Increased ompW and ompA expression and higher virulence of Acinetobacter baumannii persister cells.

BACKGROUND: Acinetobacter baumannii is one of the main causes of healthcare-associated infections that threaten public health, and carbapenems, such as meropenem, have been a therapeutic option for these infections. Therapeutic failure is mainly due to the antimicrobial resistance of A. baumannii, as well as the presence of persister cells. Persisters constitute a fraction of the bacterial population that present a transient phenotype capable of tolerating supra-lethal concentrations of antibiotics. Some proteins have been suggested to be involved in the onset and/or maintenance of this phenotype. Thus, we investigated the mRNA levels of the adeB (AdeABC efflux pump component), ompA, and ompW (outer membrane proteins) in A. baumannii cells before and after exposure to meropenem. RESULTS: We found a significant increase (p-value < 0.05) in the expression of ompA (> 5.5-fold) and ompW (> 10.5-fold) in persisters. However, adeB did not show significantly different expression levels when comparing treated and untreated cells. Therefore, we suggest that these outer membrane proteins, especially OmpW, could be part of the mechanism of A. baumannii persisters to deal with the presence of high doses of meropenem. We also observed in the Galleria mellonella larvae model that persister cells are more virulent than regular ones, as evidenced by their LD50 values. CONCLUSIONS: Taken together, these data contribute to the understanding of the phenotypic features of A. baumannii persisters and their relation to virulence, as well as highlight OmpW and OmpA as potential targets for drug development against A. baumannii persisters.

Effect of gastric acid on the surface roughness and bacterial adhesion of bulk-fill composite resins.

The purpose of this in vitro study was to evaluate the effect of gastric acid on the surface roughness and biofilm formation of bulk-fill composite resins. Twenty-seven samples of each composite resin were obtained: G1: Filtek Z250 XT (Z250), G2: Filtek Bulk Fill (FTK), G3: Tetric N-Ceram Bulk Fill (TTC), and G4: Aura Bulk Fill (AUR). The samples were quantitatively analyzed for surface roughness (Ra) using a roughness tester (n=15) and for biofilm formation (Cn) by the counting of colony-forming units (CFUs/mL) (n=9) in three different moments: after polishing (Ra0 and Cn0), after gastric acid immersion (Ra1 and Cn1), and after gastric acid and simulated tooth brushing (Ra2 and Cn2). Qualitative analysis through surface topography (n=3) was evaluated by scanning electron microscopy (SEM). Ra values were subjected to two-way repeated measures ANOVA, followed by Tukey's test. Cn values were subjected to Kruskal-Wallis analysis, followed by multiple comparisons analysis (α=0.05). Z250 and FTK showed significant increases in surface roughness at Ra1. There were fewer CFUs/mL on TTC and AUR in relation to those of Z250 and FTK for Cn0, Cn1 and Cn2. The SEM images showed that gastric acid increased the formation of cracks, exposure of fillers and micro cavities for all composite resins. After tooth brushing, the topographical changes were more evident but did not influence biofilm formation. The gastric acid promoted both degradation of the surfaces and bacterial adhesion for all composite resins.

Effect of gastric acid on the surface roughness and bacterial adhesion of bulk-fill composite resins

Abstract The purpose of this in vitro study was to evaluate the effect of gastric acid on the surface roughness and biofilm formation of bulk-fill composite resins. Twenty-seven samples of each composite resin were obtained: G1: Filtek Z250 XT (Z250), G2: Filtek Bulk Fill (FTK), G3: Tetric N-Ceram Bulk Fill (TTC), and G4: Aura Bulk Fill (AUR). The samples were quantitatively analyzed for surface roughness (Ra) using a roughness tester (n=15) and for biofilm formation (Cn) by the counting of colony-forming units (CFUs/mL) (n=9) in three different moments: after polishing (Ra0 and Cn0), after gastric acid immersion (Ra1 and Cn1), and after gastric acid and simulated tooth brushing (Ra2 and Cn2). Qualitative analysis through surface topography (n=3) was evaluated by scanning electron microscopy (SEM). Ra values were subjected to two-way repeated measures ANOVA, followed by Tukey's test. Cn values were subjected to Kruskal-Wallis analysis, followed by multiple comparisons analysis (α=0.05). Z250 and FTK showed significant increases in surface roughness at Ra1. There were fewer CFUs/mL on TTC and AUR in relation to those of Z250 and FTK for Cn0, Cn1 and Cn2. The SEM images showed that gastric acid increased the formation of cracks, exposure of fillers and micro cavities for all composite resins. After tooth brushing, the topographical changes were more evident but did not influence biofilm formation. The gastric acid promoted both degradation of the surfaces and bacterial adhesion for all composite resins.

