Antibacterial effect of Aloe Vera on Bacteria Isolated from Cases of Wound Infection.

BACKGROUND: Antimicrobial resistance exhibited by bacteria against the major-ity of antibiotics has resulted in research on alternative methods of treatment. Aloe vera has a strong tradition as a medical plant with a wide range of therapeutic uses. OBJECTIVE: The objective of this study is to determine the antibacterial activity of gel and crude ethanol leaf extract of Aloe vera against Staphylococcus aureus and Enterobacter-ales isolated from wound infections. METHODS: It is a cross-sectional study conducted over a period of 7 months. Antibacterial effect of the ethanol leaf extract and gel was determined by the punch well method. Min-imum inhibitory concentration (MIC) and minimum bactericidal concentration (MBC) of the ethanol leaf extract were determined by macro broth dilution technique. RESULTS: Aloe vera ethanol leaf extract induced a mean zone size of 13.0 ± 6.0 mm and 16.7 ± 8.4 mm, respectively, for S. aureus and Enterobacterales by Punch Well method (p≤0.002). Whereas Aloe vera gel failed to induce any zone of inhibition for all the isolates p<0.001. Mean MIC of Aloe vera leaf extract against 74 S. aureus was 94 ± 41.23 mg/ml and against 73 Enterobacterales, it was 45.6 ± 20 mg/ml p < 0.001. Mean MBC of Aloe vera leaf extract against 74 S.aureus isolates was 188 ± 82.46 mg/ml and against 73 En-terobacterales was 91.18±40 mg/ml p < 0.001. CONCLUSION: Aloe vera ethanol leaf extract showed a good antibacterial effect against the different strains of bacteria causing wound infection. The present article shows the possi-bility of future use of natural products for the treatment of wound infections.

Evaluation of the surface characteristics and antibacterial properties of Titanium dioxide nanotube and methacryloyloxyethylphosphorylcholine (MPC) coated orthodontic brackets-a comparative invitro study.

OBJECTIVES: White spot lesions are the most common iatrogenic effect observed during orthodontic treatment. This study aimed to compare the surface characteristics and antibacterial action of uncoated and coated orthodontic brackets. MATERIALS AND METHODS: Sixty commercially available stainless steel brackets were coated with TiO2 nanotubes and methacryloyloxyethylphosphorylcholine. The sample was divided into Group 1: uncoated orthodontic brackets, Group 2: Stainless steel brackets with TiO2 nanotubes coating, Group 3: Stainless steel brackets with methacryloyloxyethylphosphorylcholine coating, and Group 4: Stainless steel brackets with TiO2 nanotubes combined with methacryloyloxyethylphosphorylcholine coating. Surface characterization was assessed using atomic force microscopy and scanning electron microscopy. Streptococcus mutans was selected to test the antibacterial ability of the orthodontic brackets, total bacterial adhesion and bacterial viability were assessed. The brackets were subjected to scanning electron microscopy to detect the presence of biofilm. RESULTS: The surface roughness was the greatest in Group 1 and least in Group 2 followed by Group 4 and Group 3 coated brackets. The optical density values were highest in Group 1 and lowest in Group 4. Comparison of colony counts revealed high counts in Group 1 and low counts in Group 4. A positive correlation between surface roughness and colony counts was obtained, however, was not statistically significant. CONCLUSIONS: The coated orthodontic brackets exhibited less surface roughness than the uncoated orthodontic brackets. Group 4 coated orthodontic brackets showed the best antibacterial properties. CLINICAL RELEVANCE: Coated orthodontic brackets prevent adhesion of streptococcus mutans and reduces plaque accumulation around the brackets thereby preventing formation of white spot lesions during orthodontic treatment.

Effect of Klebsiella-specific phage on multidrug-resistant Klebsiella pneumoniae- an experimental study.

