foreign Body Osteomyelitis.

BACKGROUND: Owing to patient intolerance or drug interactions, alternative agents to rifampin are needed for management of staphylococcal periprosthetic joint infection. In the current study, we evaluated rifabutin, rifapentine and rifampin, with and without vancomycin, in a rat model of foreign body osteomyelitis. METHODS: Proximal tibiae were inoculated with methicillin-resistant Staphylococcus aureus (MRSA) and a Kirschner wire (K-wire) implanted in each. After 4 weeks of infection, rifampin, rifabutin, or rifapentine were administered, alone or with vancomycin. Tibiae and K-wires were cultured, and medians were reported as log10 colony-forming units (CFUs) per gram of bone or log10 CFUs per K-wire, respectively. RESULTS: Rifampin, rifabutin or rifapentine administered with vancomycin yielded less MRSA from bones (0.10, 3.02, and 0.10 log10 CFUs/g, respectively) than did no treatment (4.36 log10 CFUs/g) or vancomycin alone (4.64 log10 CFUs/g) (both P ≤ .02). The K-wires of animals receiving no treatment or vancomycin monotherapy recovered medians of 1.76 and 2.91 log10 CFUs/g per K-wire, respectively. In contrast, rifampin, rifabutin and rifapentine administered with vancomycin yielded medians of 0.1 log10 CFUs per K-wire, respectively. Rifampin resistance was detected in a single animal in the rifampin monotherapy group. CONCLUSIONS: Rifabutin or rifapentine with vancomycin were as active as rifampin with vancomycin against MRSA in rat foreign body osteomyelitis, suggesting that rifabutin and/or rifapentine may be alternatives to rifampin in the clinical management of staphylococcal periprosthetic joint infections.

Comparison of Agar Dilution to Broth Microdilution for Testing In Vitro Activity of Cefiderocol against Gram-Negative Bacilli.

Cefiderocol (CFDC) is a siderophore cephalosporin with activity against Gram-negative bacterial species that are resistant to carbapenems and other drugs. The MICs of CFDC were determined for 610 Gram-negative bacilli, including 302 multinational Enterobacterales isolates with characterized mechanisms of beta-lactam resistance, 180 clinical isolates from the Mayo Clinic and Mayo Clinic Laboratories not characterized for specific resistance mechanisms, and 128 isolates with CFDC MICs of ≥8 µg/ml obtained from International Health Management Associates, Inc. (IHMA, Schaumburg, IL). Broth microdilution using standard cation-adjusted Mueller-Hinton broth (BMD) and iron-depleted cation-adjusted Mueller-Hinton broth (ID-BMD), and agar dilution (AD) using standard Mueller-Hinton agar were performed according to Clinical and Laboratory Standards Institute (CLSI) guidelines. MICs were interpreted according to the investigational CLSI, FDA, and EUCAST breakpoints, and results were compared. MICs inhibiting 50 and 90% of organisms (MIC50 and MIC90, respectively), essential agreement (EA), categorical agreement (CA), and error of different types were determined. Results showed considerable discordance between AD and ID-BMD. CFDC showed low EA and CA rates and high error rates for AD in comparison to ID-BMD. Overall, this study does not support use of standard AD for determining CFDC MICs.

Influence of apitoxin and melittin from Apis mellifera bee on Staphylococcus aureus strains.

The antibacterial activities of apitoxin, a venom produced by Apis mellifera bee, and melittin, an antimicrobial peptide from apitoxin, were tested against planktonic and biofilm states of Staphylococcus aureus methicillin-resistant (MRSA), including clinical, and enterotoxin-producing isolates. Also, the synergism of apitoxin and melittin in combination with oxacillin were evaluated as well. The induced morphological changes on S. aureus cells of both products were detected by transmission electronic microscopy (TEM). The minimum inhibitory concentration (MIC) values were 7.2 µg/mL, and 6.7 µg/mL, for apitoxin and melittin, respectively. The minimum bactericidal concentration (MBC) values were 28.7 µg/mL, and 26 µg/mL for apitoxin and melittin, respectively. The time-kill curve assays of apitoxin or melittin with oxacillin exhibited bactericidal synergism against MRSA isolates. TEM images showed cell distortion, cell disintegration with leakage of cytoplasmic content and loss of cytoplasm content. However, apitoxin and melittin did not interfere with staphylococcal enterotoxin production or release. Thus, apitoxin and melittin are potential agents against MRSA that can serve as possible models for new antibacterial drugs.

Comparative Proteomics of Methicillin-Resistant Staphylococcus aureus Subjected to Synergistic Effects of the Lantibiotic Nisin and Oxacillin.