Resumo O objetivo deste estudo in vitro foi avaliar o efeito do ácido gástrico na rugosidade superficial e na formação do biofilme nas resinas compostas de incremento único. Vinte e sete amostras de cada resina composta foram confeccionadas: G1: Filtek Z250 XT (Z250), G2: Filtek Bulk Fill (FTK), G3: Tetric N-Ceram Bulk Fill (TTC), and G4: Aura Bulk Fill (AUR). As amostras foram analisadas quantitativamente quanto à rugosidade da superfície (Ra) usando um rugosímetro (n=15) e para formação de biofilme (Cn) pela contagem de unidades formadoras de colônias (UFC/mL) (n=9) em três diferentes momentos: após polimento (Ra0 and Cn0), após imersão em ácido gástrico (Ra1 and Cn1), e após ácido gástrico e simulação de escovação (Ra2 and Cn2). Análise qualitative da topografia superficial (n=3) foi avaliada por meio de microscopia eletrônica de varredura (MEV). Os valores de Ra foram analisados pela ANOVA de duas vias para amostras pareadas, seguido do teste de Tukey. Os valores de Cn foram submetidos ao teste de Kruskal-Wallis, seguido da análise de comparações múltiplas (α=0,05). Z250 e FTK tiveram aumento significativo na rugosidade superficial em Ra1. Houve menos CFUs/mL para TTC e AUR em relação à Z250 e FTK em Cn0, Cn1 and Cn2. As imagens em MEV mostraram que o ácido gástrico aumentou a formação de fendas, exposição das partículas e mcrocavidades para todas as resinas compostas. Após escovação, as mudanças topográficas foram mais evidentes, mas não influenciou na formação do biofilme. O ácido gástrico promoveu degradação da superfície e adesão bacteriana para todas as resinas compostas.

Copper-coated hospital surfaces: reduction of total bacterial loads and resistant Acinetobacter spp.

Healthcare-associated infections (HAIs) represent a global challenge and an even more staggering concern when related to microorganisms capable of resisting and surviving for long periods in the environment, such as Acinetobacter spp. Strategies that allow a reduction of pathogens from hospital environments represent an additional barrier in infection control protocols, minimizing transmission to hospitalized patients. Considering the antimicrobial properties of copper, here, the bacterial load and the presence of Acinetobacter spp. were monitored on high handling surfaces covered by 99.9% copper films on intensive and non-intensive care unit bedrooms in a tertiary care hospital. Firstly, copper-coated films were able to inhibit the adhesion and biofilm formation of A. baumannii strains in in vitro assays. On the other hand, Acinetobacter spp. were isolated from both copper-coated and uncoated surfaces in the hospital, although the majority was detected on surfaces without copper. All carbapenem-resistant A. baumannii isolates identified harbored the blaoxa-23 gene, while the A. nosocomialis isolates were susceptible to most antimicrobials tested. All isolates were susceptible to polymyxin B. Regarding the total aerobic bacteria, surfaces with copper-coated films presented lower total loads than those detected for controls. Copper coating films may be a workable strategy to mitigate HAIs, given their potential in reducing bacterial loads in nosocomial environments, including threatening pathogens like A. baumannii.

Antitubercular Activity of Novel 2-(Quinoline-4-yloxy)acetamides with Improved Drug-Like Properties.

Using cycloalkyl and electron-donating groups to decrease the carbonyl electrophilicity, a novel series of 2-(quinoline-4-yloxy)acetamides was synthesized and evaluated as in vitro inhibitors of Mycobacterium tuberculosis (Mtb) growth. Structure-activity relationship studies led to selective and potent antitubercular agents with minimum inhibitory concentrations in the submicromolar range against drug-sensitive and drug-resistant Mtb strains. An evaluation of the activity of the lead compounds against a spontaneous qcrB mutant strain indicated that the structures targeted the cytochrome bc 1 complex. In addition, selected molecules inhibited Mtb growth in a macrophage model of tuberculosis infection. Furthermore, the leading compound was chemically stable depending on the context and showed good kinetic solubility, high permeability, and a low rate of in vitro metabolism. Finally, the pharmacokinetic profile of the compound was assessed after oral administration to mice. To the best of our knowledge, for the first time, a 2-(quinoline-4-yloxy)acetamide was obtained with a sufficient exposure, which may enable in vivo effectiveness and its further development as an antituberculosis drug candidate.