BACKGROUND: The objective of this study was to study the effect of Klebsiella-specific phage isolated from sewage with and without the combination of antibiotics (imipenem) on the growth of clinical isolates of multidrug-resistant Klebsiella pneumoniae by time-kill assay and also to study the effect of bacteriophage and bacteriophage-antibiotic (imipenem) combination on biofilm production. METHODS: A total of 40 MDR K. pneumoniae isolates were used. Klebsiella-specific phage was isolated using K. pneumoniae subspp. pneumoniae ATCC 33495 as the host from sewage. In vitro time kill curve assays were performed to evaluate the effect of Klebsiella-specific phage with and without the combination of antibiotics on the viable cell counts of MDR K. pneumoniae isolates. Microtiter plate method of O'Toole and Kolter was used to study the effect of Klebsiella-specific phage with and without the combination of antibiotics on biofilm production. For the Time kill assay, results were analyzed for significant differences using Friedman test. Tests for significant differences between the different groups were found using the Mann-Whitney U test. The correlation between the formation of biofilm was analyzed using Karl Pearson's coefficient of correlation. P value of <0.05 was considered to be statistically significant. RESULTS: In vitro time-kill assay showed a 0.4 log decline and a 0.5 log decline in K. pneumoniae colony counts at 4 h, when phage was administered individually and in combination with imipenem, respectively (p < 0.001). Phage and phage-imipenem combinations reduced the ability of K. pneumoniae to produce biofilm by 38 % and 53 %, respectively. CONCLUSION: In conclusion, this study suggests that phage therapy has inhibiting activity against MDR K. pneumoniae. It is found to reduce bacterial cell count and biofilm formation but does not have a total cidal effect. However, in order to get a notable result, a phage cocktail or combination of phage with other antibiotic(s) is suggested.

A Study of Antibacterial Effect of Nigella sativa Seed Extracts on Bacterial Isolates from Cases of Wound Infection.

BACKGROUND: With an increasing trend of pathogenic bacteria developing resistance to the existing drugs, there is a need for newer therapeutic measures. Nigella sativa seeds and oil have been used for decades as Ayurveda, Unani Tibb and other forms of traditional medicine for various disorders. Thymoquinone is one of the active components of the N. sativa seeds. OBJECTIVE: The present study determines the antibacterial effect of crude methanolic extract N. sativa seeds and thymoquinone against bacteria causing wound infection. METHODS: Samples obtained from cases of wound infection received at a Microbiology laboratory attached to a tertiary care hospital over a period of six months were included in the study. The antibacterial effect of crude methanolic extract of N. sativa seeds was determined by the Punch Well method. The minimum inhibitory concentration (MIC) of thymoquinone against bacteria isolated from cases of wound infection was determined by the Micro Broth Dilution technique. RESULTS: A total of 60 isolates were collected from 60 samples of wound infection. By the Punch Well method, Staphylococcus aureus showed varying zones of inhibition whereas all gram-negative bacilli and Enterococcus faecalis did not show any zone of inhibition. Thymoquinone showed good antibacterial activity against S. aureus with MIC values ranging from 2-8µg/ml for most of the isolates. Uniformly, MIC of thymoquinone against all gram-negative bacilli and E. faecalis was >128µg/ml, p<0.001. It was found that methicillin-resistant S. aureus (MRSA) isolates showed higher MIC than methicillin sensitive S. aureus (MSSA) isolates p<0.05. CONCLUSION: Antibacterial activity of thymoquinone was very good against S. aureus but showed limited activity against Enterobacteriaceae members and E. faecalis isolated from patients with wound infection. Thymoquinone may be considered a potential antibacterial agent against wound infection caused by S. aureus.

Comparative Evaluation of the Sealing Ability of an Alkasite Restorative Material and Resin-Modified Glass Ionomer Cement in Primary Molars: An In vivo Study.

Background: Cention N is relatively new and an "alkasite" restorative material, indicated for direct restorations. Aim: The aim of this study was to comparatively evaluate the sealing ability of Cention N and resin-modified glass ionomer cement (GIC) when used to restore primary molars. Methods and Materials: It is a split-mouth study. Twenty children having bilateral deep dentinal caries involving primary molars requiring restoration were selected. After caries excavation under the rubber dam, samples were collected from the cavity. Restorations of the teeth were done using either resin-modified GIC (RMGIC) or Cention N. Patients were recalled after 6 weeks and the restorations done previously were removed using contra angled micromotor handpiece under rubber dam isolation. The samples were collected again. The collected samples were used to estimate the total viable count. Statistical Analysis: The pretreatment, posttreatment colony counts, and the differences between the groups were analyzed using paired t-test. Results: No statistically significant difference was observed in the mean differences of the pre- and posttreatment colony count between alkasite restorative material and RMGIC (P = 0.056). Conclusion: Restorations done using alkasite restorative material and RMGIC performed equally in terms of sealing ability.

