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白花丹素增强了洗必泰对临床分离株的抗菌和抗生物膜能力,同时降低了耐药突变的产生。

Plumbagin enhances antimicrobial and anti-biofilm capacities of chlorhexidine against clinical while reducing resistance mutations.

机构信息

Department of Clinical Laboratory, The First Affiliated Hospital of Wenzhou Medical University, Key Laboratory of Clinical Laboratory Diagnosis and Translational Research of Zhejiang Province, Wenzhou, Zhejiang, China.

School of Laboratory Medicine and Life Science, Wenzhou Medical University, Wenzhou, Zhejiang, China.

出版信息

Microbiol Spectr. 2024 Oct 3;12(10):e0089624. doi: 10.1128/spectrum.00896-24. Epub 2024 Aug 20.

Abstract

With the widespread misuse of disinfectants, the clinical susceptibility of () to chlorhexidine (CHX) has gradually diminished, posing significant challenges to clinical disinfection and infection control. employs overexpression of efflux pumps and the formation of thick biofilms to evade the lethal effects of CHX. Plumbagin (PLU) is a natural plant extract that enhances membrane permeability and reduces proton motive force. In this study, we elucidated the synergistic antimicrobial activity of PLU in combination with CHX, effectively reducing the MIC of CHX against to 1 µg/mL and below. Crucially, through crystal violet staining and confocal laser scanning microscopy live/dead staining, we discovered that PLU significantly enhances the anti-biofilm capability of CHX. Mechanistically, experiments involving membrane permeability, alkaline phosphatase leakage, reactive oxygen species, and RT-qPCR suggest that the combination of PLU and CHX improves the permeability of bacterial inner and outer membranes, promotes bacterial oxidative stress, and inhibits oqxA/B efflux pump expression. Furthermore, we conducted surface disinfection experiments on medical instruments to simulate clinical environments, demonstrating that the combination effectively reduces bacterial loads by more than 3 log CFU/mL. Additionally, results from resistance mutation frequency experiments indicate that combined treatment reduces the generation of resistant mutants within the bacterial population. In summary, PLU can serve as an adjuvant, enhancing the anti-biofilm capability of CHX and reducing the occurrence of resistance mutations, thereby extending the lifespan of CHX.IMPORTANCEAs disinfectants are extensively and excessively utilized worldwide, clinical pathogens are progressively acquiring resistance against these substances. However, high concentrations of disinfectants can lead to cross-resistance to antibiotics, and concurrent use of different disinfectants can promote bacterial resistance mutations and facilitate the horizontal transfer of resistance genes, which poses significant challenges for clinical treatment. Compared with the lengthy process of developing new disinfectants, enhancing the effectiveness of existing disinfectants with natural plant extracts is important and meaningful. CHX is particularly common and widely used compared with other disinfectants. Meanwhile, , as a clinically significant pathogen, exhibits high rates of resistance and pathogenicity. Previous studies and our data indicate a significant decrease in the sensitivity of clinical to CHX, highlighting the urgent need for novel strategies to address this issue. In light of this, our research is meaningful.

摘要

随着消毒剂的广泛滥用,临床分离株对洗必泰(CHX)的敏感性逐渐降低,对临床消毒和感染控制构成了重大挑战。通过过度表达外排泵和形成厚生物膜来逃避 CHX 的致命作用。白花丹素(PLU)是一种天然植物提取物,可增强细胞膜通透性并降低质子动力势。在这项研究中,我们阐明了 PLU 与 CHX 联合使用的协同抗菌活性,有效降低了 CHX 对临床分离株的 MIC 值至 1µg/mL 及以下。重要的是,通过结晶紫染色和共聚焦激光扫描显微镜活/死染色,我们发现 PLU 显著增强了 CHX 的抗生物膜能力。通过膜通透性、碱性磷酸酶渗漏、活性氧和 RT-qPCR 实验发现,PLU 和 CHX 的组合提高了细菌内外膜的通透性,促进了细菌氧化应激,并抑制了 oqxA/B 外排泵的表达。此外,我们还进行了模拟临床环境的医疗器械表面消毒实验,结果表明联合治疗可使细菌负载减少 3 个对数 CFU/mL 以上。此外,耐药突变频率实验结果表明,联合治疗可减少细菌种群中耐药突变体的产生。综上所述,PLU 可作为一种佐剂,增强 CHX 的抗生物膜能力,减少耐药突变的发生,从而延长 CHX 的使用寿命。

重要的是,由于全球范围内消毒剂的广泛和过度使用,临床病原体对这些物质的耐药性逐渐增加。然而,高浓度的消毒剂会导致对抗生素的交叉耐药性,并且同时使用不同的消毒剂会促进细菌耐药突变的发生,并促进耐药基因的水平转移,这对临床治疗构成了重大挑战。与开发新消毒剂的漫长过程相比,使用天然植物提取物增强现有消毒剂的效果非常重要且有意义。与其他消毒剂相比,CHX 更为常见且广泛使用。同时,作为一种具有重要临床意义的病原体,它表现出高耐药性和致病性。先前的研究和我们的数据表明,临床分离株对 CHX 的敏感性显著降低,这凸显了需要新的策略来解决这个问题。有鉴于此,我们的研究具有重要意义。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/41d5/11448042/7bbed20dd7b8/spectrum.00896-24.f001.jpg

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