Abstract
Study ObjectiveAim of this study was to evaluate antimicrobial effects and interaction between analgesic combinations of fentanyl citrate, dexmedetomidine hydrochloride and tramadol hydrochloride on Staphylococcus aureus, Klebsiella pneumoniae, Escherichia coli, Pseudomonas aeruginosa and Candida albicans which are some of the most common nosocomial infection related microorganisms.DesignIn vitro prospective study.SettingUniversity Clinical Microbiology Laboratory.MeasurementsIn order to evaluate in vitro antimicrobial effects and interaction between analgesic combinations, tramadol hydrochloride, fentanyl citrate and dexmedetomidin were used against S. aureus ATCC 29213, K. pneumoniae, E. coli ATCC 25922, P. aeruginosa ATCC 27853 and C. albicans ATCC 10231 standard strains by microdilution method.Main ResultsAccording to microdilution assays tramadol has shown the most efficient antimicrobial activity also it has been observed that 10 μg/ml concentrated dexmedetomidine has antimicrobial effects on S. aureus, K. pneumoniae and P. aeruginosa. Fentanyl has displayed evident inhibitory potency on the pathogens except for Klebsiella pneumoniae, nevertheless our predefined minimum concentration inhibited growth by 9.5 %. Fentanyl and dexmedetomidine together exhibited more antimicrobial effect on P. aeruginosa and E. coli growth. Additionally, when the three drugs examined together, microbial inhibition occurred more than expected on E. coli again and also on C. albicans growth.ConclusionsOur results revealed the antimicrobial properties and synergy with the different combinations of fentanyl, dexmedetomidine and tramadol against the most common nosocomial infection agents in the ICU. This is the first study in the literature looking into the microbial “interactions” of opioids and sedative drugs but more research is needed in order to define clinico-laboratory correlation.
Highlights
Intensive care patients often require sedation procedures for several reasons during their hospitalization
This study aimed to evaluate antimicrobial effects and interaction between analgesic combinations of fentanyl citrate, dexmedetomidine hydrochloride and tramadol hydrochloride on Staphylococcus aureus, Klebsiella pneumoniae, Escherichia coli, Pseudomonas aeruginosa and Candida albicans which are some of the most common nosocomial infection related microorganisms
Antimicrobial susceptibility results revealed that 500 μg/ml tramadol hydrochloride inhibited the growth of K. pneumoniae 100 %
Summary
Intensive care patients often require sedation procedures for several reasons during their hospitalization. Since intensive care units (ICU) are prone to nosocomial infections; intravenous (IV) medications gain more importance in the aspect of microbial features. Contamination based infections may complicate clinical follow-up and little is known whether the sedative agents have antimicrobial properties. -2 selective blocker dexmedetomidine has become more popular and widely used for its less respiratory depressant effects instead of midazolam which triggers delirium in the elderly [5,6,7]. There are studies comparing dexmedetomidine and midazolam from the microbiological aspect in the literature [8,9]. Since midazolam has gained a bad reputation for delirium triggering properties another sedative agent fentanyl is yet to be explored
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