Association of Streptococcus Mutans, Candida Albicans and Oral Health Practices with Activity Status of Caries Lesions Among 5-Year-Old Children with Early Childhood Caries.

PURPOSE: Candida albicans is frequently detected together with Streptococcus mutans in the plaque or biofilms of children with early childhood caries (ECC). The aim of this study was to examine the association of the microbial counts of C. albicans and S. mutans in the supragingival plaque with the activity status of carious lesions and oral health practices in children with ECC. MATERIALS AND METHODS: 66 children aged 5 years were examined and their caries status recorded as per the ICDAS-II and the Lesion Activity Assessment (LAA) criteria. A questionnaire covering oral health practices was administered to parents. Plaque samples were collected and cultured on mitis salivarus bacitracin (MSB) agar and CHROMagar. Data was analysed using Spearman's rank correlation and Mann-Whitney U test. RESULTS: There was a statistically significant positive correlation between the levels of S. mutans and C. albicans (rs = 0.702, p <0.001). A positive correlation was seen between the percentage of active carious lesions with the colony counts of S. mutans (rs = 0.884, p <0.001) and C. albicans (rs = 0.785, p <0.001). Improper toothbrushing practices, dietary and feeding practices were statistically significantly associated with activity of caries lesions, S. mutans and C. albicans count. CONCLUSION: The total count of C. albicans and S. mutans in the supragingival dental plaque of children with ECC increases with an increase in the percentage of active carious lesions and the severity of dental caries. Improper oral health practices can lead to increased number of active carious lesions, as well as increased microbial load of both S. mutans and C. albicans.

Effect of three silver diamine fluoride application protocols on the microtensile bond strength of resin-modified glass ionomer cement to carious dentin in primary teeth.

BACKGROUND: Use of silver diamine fluoride (SDF) after selective caries excavation can arrest the further progress of the carious lesion. Application of potassium iodide (KI) can reduce the staining due to SDF. AIM: The aim of the study was to evaluate the effect of the application of SDF, with and without acid etching and KI on the bond strength of resin-modified glass ionomer cement (RMGIC) to the carious dentin of primary teeth. MATERIALS AND METHODS: In thisin vitro study, caries was induced on the occlusal surface by inoculating Streptococcus mutans strain in 36 extracted primary molars. The teeth were divided into four groups (n = 9), and the following treatments were done to the carious dentin prior to final restoration with RMGIC: Group I: 10% polyacrylic acid conditioner, Group II: 38% SDF, Group III: 37% phosphoric acid etchant followed by 38% SDF, and Group IV: 37% phosphoric acid etchant followed by 38% SDF and 10% potassium iodide solution. The microtensile bond strength was measured using universal testing machine. Failure modes were recorded using a scanning electron microscope. RESULTS: There was no significant difference in microtensile bond strengths between the groups (P = 0.665), with the highest value seen in Group III. CONCLUSIONS: Application of SDF with or without acid etching and KI does not affect the bond strength of RMGIC to carious dentin of primary teeth.

Comparative Evaluation of Plaque Inhibitory and Antimicrobial Efficacy of Probiotic and Chlorhexidine Oral Rinses in Orthodontic Patients: A Randomized Clinical Trial.

BACKGROUND: Antimicrobial agents serve as an effective adjunct in plaque control, and chlorhexidine has been the gold standard. However, the philosophy that natural agents are better for children's oral health is on the rise. Probiotic technology represents a breakthrough approach to maintain oral health by utilizing natural beneficial bacteria commonly found in healthy mouths. AIM AND OBJECTIVE: To compare efficacy of probiotic and chlorhexidine oral rinses in orthodontic patients. MATERIALS AND METHODS: 30 healthy patients undergoing fixed orthodontic treatment were randomly selected for the study by block randomization and allocation concealment and were divided into three groups: group a, 0.2% chlorhexidine mouthwash; group b, probiotic mouthwash; and group c, a control group. RESULTS: Probiotic and chlorhexidine groups had significantly decreased plaque indices as compared to the control group. However, greater improvement was seen in the gingival indices than plaque indices with better results in the probiotic group than the chlorhexidine group. No statistical significance was observed in the streptococcus count of probiotic and chlorhexidine groups at the end of the intervention period. CONCLUSION: The comparison of probiotics to chlorhexidine has proven that probiotics are as effective as chlorhexidine as an adjunctive chemical plaque control agent.

Bacterial and fungal biofilm formation on contact lenses and their susceptibility to lens care solutions.