Osteoblastic Cell Behavior and Early Bacterial Adhesion on Macro-, Micro-, and Nanostructured Titanium Surfaces for Biomedical Implant Applications.

PURPOSE: Surface treatments may significantly affect physical-chemical properties and surface biologic responses. This study aimed to investigate the influence of alterations in the physical-chemical properties of pure titanium with different surface topographies on biocompatibility and early microbiologic response. MATERIALS AND METHODS: Titanium disks were exposed to five different surface treatments created through acid etching and anodizing methods. Surface morphology, 2D and 3D roughness, wettability, biocompatibility, and cell viability were evaluated. Osteoblast adhesion and bacterial adhesion tests were also executed. Data were statistically analyzed using analysis of variance followed by Tukey test, roughness (P < .05), and bacterial proliferation (P < .05). RESULTS: Five different surface morphologies were developed; double acid etching was shown to be significantly rougher than the others. The 2D roughness measurements were shown to be less consistent than the 3D measurements. All surfaces presented biocompatibility to allow cell behavior and differentiation. Osteoblasts presented better evolution in terms of adhesion and behavior in the nanomorphologies. High roughness significantly increased bacterial adhesion. CONCLUSION: Surface treatments may critically alter titanium properties and morphology. Therefore, roughness measurements with a wide area should be used in their evaluation. Nanotextured surfaces show a positive effect on bone cells and antibacterial response; their application is suggested when considering surface texturization for biomedical implants.

Salmonella enterica persister cells form unstable small colony variants after in vitro exposure to ciprofloxacin.

Persistence phenotype and small colony variants (SCVs) can be part of a bacterial bet-hedging strategy for survival under environmental stresses, such as antimicrobial exposure. These phenotypes are of particular concern in persistent and relapsing infections, since cells resume to normal growth after cessation of the stressful condition. In this context, we found persisters and unstable SCVs as phenotypic variants of Salmonella enterica that were able to survive ciprofloxacin exposure. A high heterogeneity in persister levels was observed among S. enterica isolates grown under planktonic and biofilm conditions and exposed to ciprofloxacin or ceftazidime, which may indicate persistence as a non-multidrug-tolerant phenotype. Nevertheless, a comparable variability was not found in the formation of SCVs among the isolates. Indeed, similar proportions of SCV in relation to normal colony phenotype (NCP) were maintained even after three successive cycles of ciprofloxacin exposure testing colonies from both origins (SCV or NCP). Additionally, we found filamentous and dividing cells in the same scanning electron microscopy images from both SCV and NCP. These findings lead us to hypothesize that besides variability among isolates, a single isolate may generate distinct populations of persisters, where cells growing under distinct conditions may adopt different and perhaps complementary survival strategies.

Antibacterial potential associated with drug-delivery built TiO2 nanotubes in biomedical implants.

The fast evolution of surface treatments for biomedical implants and the concern with their contact with cells and microorganisms at early phases of bone healing has boosted the development of surface topographies presenting drug delivery potential for, among other features, bacterial growth inhibition without impairing cell adhesion. A diverse set of metal ions and nanoparticles (NPs) present antibacterial properties of their own, which can be applied to improve the implant local response to contamination. Considering the promising combination of nanostructured surfaces with antibacterial materials, this critical review describes a variety of antibacterial effects attributed to specific metals, ions and their combinations. Also, it explains the TiO2 nanotubes (TNTs) surface creation, in which the possibility of aggregation of an active drug delivery system is applicable. Also, we discuss the pertinent literature related to the state of the art of drug incorporation of NPs with antibacterial properties inside TNTs, along with the promising future perspectives of in situ drug delivery systems aggregated to biomedical implants.

Bacteriophages in Dentistry-State of the Art and Perspectives.

Bacteriophages, viruses capable of killing bacteria, were discovered in 1915, but the interest in their study has been limited since the advent of antibiotics. Their use in dentistry is still very limited. The authors reviewed studies about bacteriophage structure, mode of action, uses in oral health, and possible future uses in dentistry associated with their possible action over biofilm, as well as the advantages and limitations of phage therapy.

Antimicrobial efficacy of 0.5% peracetic acid and EDTA with passive ultrasonic or manual agitation in an Enterococcus faecalis biofilm model.

