Synergistic Antibiofilm Action of and Brazilian Green Propolis Hydroethanolic Extracts against Multidrug-Resistant Strains of and and Their Biocompatibility on Human Keratinocytes.

The accumulated dental biofilm can be a source of oral bacteria that are aspirated into the lower respiratory tract causing ventilator-associated pneumonia in hospitalized patients. The aim of this study was to evaluate the synergistic antibiofilm action of the produced and phytochemically characterized extracts of and Brazilian green propolis (BGP) hydroethanolic extracts against multidrug-resistant clinical strains of and , in addition to their biocompatibility on human keratinocyte cell lines (HaCaT). For this, High-performance liquid chromatography analysis of the plant extracts was performed; then the minimum inhibitory and minimum bactericidal concentrations of the extracts were determined; and antibiofilm activity was evaluated with MTT assay to prevent biofilm formation and to reduce the mature biofilms. The cytotoxicity of the extracts was verified using the MTT colorimetric test, evaluating the cellular enzymatic activity. The data were analyzed with one-way ANOVA and Tukey's tests as well as Kruskal-Wallis and Dunn's tests, considering a significance level of 5%. It was possible to identify the cinnamic aldehyde in and p-coumaric, caffeic, and caffeoylquinic acids as well as flavonoids such as kaempferol and kaempferide and Artepillin-C in BGP. The combined extracts were effective in preventing biofilm formation and reducing the mature biofilms of and . Moreover, both extracts were biocompatible in different concentrations. Therefore, C. and BGP hydroethanolic extracts have bactericidal and antibiofilm action against multidrug resistant strains of and . In addition, the combined extracts were capable of expressively inhibiting the formation of and biofilms (prophylactic effect) acting similarly to 0.12% chlorhexidine gluconate.