BACKGROUND: Microbial biofilm formation on contact lenses and lens storage cases may be a risk factor for contact lens-associated corneal infections. Various types of contact lens care solutions are used to reduce microbial growths on lenses. OBJECTIVES: The present study aimed at comparing the growths of biofilms on the different contact lenses and lens cases. The study also aimed at determining the effect of lens care solutions and bacteriophage on these biofilms. MATERIALS AND METHODS: One type of hard lens and two types of soft lenses were used for the study. The organisms used were Staphylococcus aureus ATCC 25923, Pseudomonas aeruginosa ATCC 27853, Candida albicans ATCC 60193 and Escherichia coli ATCC 25922. Biofilm production was performed by modified O'Toole and Kolter method and effect of lens cleaning solutions and a crude coliphage on biofilms was also studied. Results were visualised using scanning electron microscopy and quantitated by colony counting method and spectrophotometric measurement of optical density (OD). Statistical analysis was done by SPSS 11.5, Kruskal-Wallis test and Chi-square test. RESULTS: Soft lens cleaning solutions had a significant inhibitory effect (P = 0.020) on biofilm formation on soft lenses and also lens cases (P < 0.001). Soft lens cleaning solution 2 was more efficient than solution 1. However, no such inhibitory effect was observed with regard to hard lens cleaning solution, but for a significant reduction in the OD values (P < 0.001). There was no significant inhibitory effect by bacteriophages. CONCLUSION: This study showed the importance of selecting the appropriate lens cleaning solution to prevent biofilm production on contact lenses.

Evaluation of conventional, protaper hand and protaper rotary instrumentation system for apical extrusion of debris, irrigants and bacteria- An in vitro randomized trial.

BACKGROUND: Endodontic instrumentation carries the risk of over extrusion of debris and bacteria. The technique used and the type of instrumentation influences this risk. AIM: The purpose of this study was to evaluate and compare the K-file, ProTaper hand and ProTaper rotary instrumentation systems for the amount of apically extruded debris, irrigant solution and intracanal bacteria. DESIGN: Experimental single blinded randomized type of in vitro study with sample of 30 single rooted teeth. Endodontic access cavities were prepared and the root canals were filled with the suspension of E. faecalis. Myers and Montogomery Model was used to collect apically extruded debris and irrigant. Canals were prepared using K files, Hand protapers and Protaper rotary files. STATISTICAL ANALYSIS: Non Parametric test like Kruskal-Wallis and Mann-Whitney U test were applied to determine the significant differences among the group. RESULTS: Tests revealed statistically significant difference between the amount of debris and number of bacteria extruded by the ProTaper hand and the K-files. No statistically significant difference was observed between the amounts of irrigant extruded by the ProTaper hand and the K-file system. Statistically significant differences were observed between the amounts of bacteria and irrigant extruded by the ProTaper rotary and the Protaper hand. No statistically significant difference was observed between the amounts of debris extruded by the ProTaper hand and the K-file system. CONCLUSIONS: Amount of apical extrusion of irrigant solution, bacteria and debris are significantly greater with K File instruments and least with Protaper rotary instruments. Key words:Protaper, rotary, periapical extrusion.

Fungal spores and fruiting bodies in cervicovaginal smears: Contaminant or infection?

BACKGROUND: Contaminants from various sources are curious findings in cervicovaginal smears and pose diagnostic challenges especially when they need to be distinguished from pathogens. Candidiasis is the most frequently encountered fungal infection but fungal contaminants are relatively common. Detection of fruiting bodies and spores of Aspergillus species is uncommon and may represent either a true infection or contamination. This study was undertaken to evaluate the presence of fungal spores, hyphae, and fruiting bodies in routine cervical smears and distinguish a true infection from contamination. METHODS: Conventional cervicovaginal smears collected from women were incidentally found to have fungal fruiting bodies and spores. All smears received in the Cytology Department during that one month were reviewed for the presence of these elements. RESULTS: Five out of the 120 smears, received from the outpatient department over a period of three consecutive days, showed evidence of fungal organisms. The patients were 28-59 years of age. While four patients were asymptomatic, only one patient complained of minimal vaginal discharge. All were immunocompetent. Cervicovaginal smears were prepared as part of routine screening. Fungal fruiting bodies, branching hyphae and numerous spores were seen in otherwise normal smears. Culture of scrapings from the surface of the wooden spatulas grew Aspergillus niger. CONCLUSIONS: Contamination of Pap smears by fungus must be distinguished from true infection, the latter being supported by positive clinical findings and the presence of significant inflammation in the smears. Literature review was done to see the range of contaminants detected in Pap smears. Diagn. Cytopathol. 2017;45:191-194. © 2016 Wiley Periodicals, Inc.