We compared the antimicrobial efficacy of EDTA and 0.5% peracetic acid (PAA), with manual agitation (MA) or passive ultrasonic irrigation (PUI) in an Enterococcus faecalis biofilm model. Fifty-five single-rooted human premolar teeth were chemo-mechanically prepared and inoculated with E. faecalis for biofilm formation. These were divided into five groups (n = 11): saline solution, PAA+MA, PAA+PUI, EDTA+MA and EDTA+PUI. Root canal sampling and scanning electron microscopy of the canal lumen and dentinal tubule areas at the different root thirds were performed. The images were ranked based on contamination level. Only the PAA groups presented with no bacterial growth, with the remaining groups not presenting significant differences among them. PAA+PUI presented with the highest median position rankings in every third and location, whereas EDTA+MA performed similarly to the saline control. No differences were found when comparing MA and PUI within the same solution, however, PUI was associated with lower contamination levels mean rankings.

The topical effect of chlorhexidine and povidone-iodine in the repair of oral wounds. A review.

PURPOSE: The aim of this paper was to review the current literature with regard to the use of chlorhexidine and povidone-iodine in the treatment of oral wounds. BACKGROUND: Oral mucosa is continuously subjected to physical or chemical injuries, where it becomes a common site for the occurrence of ulcerated lesions. These lesions are susceptible to infections that may delay healing. MATERIALS AND METHODS: A search of the medical and dental literature was conducted in Medline/Pubmed and Scielo using a combination of the terms oral ulcer, oral wound, wound healing, povidone-iodine and chlorhexidine, to review their mechanism of action and their use in the healing of oral wounds. RESULTS AND CONCLUSION: The use of chlorhexidine and povidone-iodine is effective in the control of local infection in a concentration-dependent manner, exerting a positive influence on the tissue repair process. Oral antiseptics appear be a good alternative in the management of these lesions, since there is a low risk of systemic toxicity and allergies, and less clinical evidence of bacterial resistance.

Topical chlorhexidine, povidone-iodine and erythromycin in the repair of traumatic ulcers on the rat tongue: Clinical, histological and microbiological evaluation.

OBJECTIVE: This study investigated the effect of topical application of 0.12% chlorhexidine, 10% povidone-iodine and 50% erythromycin on the optimization of healing process of traumatic ulcers made on ventral tongue of rats. DESIGN: Forty-Eight Wistar rats were randomly divided into four groups: control, chlorhexidine (Chx), povidone-iodine (PvI) and erythromycin (Er). An ulcer of 5 mm in diameter was made on the ventral tongue of the animals. After 24 h, a microbiological sample was taken and daily application of the substances started. Six animals each group were euthanized at 4 days and the others at 8 days postoperative, totaling three and seven days of treatment. Prior to euthanasia, a new microbiological collection was performed. RESULTS: The experimental groups showed less area of residual ulcer. A significant difference was seen between the PvI and Chx in relation to the control after three days of treatment (p < 0.05). Although the experimental groups displayed greater newly formed epithelial area, there was no significant difference compared to the control (p > 0.05). Er exhibed the lowest inflammation scores after seven days of treatment (p < 0.05). PvI showed reduction of microorganisms at both times and under aerobic (p < 0.01 at 3 days and p < 0.001 at 7 days) and microaerophilic (p < 0.05) conditions. Er significantly reduced the count of microorganisms in aerobic condition when compared to control group (p < 0.05 at 3 days and p < 0.01 at 7 days). CONCLUSIONS: All drugs promoted reduction of the microorganisms at the site of the injury, which may have a direct effect on the tissue repair process.

Levels of persisters influenced by aeration in Acinetobacter calcoaceticus-baumannii.

AIM: To evaluate the influence of aeration on persister levels from Acinetobacter calcoaceticus-baumannii isolates exposed to meropenem or tobramycin, as well as analyze morphological and structural changes in persisters. MATERIALS & METHODS: Levels of persisters were determined after a 48-h exposure to tobramycin or meropenem under aerated or static conditions, and persisters were analyzed by scanning and transmission electron microscopy. RESULTS: The fractions of persisters varied between isolates. Aeration reduced cell survival under each antibiotic treatment, and cell survival decreased as the tobramycin concentration was increased. Interestingly, division septa were observed in persisters by electron microscopy. CONCLUSION: Aeration may have stimulated bacterial growth, providing more targets for antibiotic action and leading to increased production of reactive oxygen species, which decreased levels of persisters.

In vitro evaluation of hydrolytic enzyme activity and biofilm formation of Candida parapsilosis species complex from a nosocomial environment.

