Effect of N-acetyl cysteine, rifampicin, and ozone on biofilm formation in pan-resistant <i>Klebsiella pneumoniae</i>: an experimental study

Tuncer, Gulsah; Aktas, Zerrin; Basaran, Seniha; Cagatay, Atahan; Eraksoy, Haluk

doi:10.1590/1516-3180.2023.0113.R1.29112023

Gulsah Tuncer

proposed the concept

designed the study

wrote the protocol

managed the study

performed the statistics

performed data acquisition

analyzed the data

interpreted the data

wrote the manuscript

critically reviewed the manuscript

reviewed and approved the final version of the manuscript submitted for publication

MD. Physician, Assistant Professor, Department of Infectious Diseases and Clinical Microbiology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey.

https://orcid.org/0000-0002-9841-9146

Zerrin Aktas

critically reviewed the manuscript

performed data acquisition

analyzed and interpreted the data

reviewed and approved the final version of the manuscript submitted for publication

PhD. Professor, Department Microbiology and Clinical Microbiology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey.

https://orcid.org/0000-0002-5998-0440

Seniha Basaran

critically reviewed the manuscript

performed data acquisition

analyzed and interpreted the data

reviewed and approved the final version of the manuscript submitted for publication

MD. Physician, Assistant Professor, Department of Infectious Diseases and Clinical Microbiology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey.

https://orcid.org/0000-0002-3402-2510

Atahan Cagatay

proposed the concept

designed the study

wrote the protocol

managed the study

performed the statistics

performed data acquisition

analyzed and interpreted the data

wrote the manuscript

critically reviewed the manuscript

reviewed and approved the final version of the manuscript submitted for publication

MD. Physician, Professor, Department of Infectious Diseases and Clinical Microbiology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey.

https://orcid.org/0000-0002-3051-8199

Haluk Eraksoy

reviewed and approved the final version of the manuscript submitted for publication

MD. Physician, Professor, Department of Infectious Diseases and Clinical Microbiology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey.

https://orcid.org/0000-0002-5790-0806

Address for correspondence: Gulsah Tuncer, Department of Infectious Diseases and Clinical Microbiology, Istanbul, Faculty of Medicine, Istanbul University, Street No 36, Meydan life complex, floor 7, Cebeci district, 2476 — Sultangazi, Istanbul, Turkey, Phone: 905435799409 E-mail: gulsah_durak_51@hotmail.com

Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey

Conflicts of interest: None

Editor responsible for the evaluation process: Paulo Manuel Pêgo-Fernandes MD, PhD

This study was awarded as the best thesis by the “Dr. Cengiz Cetin Assistant Thesis Competition” on March 14, 2020.

Antibiotic susceptibility test	Antibiotic	Isolate no
Antibiotic susceptibility test	Antibiotic	4	6	7	8	9	12	13	14	15
Gradient test	Meropenem	> 32	> 32	> 32	24	> 32	> 32	16	32	> 32
	Imipenem	32	24	12	8	> 32	> 32	12	8	8
	Ertapenem	> 32	> 32	> 32	> 32	> 32	> 32	24	> 32	> 32
	Amikacine	24	64	64	48	96	> 256	32	48	> 256
	Gentamicin	32	8	12	48	64	> 256	16	16	> 256
	Ciprofloxacine	> 32	> 32	> 32	> 32	> 32	> 32	> 32	> 32	> 32
	Levofloxacine	> 32	> 32	> 32	> 32	> 32	> 32	> 32	> 32	> 32
	Ceftriaxone	> 32	> 32	> 32	> 32	> 32	> 32	> 32	> 32	> 32
	Ceftroline	> 32	> 32	> 32	> 32	> 32	> 32	> 32	> 32	> 32
	Piperacillin-tazobactam	96	64	64	64	64	256	64	128	256
	Cefepime	> 256	> 256	> 256	> 256	> 256	> 256	> 256	> 256	> 256
	Aztreonam	64	96	96	128	128	128	> 256	32	> 256
	Chloramphenicol	64	64	64	128	96	96	64	128	96
	Trimethoprim-sulphamethoxazole	> 32	> 32	> 32	> 32	> 32	> 32	> 32	> 32	> 32
	Rifampicin	> 32	> 32	> 32	> 32	> 32	> 32	> 32	> 32	> 32
Fluid microdilution	Tigecycline	2	2	1	2	1	4	1	1	1
Fluid microdilution	Colistin	4	8	64	64	32	32	4	8	16
Agar dilution	Fosfomycin	125	125	256	> 256	> 256	> 256	> 256	256	125