Diphtheroids-Important Nosocomial Pathogens.

INTRODUCTION: Diphtheroids are defined as aerobic, non-sporulating, pleomorphic Gram-positive bacilli which are more uniformly stained than Corynebacterium diphtheriae, lack the metachromatic granules and are arranged in a palisade manner. They are usually commensals of the skin and mucous membranes. They differ from C.diphtheriae in biochemical rea-ctions as well as in toxin production. Since, they are usually found as commensals on the skin, they are often considered as mere contaminants when isolated from clinical samples. However, there are increasing reports of these organisms being associated with various infections. Hence, we felt the need to study the common species associated with infections and know the properties of these organisms which are otherwise considered as mere laboratory contaminants. AIM: To identify the various species of diphtheroids isolated as pure growth from clinical specimens whose Gram's smear revealed numerous inflammatory cells with Gram positive bacilli and had clinical evidence. MATERIALS AND METHODS: A total of 100 isolates of Gram-positive bacilli from 16,242 clinical samples received in the Microbiology Department of Kasturba Medical College were considered for this study from Dec 2013-Dec 2014. Gram-positive bacilli which were seen in the smear along with pus cells, isolated as pure growth and reported as "Corynebacterium spp having clinical significance" were taken for this study while those which were reported as 'Probable skin contaminants' were excluded from this study. Species identification of Gram-positive bacilli was done by biochemical reactions. Antibiotic susceptibility test was done by Kirby-Bauer disk diffusion method. Biofilm production was done by the microtitre plate method of O'Toole and Kolter and statistical analysis was done by using proportion test and Chi-square test. RESULTS: Various species of diphtheroids were isolated from different clinical specimens. C. pseudotuberculosis, C. renale, C. ulcerans, C. striatum, C. minutissimum, Corynebacterium haemolyticum isolated from catheter tips, sputum, tracheostomy secretions and wound infections were highly resistant to many antibiotics while isolates from blood namely C. pseudotuberculosis, C. minutissimum, C. ulcerans and C. renale were nearly sensitive to most of them. It was also interesting to note that there was an increased rate of biofilm production in these isolates. CONCLUSION: Corynebacterium pseudotuberculosis, Coryne- bacterium ulcerans, Corynebacterium renale, Corynebacterium bovis, Corynebacterium striatum, Corynebacterium minutissimum, Corynebacterium pseudodiphtheriticum and Corynebacterium haemolyticum may survive in the form of biofilms in hospitals and cause multidrug resistant infections. Hence, we need to judiciously identify these organisms, find their antimicrobial susceptibility, treat them and thus prevent infections in hospitals.

Effect of fluoride varnish and chlorhexidine-thymol varnish on mutans streptococci levels in human dental plaque: a double-blinded randomized controlled trial.

BACKGROUND: Recent systematic reviews on clinical trials comparing the efficacy of chlorhexidine and fluoride varnish found that the evidence was inconclusive and further well-conducted randomized controlled clinical trials were advocated. AIM: To compare the effect of fluoride varnish (F) and Chlorhexidine-thymol varnish (CHX/T) with intensive application regimen on mutans streptococci (MS) levels in human dental plaque. DESIGN: Seventy-five subjects between 6 and 10 years of age were allocated into three groups: Group 1-F varnish (n = 29); Group 2-CHX/T varnish(n = 29); Group 3-placebo varnish (n = 17) by stratified block randomization. After baseline plaque samples were obtained, varnish application was applied and repeated at an interval of 3 days in each group. Plaque samples were repeated at 48 h, 1 month, and 3 months. The samples were spread over mitis-salivarius-bacitracin (MSB) culture media, and the colony-forming units per ml (CFU) were measured. RESULTS: In both Groups 1 and 2, Wilcoxon matched-pairs signed-rank test revealed significant differences in log CFU values of MS between baseline and 48 h, baseline and 1 month but no significant difference between baseline and 3 months. An intergroup comparison at different time intervals showed that the difference between three groups was statistically insignificant. CONCLUSION: F varnish and CHX/T varnish, with an intensive regimen application have equivocal effect on MS levels in dental plaque.