INTRODUCTION:: Candida parapsilosis complex species, frequently found in hospital environments, have gained importance as etiological agents of candidemia. METHODS:: Candida parapsilosis complex isolates from a nosocomial environment were identified and their hydrolitic enzyme activity and ability to form biofilm were characterized. RESULTS:: Twenty-two C. parapsilosis sensu stricto isolates produced proteinase and three produced phospholipase. Most Candida metapsilosis isolates produced proteinase and one also produced phospholipase. All 29 isolates formed biofilms. CONCLUSIONS:: The nosocomial environment may act as a reservoir for C. parapsilosis complex isolates with phenotypic features that could possibly lead to nosocomial infections and health complications in hospital patients.

In vitro evaluation of hydrolytic enzyme activity and biofilm formation of Candida parapsilosis species complex from a nosocomial environment

Abstract INTRODUCTION: Candida parapsilosis complex species, frequently found in hospital environments, have gained importance as etiological agents of candidemia. METHODS: Candida parapsilosis complex isolates from a nosocomial environment were identified and their hydrolitic enzyme activity and ability to form biofilm were characterized. RESULTS: Twenty-two C. parapsilosis sensu stricto isolates produced proteinase and three produced phospholipase. Most Candida metapsilosis isolates produced proteinase and one also produced phospholipase. All 29 isolates formed biofilms. CONCLUSIONS: The nosocomial environment may act as a reservoir for C. parapsilosis complex isolates with phenotypic features that could possibly lead to nosocomial infections and health complications in hospital patients.

Carbapenem-resistant Acinetobacter baumannii contamination in an intensive care unit.

INTRODUCTION:: Acinetobacter baumannii is a major pathogen causing infections in intensive care units (ICUs). In this study, we aimed to evaluate the presence of A. baumannii in an ICU environment and gloves from ICU workers and to characterize the antimicrobial resistance of the isolates in comparison with those isolated from ICU patients at the same hospital. METHODS:: ICU samples were collected from March to November 2010. Isolates biochemically characterized as Acinetobacter calcoaceticus-Acinetobacter baumannii complex were evaluated by PCR targeting the 16S rDNA and bla OXA-51 genes. Antimicrobial susceptibility was determined using the disk diffusion method, and carbapenem-resistant isolates were also evaluated for the minimum inhibitory concentration of imipenem using broth microdilution. The presence of the bla OXA-23 gene was evaluated in isolates with reduced susceptibility to carbapenems. RESULTS:: A. baumannii was detected in 9.5% (84) of the 886 samples collected from the ICU environment, including from furniture, medical devices, and gloves, with bed rails being the most contaminated location (23.8%; 20/84). Multidrug-resistant (MDR) A. baumannii was found in 98.8% (83/84) of non-clinical and 97.8% (45/46) of clinical isolates. Reduced susceptibility to carbapenems was detected in 83.3% (70/84) of non-clinical and 80.4% (37/46) of clinical isolates. All isolates resistant to carbapenems harbored bla OXA-23. CONCLUSIONS:: We found a strong similarity between the antimicrobial susceptibility profiles of non-clinical and clinical A. baumannii isolates. Such data highlight the ICU environment as a potential origin for the persistence of MDR A. baumannii, and hence the ICU may be a source of hospital-acquired infections caused by this microorganism.

Histopathological, Microbiological, and Radiographic Analysis of Antimicrobial Photodynamic Therapy for the Treatment of Teeth with Apical Periodontitis: A Study in Rats' Molars.

OBJECTIVE: The aim of this study was to evaluate in vivo, by histological and radiographic analysis, the response of apical tissues of rats' teeth with experimentally induced apical periodontitis, after one- and two-session endodontic treatment with and without photodynamic therapy (PDT). A microbiological analysis was also performed to verify bacterial reduction after each treatment. BACKGROUND DATA: Studies carried out in recent years highlighted the antibacterial potential of PDT when associated with conventional endodontic therapy in vitro. Although the antimicrobial effect of PDT is well-established, tissue response to PDT in teeth with apical periodontitis lacks studies. METHODS: Thirty-two rats' root canals were assigned to four groups: one session/PDT-[chemomechanical preparation (CMP)+root canal filling (RCF)]; two sessions/PDT- [CMP+calcium hydroxide (CH) for 14 days+RCF]; one session/PDT+ [CMP+PDT+RCF], and two sessions/PDT+ [CMP+PDT+CH for 14 days+RCF]. For microbiological evaluation, samples were collected before and after proposed treatments. For radiographic and histological analysis, the animals were euthanized after 28 days and the mandibles surgically removed. RESULTS: PDT associated with conventional endodontic therapy was able to promote significant bacterial reduction in root canals with induced apical periodontitis, but this reduction was not significantly different to conventional endodontic therapy alone. Although radiographic evaluation showed no significant differences, histological analysis showed lower scores for neutrophils/eosinophils in PDT-treated groups and macrophages/giant cells in CH groups. CONCLUSIONS: The use of low-level laser as light source did not promote major improvement on radiographic and histological repair, but since the number of inflammatory cells slightly decreased, it may optimize repair by modulating inflammatory process. PDT may be indicated as an adjunct to conventional endodontic therapy for teeth with apical periodontitis, in association with an interappointment dressing with CH, in an attempt to produce better conditions to stimulate repair.