We investigated the responses and mechanisms of action of methicillin-resistant Staphylococcus aureus (MRSA) metabolism when exposed under sublethal concentrations of the synergistic antibacterial combination of nisin + oxacillin (» of maximum sublethal concentration) and sublethal concentrations of oxacillin only and nisin only. A total of 135 proteins were identified, showing an alteration in the expression of 85 proteins when treatment was compared with untreated bacteria (control). When the bacteria were treated using the combination, there was an increase in the expression of proteins related to resistance (e.g., beta-lactamase) and also in the ones involved in protein synthesis, and there was a decrease in the expression of proteins related to stress and alterations in proteins related to bacterial energy metabolism. Bacterial oxidative stress showed that the combination was able to induce oxidative stress (p < 0.05) and increase enzyme activities and lipid hydroperoxide levels compared with individual treatments. The analysis of cell ultrastructure showed damage in MRSA, especially on the bacterial wall and the plasma membrane, with cell lysis and death. Thus, the changes caused by these treatments affected different proteins related to the bacterial biological processes and signaling pathways such as cell division, structure, stress, regulation, bacterial resistance, protein synthesis, gene expression, energetic metabolism, and virulence. It was observed that synergism among antimicrobials has high potential in therapeutic use and may reduce the required amounts of antibacterial substances in addition to being effective on different targets in bacterial cells.

Proteomic analysis and antibacterial resistance mechanisms of Salmonella Enteritidis submitted to the inhibitory effect of Origanum vulgare essential oil, thymol and carvacrol.

Biological properties of natural products are an important research target and essential oils (EO) from aromatic plants with antimicrobial properties are well documented. However, their uses are limited, and the mechanisms underlying their antibacterial activity are still not well known. Therefore, our objective was to evaluate the antibacterial activities of Origanum vulgare EO, thymol and carvacrol against Salmonella Enteritidis ATCC 13076 strain, particularly regarding the bacterial proteic profile, enzymatic activities and DNA synthesis. Bacterial expressed proteins were evaluated using an untreated assay control and treatments with sublethal concentrations of oregano EO, carvacrol and thymol. The same protein extracts were also assayed for oxidative stress and energy metabolism enzyme activities, as well as effect on DNA synthesis. Protein expression outcomes revealed by 2D-SDS-PAGE, from antimicrobial actions, showed a stress response with differential expressions of chaperones and cellular protein synthesis mediated by the bacterial signaling system. In addition, Salmonella used a similar mechanism in defense against oxidative stress, for its survival. Thus, the antibacterial inhibitory activity of EO was preferentially associated with the presence of thymol and there was interference in protein regulation as well as DNA synthesis affected by these compounds. SIGNIFICANCE: Antimicrobial activity of essential oils (EO) is already known. In this way, the understanding of how this activity occurs is a fundamental part to provide the practical and rational use of these substances. In the current scenario, where the emergence of resistant bacteria or even multiresistant bacteria against conventional antimicrobials, the search for alternatives becomes essential, since the discovery of new inhibitory substances does not occur at the same speed. The anti-Salmonella action allied to the knowledge about the biological processes affected by O. vulgare EO contribute to these bioactive compounds being effectively used as agents in the safety and shelf life of food in a future product, packaging or process where the antibacterial activity is safe and best used.

In Vitro Activity of Rifampin, Rifabutin, Rifapentine, and Rifaximin against Planktonic and Biofilm States of Staphylococci Isolated from Periprosthetic Joint Infection.

The in vitro activities of rifampin, rifabutin, rifapentine, and rifaximin were tested against 200 periprosthetic joint infection (PJI)-associated staphylococci. Seven rifampin-resistant isolates had MICs of ≥4 µg/ml. Three isolates had rifampin MICs of 0.25 to 1 µg/ml and harbored an Asp471Gly RpoB variant, suggesting that the CLSI rifampin-susceptible staphylococcal breakpoint of ≤1 µg/ml may be too high. The remaining isolates had rifampin MICs of ≤0.016 µg/ml, and the rifampin, rifabutin, rifapentine, and rifaximin minimum biofilm bactericidal concentrations (MBBC) for ≥50% of isolates were 8, 1, 2, and 4 µg/ml (for S. aureus) and 2, 0.06, 0.25, and 0.5 µg/ml (for S. epidermidis), respectively, for rifampin-susceptible isolates. Nonrifampin rifamycins have promising staphylococcal activity, including antibiofilm activity.

Antibacterial and anti-biofilm activities of cinnamaldehyde against S. epidermidis.