Isolate no	Difference at 2 h	Result	Difference at 6 h	Result	Difference at 24 h	Result	Difference at 72 h	Result	Antibiofilm agent (mg/L)
Isolate no	log₁₀ CFU/mL	Result	log₁₀ CFU/mL	Result	log₁₀ CFU/mL	Result	log₁₀ CFU/mL	Result	Antibiofilm agent (mg/L)
4/4 C	0.17	–	0.03	–	1.49	–	0.04	–	NAC (2)
	0.7	–	0.52	–	0.02	–	0.52	–	RIF (0.1)
	0.14	–	0.8	–	0.52	–	0.42	–	Ozone (0.6)
	0.06	–	0.49	–	0.06	–	2.06	+	Ozone (4. 78)
6/6 C	1.27	–	0.12	–	0.14	–	0	–	NAC (2)
	1.1	–	0.66	–	0.3	–	0.12	–	RIF (0.1)
	0.05	–	0.06	–	0.11	–	0.03	–	Ozone (0.6)
	0.11	–	0.06	–	1.27	–	2.4	+	Ozone (4. 78)
7/7 C	1.85	–	0.6	–	0.24	–	1	–	NAC (2)
	0.05	–	0.21	–	0.12	–	0.43	–	RIF (0.1)
	0.52	–	0.34	–	0.79	–	0.85	–	Ozone (0.6)
	0.34	–	0.1	–	0.92	–	2.07	+	Ozone (4. 78)
8/8 C	1.05	–	0.11	–	0.03	–	0.46	–	NAC (2)
	0.06	–	0.2	–	0.43	–	0.31	–	RIF (0.1)
	0.85	–	0.08	–	0.22	–	0.45	–	Ozone (0.6)
	0.28	–	0.21	–	0.17	–	4.08	+	Ozone (4. 78)
9/9 C	1.3	–	0.39	–	1.23	–	0.69	–	NAC (2)
	0.86	–	0.06	–	0.07	–	0.46	–	RIF (0.1)
	0.58	–	0.14	–	0.1	–	0	–	Ozone (0.6)
	0.39	–	0.11	–	0.59	–	3.4	+	Ozone (4. 78)
12/12 C	0.29	–	1	–	0.41	–	0.71	–	NAC (2)
	0.72	–	0.1	–	0.14	–	0.28	–	RIF (0.1)
	0.27	–	0.12	–	0	–	0.56	–	Ozone (0.6)
	0.05	–	0.45	–	1.07	–	2.15	+	Ozone (4. 78)
13/13C	0	–	0.47	–	0.78	–	0.39	–	NAC (2)
	0.48	–	0.59	–	0.86	–	0.31	–	RIF (0.1)
	1.9	–	1.22	–	0.08	–	0.85	–	Ozone (0.6)
	2.1	–	0.81	–	0.05	–	3.16	+	Ozone (4. 78)
14/14 C	0.1	–	0.4	–	0.37	–	0.18	–	NAC (2)
	0.88	–	0.87	–	0.52	–	1	–	RIF (0.1)
	0.9	–	1.46	–	0.88	–	0.13	–	Ozone (0.6)
	1.65	–	0.13	–	0.04	–	3.12	+	Ozone (4. 78)
15/15 C	0.4	–	0.96	–	0.28	–	0.21	–	NAC (2)
	0.06	–	0.26	–	0.95	–	0.03	–	RIF (0.1)
	0.08	–	0.7	–	0.59	–	0.02	–	Ozone (0.6)
	0.04	–	0.15	–	0.2	–	3.05	+	Ozone (4. 78)