Carbapenem-resistant Acinetobacter baumannii contamination in an intensive care unit

Abstract INTRODUCTION: Acinetobacter baumannii is a major pathogen causing infections in intensive care units (ICUs). In this study, we aimed to evaluate the presence of A. baumannii in an ICU environment and gloves from ICU workers and to characterize the antimicrobial resistance of the isolates in comparison with those isolated from ICU patients at the same hospital. METHODS: ICU samples were collected from March to November 2010. Isolates biochemically characterized as Acinetobacter calcoaceticus-Acinetobacter baumannii complex were evaluated by PCR targeting the 16S rDNA and bla OXA-51 genes. Antimicrobial susceptibility was determined using the disk diffusion method, and carbapenem-resistant isolates were also evaluated for the minimum inhibitory concentration of imipenem using broth microdilution. The presence of the bla OXA-23 gene was evaluated in isolates with reduced susceptibility to carbapenems. RESULTS: A. baumannii was detected in 9.5% (84) of the 886 samples collected from the ICU environment, including from furniture, medical devices, and gloves, with bed rails being the most contaminated location (23.8%; 20/84). Multidrug-resistant (MDR) A. baumannii was found in 98.8% (83/84) of non-clinical and 97.8% (45/46) of clinical isolates. Reduced susceptibility to carbapenems was detected in 83.3% (70/84) of non-clinical and 80.4% (37/46) of clinical isolates. All isolates resistant to carbapenems harbored bla OXA-23. CONCLUSIONS: We found a strong similarity between the antimicrobial susceptibility profiles of non-clinical and clinical A. baumannii isolates. Such data highlight the ICU environment as a potential origin for the persistence of MDR A. baumannii, and hence the ICU may be a source of hospital-acquired infections caused by this microorganism.

Effects of meropenem exposure in persister cells of Acinetobacter calcoaceticus-baumannii.

AIM: To evaluate the influence of meropenem in the Acinetobacter calcoaceticus-baumannii (ACB) persister levels. METHODS: Persister levels in planktonic and biofilm cultures from ACB isolates were evaluated after exposure to different meropenem concentrations. RESULTS: A high variability of persister fractions was observed among the isolates cultured under planktonic and biofilm conditions. Meropenem concentration did not influence persister fractions, even when far above the MIC. No correlation was found between persister levels and biofilm biomass. CONCLUSION: The magnitude of persister levels from ACB planktonic and, particularly, biofilm cultures exposed to meropenem was independent of the antibiotic concentration, dosing regimen and biofilm biomass. These findings, in a context of meropenem failure to treat chronic infections, strengthen the importance of understanding persister behavior.

In vitro antibacterial activity of a silicone-based endodontic sealer and two conventional sealers.

The aim of this study was to evaluate whether the modification in the silver component is capable of providing GuttaFlow 2 with antibacterial activity against Enterococcus faecalis compared with epoxy resin-based (AH Plus) and zinc oxide and eugenol-based (Endofill) sealers. The antibacterial activity was evaluated using a reference strain of E. faecalis (ATCC 29212). Freshly mixed sealers were subjected to the agar diffusion test (ADT), while the direct contact test (DCT) was performed after materials setting. ADT results were obtained through measurements, in millimeters, of the inhibition zones promoted by the materials, using a digital caliper. In DCT, values of CFU/mL promoted by the three sealers were compared in three experimental periods (1 min, 1 h, and 24 h). The data were analyzed using Kruskal-Wallis and Dunn post-hoc tests (p < 0.05). In both ADT and DCT, GuttaFlow 2 presented no effect against E. faecalis, while Endofill and AH Plus showed similar inhibition zones. Endofill was the only material capable of reducing bacterial growth in DCT. In conclusion, modifications in the silver particle of GuttaFlow 2 did not result in a sealer with antibacterial effect against E. faecalis.