The search for new antimicrobial drugs has been necessary due to the increased bacterial resistance to antibiotics currently in use, and natural products play an important role in this field. The aim of this study was to evaluate the in vitro effect of cinnamaldehyde on S. epidermidis strains, biofilm set-up prevention, as well as its effect on pre-established biofilms. The minimum inhibitory concentration (MIC) ranged from 300 to 500 µg/mL, and the minimum bactericidal concentration (MBC) from 400 to 600 µg/mL. The biofilm inhibitory concentration and biofilm eradication concentration values were four-fold (clinical isolate) and eight-fold (ATCC strain) greater than the concentration required to inhibit planktonic growth. Sub-inhibitory concentrations of cinnamaldehyde attenuated biofilm formation of S. epidermidis strains on polystyrene microtiter plates. The combination of cinnamaldehyde and linezolid was able to inhibit S. epidermidis with a bactericidal effect. Further investigation of the mechanism of action of cinnamaldehyde revealed its effect on the cell membrane permeability, and confocal laser scanning microscopy (CLSM) images illustrated the impact of cinnamaldehyde in the detachment and killing of existing biofilms. Thereby, our data confirmed the ability of cinnamaldehyde to reduce bacterial planktonic growth of S. epidermidis, inhibiting biofilm formation and eradicating pre-formed biofilm.

The impact of Cymbopogon martinii essential oil on Cutibacterium (formerly Propionibacterium) acnes strains and its interaction with keratinocytes.

OBJECTIVES: The human skin microbiota is mainly composed of bacteria belonging to the genera Staphylococcus, Cutibacterium, Micrococcus and Corynebacterium, but on the skin of the face and back, ca. 50% of the total microbiota is represented by the bacterium Cutibacterium acnes. The aim of this research was to evaluate the impact of C. martini EO and its major compound, geraniol, on C. acnes. METHODS: The minimum inhibitory concentration against C. acnes strains, phenotypic changes and responses of the proteome was determined. In addition, was assessed the effect of compounds in RNA-binding assay, on C. acnes-exposed keratinocytes and on the C. acnes type distribution on shoulder skin. KEY FINDINGS: The range of the MIC was 0.7 to 1.6 mg/ml for the three main C. acnes types. There were no cytotoxic effects of compounds in the absence or presence of C. acnes; after 7 days of exposure to C. martini EO, we could not detect a major shift of the C. acnes types on shoulder skin that was found to be dominated by C. acnes strains of types II and IA2. CONCLUSIONS: Our work gives novel insight into the skin microbiota-interacting properties of C. martini EO.

Seasonality effects on chemical composition, antibacterial activity and essential oil yield of three species of Nectandra.

In this study, we aimed to determine whether seasonality affects the content, chemical composition, and antimicrobial activity of essential oils (EOs) from the leaves of three species of Nectandra (Nectandra megapotamica, Nectandra grandiflora, and Nectandra lanceolata) native to the Atlantic rainforest, Sao Paulo state, Brazil. In addition, we identified the compounds potentially related to the antimicrobial activity. Leaves were randomly collected in the middle of winter (August), spring (November), summer (February), and autumn (May). The influence of seasonality on the content and chemical composition of EOs from the Nectandra species was evident in this study. The EOs from N. lanceolata and N. grandiflora were characterized by similarities in the chemical composition and had a higher relative proportion of oxygenated sesquiterpenes. N. megapotamica presented a different chemical profile, with plenty of monoterpenic and sesquiterpenic hydrocarbons. Changes in the EO chemical profile because of seasonality were shown by the similarities between the EOs obtained in spring and autumn and the differences between the EOs obtained in summer and winter. The EO from the leaves of N. megapotamica harvested in winter and spring showed the highest control of the growth of Escherichia coli, and this antimicrobial action can be related to the monoterpenes α-pinene and ß-pinene as well as myrcene and limonene. The minimum inhibitory concentration (MIC) of the EO from the leaves of N. lanceolata harvested in summer and autumn was lower against the gram-positive bacterium Staphylococcus aureus and can be related to the sesquiterpene hydrocarbons isobicyclogermacrenal, epi-zizanone, and germacrene B.

Short communication: Inhibitory activities of the lantibiotic nisin combined with phenolic compounds against Staphylococcus aureus and Listeria monocytogenes in cow milk.

We aimed to investigate the antibacterial activities of carvacrol, thymol, eugenol, cinnamaldehyde, and lantibiotic nisin against standard bacterial strains of the milk pathogens Staphylococcus aureus ATCC 25923 and Listeria monocytogenes ATCC 15313 in cow milk. The minimum inhibitory concentrations (MIC) of these substances were recorded. The synergistic effects were also assessed in culture medium (time kill curve) and in a food model (cow milk) during the storage period (4 °C for 6 d) after inoculation with S. aureus and L. monocytogenes individually by combining nisin and the phenolic compounds at proportions of 1/4 + 1/4 the MIC (determined in a previous in vitro assay) in the culture medium and 1/4 + 1/4 of MIC in the food model. Inhibitory activities of nisin and the tested compounds, as well as synergism in the combinations, were found against both bacteria assayed. Bacteriostatic effects were found with all combinations and a significant difference in L. monocytogenes reduction was found compared with the control assays. Thus, the antibacterial activity of nisin combined with phenolic compounds was confirmed against these pathogenic bacteria that are important in the milk industry, or more broadly in food science, with potential applications for milk preservation.

In vitro antibacterial and chemical properties of essential oils including native plants from Brazil against pathogenic and resistant bacteria.

The antimicrobials products from plants have increased in importance due to the therapeutic potential in the treatment of infectious diseases. Therefore, we aimed to examine the chemical characterisation (GC-MS) of essential oils (EO) from seven plants and measure antibacterial activities against bacterial strains isolated from clinical human specimens (methicillin-resistant Staphylococcus aureus (MRSA) and sensitive (MSSA), Escherichia coli, Pseudomonas aeruginosa, Salmonella Typhimurium) and foods (Salmonella Enteritidis). Assays were performed using the minimal inhibitory concentration (MIC and MIC90%) (mg/mL) by agar dilution and time kill curve methods (log CFU/mL) to aiming synergism between EO. EO chemical analysis showed a predominance of terpenes and its derivatives. The highest antibacterial activities were with Cinnamomun zeylanicum (0.25 mg/mL on almost bacteria tested) and Caryophyllus aromaticus EO (2.40 mg/mL on Salmonella Enteritidis), and the lowest activity was with Eugenia uniflora (from 50.80 mg/mL against MSSA to 92.40 mg/mL against both Salmonella sources and P. aeruginosa) EO. The time kill curve assays revealed the occurrence of bactericide synergism in combinations of C. aromaticus and C. zeylanicum with Rosmarinus. officinalis. Thus, the antibacterial activities of the EO were large and this can also be explained by complex chemical composition of the oils tested in this study and the synergistic effect of these EO, yet requires further investigation because these interactions between the various chemical compounds can increase or reduce (antagonism effect) the inhibitory effect of essential oils against bacterial strains.

Essential oils from herbs against foodborne pathogens in chicken sausage.

Consumption of chicken meat and its products, especially sausage, have increased in recent years. However, this product is susceptible to microbial contamination during manufacturing, which compromises its shelf life. The flavoring and preservative activities of essential oils (EO) have been recognized and the application of these antimicrobial agents as natural active compounds in food preservation has shown promise. The aim of this study was to evaluate the effect of Ocimum basilicum and Origanum vulgare EO on Listeria monocytogenes and Salmonella Enteritidis strains in artificially inoculated samples of fresh chicken sausage. First, the minimal inhibitory concentration (MIC) of EO in vitro was determined. The sausage was prepared and kept at ± 4°C; then, the inoculation of individual bacteria was carried out. EO were added at 0.3%, 1.0% and 1.5%v/w. After 0, 5, and 24 hours, the most probable number method (MPN) was performed. Transmission electron microscopy (TEM) was used to view the damage caused by these EO on bacterial morphology and/or structure. Only the 1.5% concentration was effective in reducing L. monocytogenes. 0.3% of O. vulgare EO was able to reduce the MPN/g of Salmonella Enteritidis (2 log) after 5 hours trials. O. basilicum EO showed no effect on Salmonella after 5 hours, but decreased by 2 log after 24 hours. O. vulgare EO at 1% gave a greater reduction of S. Enteritidis at 5 hours, increasing or maintaining this effect after 24 hours. The results confirmed the potential benefits of use EO in control of foodborne pathogens.

Effects of Ocimum basilicum Linn essential oil and sodium hexametaphosphate on the shelf life of fresh chicken sausage.

Although consumers and the food industry have an interest in reducing the use of synthetic additives, the consumption of processed meat in Brazil has been increasing because of the easy preparation and low cost. Owing to the antimicrobial and antioxidative properties of Ocimum basilicum essential oil (EO), it has potential applications in food products. Polyphosphates are already used in meat processing with the goal of improving the quality of the products. The aim of this work was to assess the effects of sodium hexametaphosphate (SHMP) and O. basilicum EO, when added separately or together, on physical, chemical, and microbiological parameters during the shelf life of chicken sausage. We also performed sensory analysis of the product prepared in this manner. Six different treatments were produced in which the substances were tested together or separately, and the content of EO was 0.3 or 0.03%. The samples were analyzed after 1, 7, and 15 days of storage at 4°C. An increase in pH on days 7 and 15 in samples that contained SHMP was observed. In the samples that contained either 0.3 or 0.03% EO, coliforms were inhibited throughout the study period (P < 0.05), which was not observed in samples with EO plus SHMP, thus demonstrating that the stabilizer blocked the antibacterial action of EO. There was a reduction in the cook loss and increased compressive force in the samples with 0.5% SHMP, contributing to greater juiciness of the product. The EO had substantial impact on acceptability of samples, but it did not influence the activities already described of polyphosphate.