The bacterial biofilms in dialysis water systems and the effect of the sub inhibitory concentrations of chlorine on them.

INTRODUCTION: The presence of bacteria in the form of biofilms poses a problem in the fluid pathways of haemodialysis plants and procedures which are aimed to detach and neutralize biofilms are necessary to improve the patient safety and the quality of the healthcare. The present study was therefore aimed at isolating the organisms which colonized dialysis water systems as biofilms, as well as to study the effect of the sub inhibitory concentrations of chlorine on the biofilms which were produced by these isolates. METHODS: Swabs were used to collect the biofilms which were produced on the internal surface of the dialysis tubing from the dialysis units. This study was conducted at the Department of Microbiology, Kasturba Medical College (KMC), Mangalore, India. The cultures were performed on MacConkey's agar and blood agar. The organisms which were isolated were identified and antibiotic sensitivity tests were performed. The biofilm production was done by the microtitre plate method of O'Toole and Kolter. The biofilm production was also studied in the presence of sub inhibitory concentrations of chlorine. RESULTS: Acinetobacter spp and Pseudomonas aeruginosa were the two predominant organisms which colonized the dialysis water systems as biofilms. The sub inhibitory concentrations of chlorine did not bring about any decrease in the biofilm production by the isolates. On the contrary, there was an increase in the biofilm production. CONCLUSION: Our study highlighted the importance of using appropriate methods to improve the quality of the water in dialysis units. This in turn, may help in reducing the biofilm formation in the water systems of dialysis units and thus, contribute to the prevention of hospital acquired infections in the patients who need haemodialysis.

Anti-biofilm and anti-adherence activity of Glm-U inhibitors.

BACKGROUND: Intravascular catheters and urinary catheters are an important source of hospital-acquired infections. Many microorganisms colonize indwelling catheters, including central venous catheters (CVCs) forming biofilms and cause infections that are difficult to treat. Although various methods have been employed to reduce biofilms, enzymes involved in bacterial cell wall synthesis could provide novel targets for the development of anti-biofilm agents. N-Acetylglucosamine-1-phosphate uridyltransferase (GlmU) is an essential enzyme in aminosugars metabolism and catalyzes the formation of uridine-diphospho-N-acetylglucosamine (UDP-GlcNAc), an important precursor in the peptidoglycan and lipopolysaccharide biosynthesis of Gram-positive and Gram-negative bacteria. Previous study has been conducted on the anti-biofilm effect of GlmU inhibitors such as N-ethyl maleimide (NEM) and NEM analogs along with a cationic polypeptide protamine sulfate (PS), which enhanced its anti-biofilm activity. AIM: The present study aimed at finding the effect of sub-inhibitory concentrations of N-ethyl maleimide (NEM) and protamine sulfate (PS) on the biofilms produced by Pseudomonas aeruginosa and Enterococcus spp. isolated from cases of catheter-associated UTI as well as Klebsiella pneumoniae and Staphylococcus aureus isolated from cases of catheter-related bloodstream infections (CRBSI). MATERIALS AND METHODS: In order to enhance the activity of NEM and to develop a broad-spectrum anti-microbial composition, NEM (50 µg/ml) was combined with protamine sulfate (50 µg/ml) and tested for anti-biofilm activity using a standard quantitative biofilm assay method. RESULTS AND CONCLUSION: It was observed that NEM had no effect on the biofilm produced by Pseudomonas aeruginosa as well as by Enterococcus spp. NEM also caused a significant decrease in biofilm production by Staphylococcus aureus while it had no effect on the biofilm produced by Klebsiella pneumoniae. There was a significant synergistic inhibitory effect on Staphylococcus aureus and Enterococcus spp., whereas Pseudomonas aeruginosa and Klebsiella pneumoniae remained unaffected. Combination of GlmU inhibitor-plus-protamine sulfate failed to significantly reduce bacterial adherence of Pseudomonas aeruginosa and Klebsiella pneumoniae to catheter and cannula pieces, respectively. We found that the GlmU inhibitor was mainly effective in preventing the adherence and biofilm formation by gram-positive organisms. The combination of NEM and protamine sulfate may, therefore, be tried as anti-infective coatings for medical devices such as catheters and cannulas, and thus help in overcoming microbial resistance in the current era of increasing device-associated hospital infections.