Isolate n	Difference at h 2	Result	Difference at h 6	Result	Difference at h 24	Result	Antibiofilm agent (mg/L)
Isolate n	log₁₀	Result	log₁₀	Result	log₁₀	Result	Antibiofilm agent (mg/L)
4/4C	0.02 cell/mL	–	0.33 cell/mL	–	0.38 cell/mL	–	NAC^dead (2)
	0.87 CFU/mL	–	0.78 CFU/mL	–	0.19 CFU /mL	–	NAC^alive (2)
	0.4 cell/mL	–	0.14 cell/mL	–	0.12 cell/mL	–	RIF^dead (0.1)
	0.5 CFU/mL	–	0.96 CFU/mL	–	0.02 CFU /mL	–	RIF^alive (0.1)
6/6 C	0.11 cell/mL	–	0.47 cell/mL	–	0.36 cell/mL	–	NAC^dead (2)
	0.14 CFU/mL	–	0.67 CFU/mL	–	0.24 CFU /mL	–	NAC^alive (2)
	0.67 cell/mL	–	0.36 cell/mL	–	0.12 cell/mL	–	RIF^dead (0.1)
	0.43 CFU/mL	–	0.59 CFU/mL	–	0.4 CFU /mL	–	RIF^alive (0.1)
7/7 C	0.17 cell/mL	–	0.02 cell/mL	–	0.21 cell/mL	–	Ozone^dead (4.78)
	0.03 CFU/mL	–	0.08 CFU/mL	–	0.47 CFU /mL	–	Ozone^alive (4.78)
	0.5 cell/mL	–	0.6 cell/mL	–	0.28 cell/mL	–	NAC^dead (2)
	0.43 CFU/mL	–	0.08 CFU/mL	–	0.06 CFU /mL	–	NAC^alive (2)
	0.48 cell/mL	–	0.63 cell/mL	–	0.23 cell/mL	–	RIF^dead (0.1)
	0.22 CFU/mL	–	0.02 CFU/mL	–	0.63 CFU /mL	–	RIF^alive (0.1)
8/8C	0.19 cell/mL	–	0.02 cell/mL	–	0.54 cell/mL	–	NAC^dead (2)
	0.39 CFU /mL	–	0 CFU/mL	–	0.1 CFU /mL	–	NAC^alive (2)
	0.06 cell/mL	–	0.37 cell/mL	–	0.55 cell/mL	–	RIF^dead (0.1)
	0.13 CFU /mL	–	0.03 CFU/mL	–	0.38 CFU /mL	–	RIF^alive (0.1)
9/9C	0.12 cell/mL	–	0 cell/mL	–	0.23 cell/mL	–	NAC^dead (2)
	0.14 CFU /mL	–	0.01 CFU/mL	–	0.45 CFU /mL	–	NAC^alive (2)
	0.4 cell/mL	–	0.44 cell/mL	–	0.24 cell/mL	–	RIF^dead (0.1)
	0.14 CFU /mL	–	0.83 CFU/mL	–	0.02 CFU /mL	–	RIF^alive (0.1)
12/12C	0.53 cell/mL	–	0 cell/mL	–	0.16 cell/mL	–	Ozone^dead (4.78)
	0.06 CFU /mL	–	0.09 CFU/mL	–	0.52 CFU /mL	–	Ozone^alive (4.78)
	0.68 cell/mL	–	0.23 cell/mL	–	0.33 cell/mL	–	NAC^dead (2)
	0.19 CFU /mL	–	0.09 CFU/mL	–	0.3 CFU /mL	–	NAC^alive (2)
	0.7 cell/mL	–	0.36 cell/mL	–	0.57 cell/mL	–	RIF^dead (0.1)
	0.32 CFU /mL	–	0.11 CFU/mL	–	0.30 CFU /mL	–	RIF^alive (0.1)
13/13 C	0.73 cell/mL	–	0.41 cell/mL	–	0.52 cell/mL	–	NAC^dead (2)
	0.15 CFU /mL	–	0.13 CFU/mL	–	0.33 CFU /mL	–	NAC^alive (2)
	0.4 cell/mL	–	0.37 cell/mL	–	0.29 cell/mL	–	RIF^dead (0.1)
	0.5 CFU /mL	–	0.3 CFU/mL	–	0.51 CFU /mL	–	RIF^alive (0.1)
14/14 C	0.03 cell/mL	–	0 cell/mL	–	0.16 cell/mL	–	NAC^dead (2)
	0.33 CFU /mL	–	1.19 CFU/mL	–	0.64 CFU /mL	–	NAC^alive (2)
	0.27 cell/mL	–	0.79 cell/mL	–	0.39 cell/mL	–	RIF^dead (0.1)
	0.45 CFU /mL	–	0.75 CFU/mL	–	0.43 CFU /mL	–	RIF^alive (0.1)
15/15 C	0.06 cell/mL	–	0.09 cell/mL	–	0.2 cell/mL	–	Ozone^dead (4.78)
	0.03 CFU /mL	–	0.15 CFU/mL	–	0.15 CFU /mL	–	Ozone^alive (4.78)
	0.82 cell/mL	–	0.41 cell/mL	–	0.64 cell/mL	–	NAC^dead (2)
	0.13 CFU /mL	–	0.23 CFU/mL	–	0.45 CFU /mL	–	NAC^alive (2)
	0.76 cell/mL	–	0.42 cell/mL	–	0.74 cell/mL	–	RIF^dead (0.1)
	0.24 CFU /mL	–	0.71 CFU/mL	–	0.13 CFU/mL	–	RIF^alive (0.1)

[1] Address for correspondence: Gulsah Tuncer, Department of Infectious Diseases and Clinical Microbiology, Istanbul, Faculty of Medicine, Istanbul University, Street No 36, Meydan life complex, floor 7, Cebeci district, 2476 — Sultangazi, Istanbul, Turkey, Phone: 905435799409 E-mail: gulsah_durak_51@hotmail.com

Brasil

Brasil

Effect of N-acetyl cysteine, rifampicin, and ozone on biofilm formation in pan-resistant Klebsiella pneumoniae: an experimental study

ABSTRACT

BACKGROUND:

OBJECTIVES:

DESIGN AND SETTING:

METHODS:

RESULTS:

CONCLUSION: