Chlorhexidine Research Articles

Virulence Factors and Susceptibility to Ciprofloxacin, Vancomycin, Triclosan, and Chlorhexidine among Enterococci from Clinical Specimens, Food, and Wastewater.

Enterococcus faecalis and E. faecium are opportunistic pathogens commonly found in the microbiota of humans and other animals as well as in the environment. This article presents the results of antimicrobial susceptibility testing using phenotypic methods (broth microdilution and standardized disk diffusion) on selected clinical, food, and wastewater isolates of E. faecalis and E. faecium. The isolates were divided into subgroups based on their sensitivity to the following antibiotics: vancomycin (VAN) and ciprofloxacin (CIP), and biocides triclosan (TCL) and chlorhexidine (CHX). The study also investigated in vitro virulence factors, including biofilm formation ability, cell surface hydrophobicity (CSH) and β-hemolysis, to explore aspects of pathogenesis. In our study, regardless of the isolation source, VAN-resistant (VAN-R) and CIP-resistant (CIP-R) E. faecalis and E. faecium were detected. The highest proportion of CIP-R strains was found among clinical isolates of E. faecalis and E. faecium, with clinical E. faecium also showing the highest proportion of VAN-R strains. But the highest proportion of VAN-R E. faecalis strains was found in wastewater samples. The highest TCL MIC90 values for E. faecalis were found in wastewater isolates, while for E. faecium, the highest TCL MIC90 values were observed in food isolates. The highest CHX MIC90 values for both E. faecalis and E. faecium were identified in clinical specimens. The results obtained for E. faecalis did not indicate differences in TCL MIC and CHX MIC values with respect to sensitivity to VAN and CIP. Higher CHX MIC50 and CHX MIC90 values were obtained for CIP-R and VAN-R E. faecium. Among the tested isolates, 97.75% of the E. faecalis isolates produced biofilm, while 72.22% of the E. faecium isolates did so as well. In biofilm-forming strength categories III and IV, statistically significantly higher proportions of CIP-susceptible (CIP-S) and VAN-susceptible (VAN-S) E. faecalis were determined. In category III, there is no statistically significant difference in E. faecium CIP sensitivity. In category IV, we had a significantly higher proportion of CIP-R strains. On the other hand, the association between the moderate or strong category of biofilm formation and E. faecium VAN susceptibility was not significant. E. faecalis isolated from wastewater had a CSH index (HI) ≥ 50%, categorizing them as "moderate", while all the other strains were categorized as "low" based on the CSH index. Among the E. faecalis isolates, cell surface hydrophobicity indices differed significantly across isolation sources. In contrast, E. faecium isolates showed similar hydrophobicity indices across isolation sources, with no significant difference found. Moreover, no correlation was found between the enterococcal cell surface hydrophobicity and biofilm formation in vitro. After anaerobic incubation, β-hemolytic activity was confirmed in 19.10% of the E. faecalis and 3.33% of the E. faecium strains.

Comparison of Dracocephalum Moldavica Essential Oil with Chlorhexidine on Cariogenic Bacteria.

Dental caries and periodontal disease are the most common oral problems. Chemical antibacterial agents often have side effects; thus, researchers have long been in search for organic and herbal products to prevent dental caries and periodontal disease. The present study has aimed to assess the effects of Dracocephalum moldavica essential oil on Streptococcus mutans, Streptococcus salivarius, Streptococcus sobrinus, and Lactobacillus acidophilus compared to Chlorhexidine (CHX). In this in vitro study, the plants were collected from Zanjan Province, Iran. Analysis of the essential oil was carried out by gas chromatography/mass chromatography. Micro-broth dilution and disc diffusion methods were used for assessment of the antimicrobial activity, and minimum inhibitory concentration (MIC) and minimum bactericidal concentration (MBC) were evaluated. The mean diameter of the growth inhibition zones in the well plate method for Dracocephalum moldavica showed that it had greater antimicrobial activity against Lactobacillus acidophilusthan others (p Value= 0.01). Furthermore, Dracocephalum moldavica had higher antimicrobial activity than CHX. The results of MIC and MBC showed that Dracocephalum moldavica had lower antibacterial activity than CHX. Dracocephalum moldavica essential oil demonstrated antibacterial properties against cariogenic bacteria. Given that other favorable properties of these essential oils are confirmed, they may be suitable for use as antibacterial agents in the formulation of oral healthcare products.

Comparing 0.05% chlorhexidine gluconate monotherapy to conventional antibiotic irrigation in de-novo penile prosthesis implantation: a two-center prospective randomized controlled non-inferiority study (preliminary results).

Infection remains a significant concern following penile prosthesis (PP) implantation surgery. Published guidelines have indicated the use of pre-operative intravenous (IV) antibiotics but have not provided specific recommendations regarding intra-operative irrigation. For long in our practice, we have been using a combination of antibiotics for irrigation (rifampin 600 mg/L of sterile water, gentamicin 80 mg/L of sterile water). Recently, 0.05% chlorhexidine gluconate (CHG) (Irrisept®) (Irrimax Corp, Lawrenceville, GA, USA), has shown promise as an alternative irrigant, with potential advantages in terms of cost, ease of administration and reduced antibiotic resistance risk. The study aims to assess the non-inferiority of CHG antiseptic irrigation compared to conventional combined antibiotic irrigation in preventing postoperative infections for men undergoing de-novo PP implantation. This is a two-center Institutional Review Board (IRB) approved prospective randomized controlled non inferiority trial, involving men undergoing de-novo PP implantation with a predetermined non-inferiority margin of 4%. Patients were randomly assigned into one of two groups: the CHG irrigation or the group receiving conventional antibiotic irrigation. All patients received IV antibiotics preoperatively and were sent home on oral antibiotics for 2 weeks post-operatively. The primary endpoint of this trial was to evaluate the incidence of PP infections. Secondary objectives encompassed the assessment of simplicity of use and cost-effectiveness. A hundred patients were enrolled in our study so far (50 in each arm). Only one case of PP infection necessitating explanation was reported in each arm. Moreover, the use of CHG irrigation offered the potential advantages of ease of administration and less cost as compared to antibiotic irrigation solutions. Preliminary data from this non-inferiority study demonstrate that CHG irrigation is non-inferior to conventional antibiotic irrigation in preventing postoperative infection following PP implantation. These findings support the consideration of CHG irrigation as a viable alternative during PP implantation, offering both clinical effectiveness and potential cost savings as well as reducing the risk of antibiotic resistance. ClinicalTrials.gov NCT06489431.

Comparative analysis of remineralizing efficacy of strontium-doped bioactive glass, BioMin, and NovaMin containing dentifrice on artificial white spot lesions after chlorhexidine pretreatment - An in vitro study.

This study aimed to compare the remineralizing efficacy of strontium-doped bioactive glass, BioMin, and NovaMin containing dentifrices on artificial white spot lesions (WSLs) after chlorhexidine (CHX) pretreatment using energy-dispersive X-ray analysis (EDAX). Twenty-four samples of maxillary first premolars extracted for orthodontic purposes were selected. Artificial WSLs were produced by immersing the samples in a prepared demineralizing solution for 3 days. All the samples were pretreated with CHX and divided into four groups and six samples each. Group A treated with strontium-doped bioactive glass, Group B with BioMin, Group C with NovaMin, and Group D with artificial saliva as the control group for 14 days. pH-cycling model was used to simulate the oral cavity changes. EDAX was used to record the values at baseline, demineralization, and after remineralization. Data were analyzed using one-way ANOVA (post hoc), followed by unpaired t-test and Scheffe tests with Statistical Package for the Social Sciences version 16. Strontium-doped bioactive glass exhibited a greater mineral regain compared to BioMin, NovaMin, and control groups. Strontium-doped bioactive glass has enhanced mineral deposition on carious teeth and may provide an alternative clinical strategy for remineralizing early enamel lesions.

Adoption and factors associated with 7.1% chlorhexidine digluconate cord care standards in public health facilities in Kiambu County, Kenya

BackgroundThe Government of Kenya adopted the practice of 7.1% chlorhexidine digluconate (CHX) application for all newborns. However, challenges in implementation have arisen, as some counties in Kenya do not align with the underlying criteria for this recommendation. Therefore, we aimed to evaluate CHX adoption and associated factors in Kiambu County, Kenya. MethodsA cross-sectional survey was conducted among 434 caregivers attending their 6-week well-child clinics using multistage sampling. Descriptive statistics summarized sociodemographic data and CHX cord care uptake, while logistic regression analyzed associations between variables and CHX uptake. ResultsThe prevalence of use of CHX in Kiambu county was 41.0%. Twenty-two percent (22%) of the mothers were provided CHX post-delivery and 100% used it. Of the 78% who weren't provided CHX post-delivery, 39% were given prescriptions for CHX. The 61% who were not issued a prescription resorted to the use of surgical spirit (34.8%), dry cord care (9.2%) and saliva (3%). In public facilities, being married [AOR 0.19 (0.11–0.33)] and index use of CHX [AOR 0.17 (0.08–0.35)] were associated with non-adherence. Being employed [AOR 2.46 (1.26–4.77)] and delivering in hospital [COR 3.29 (1.69–7.08)] increased the likelihood of using CHX. ConclusionWeak prescription and adherence to the CHX cord care policy in Kiambu county has led to women turning to alternative substances for cord care. Quality improvement strategies are necessary to enhance adherence to guidelines, such as refining county-specific recommendations for cord care and providing corresponding patient education, or issuing definitive prescriptions for CHX post-delivery.

Enhancing the antibacterial and surface hardness of glass ionomer cement modified with Salvadora persica and Chlorhexidine: An in vitro study.

This laboratory study evaluated the effect of Salvadora persica (S. persica) root extracts and Chlorhexidine Digluconate (CHX) on the antibacterial and surface hardness properties of glass ionomer cement (GIC). The in vitro experimental study was conducted at the Baqai Institute of Pharmaceutical Sciences of Baqai Medical University, Karachi, Pakistan, from October 2022 to March 2023. There were a total four experimental groups. The first group consisted of ethanol extract (GIC-SPEE) and second group consisted of hexane extract as (GIC-SPHE) both prepared from Salvadora persica root respectively, and mixed with liquid of GIC separately. The third group comprised chlorhexidine (GIC-CHX) that was also mixing into liquid portion of GIC and the last group was Control i.e. (cGIC). The GIC samples were prepared by using stainless steel metallic moulds with dimension (5mm x 2mm), following the manufacturer guidelines. Antibacterial activity against Streptococcus mutans was done by disc diffusion test (DDT), and surface hardness test was done by Vickers hardness tester. Statistical analysis was performed using One-Way ANOVA and Tukey's post hoc tests (p<0.05). The antibacterial activity against S. mutans reported that the maximum zone of inhibition was obtained at 3 wt% by the GIC-SPEE, when compared with other experimental groups. For surface hardness, the highest mean and standard deviation and significant findings was reported by the group GIC-SPEE. Considering the outcome of this in vitro study, it can be concluded that the addition of 3 wt% GIC-SPEE increased the surface hardness and antibacterial activity against Streptococcus mutans.

Influence of different types of mouthwashes on force decay of elastomeric chain recommended in SARS-COV-2 pandemic.

This study aimed to compare the force decay of the power-chain elastics after exposure to anti-coronavirus 2019 (COVID-19) antiseptic mouthwashes at different intervals. A total of 300 power-chain pieces were used from American Orthodontics (AO) and Dentaurum (D) brands. Each piece composed of five loops that were selected to simulate canine retraction distally. The samples were randomly grouped according to immersion in the tested mouthwashes 0.2% povidone-iodine (PVP-I), 1% hydrogen peroxide (H2O2), and 0.2% chlorhexidine (CHX) and cetylpyridinium chloride (CPC). The maximum tensile load failure testing (MTLT) was assessed at six time points (zero, one hour, 24 hours, 1, 2 and 4 weeks). Analysis of variance (ANOVA) and Tukey's post hoc tests were used to analyse the data, where P < 0.05. Significant differences in MTLT of power-chain elastics used at different immersion intervals were observed. MTLT, in each tested group, decreased significantly as the immersion time increased with significant differences among the tested mouthwashes at each time point. H2O2 group displays a maximum force decay throughout the time intervals for both brands, in contrast to CPC group, which shows less degradation over time. Both brands are decade over time during exposure to the tested mouthwashes. CPC mouthwashes is a good option to be described for orthodontic patient during COVID-19 pandemic, whereas H2O2 mouthwashes should be avoided.

Oral Complications Due to Medication in Stevens-Johnson Syndrome Patient with Systemic Involvement

Background: Stevens-Johnson Syndrome (SJS) is a drug-induced hypersensitivity reaction involving mucocutaneous with various trigger factors including drugs and herpes simplex virus. Objective: This case report aimed to discuss oral complications due to medication in SJS patients with systemic disease involvement. Case: A 51-year-old man was referred to the Department of Oral Medicine, Faculty of Dentistry, Padjadjaran University, at Hasan Sadikin Hospital from the dermatology and venereology department complaining of pain in the oral cavity, especially when eating and drinking two months before, with a history of phenytoin, salbutamol and theophylline therapy. Extraoral examination showed erosive lesions and tended to bleed serosanguinolenta crusts on the lips. Intraoral there were erosive lesions and white plaque on the tongue, buccal mucosa, labial mucosa, and palate, as well as dental caries and calculus. Blood examination showed low hemoglobin, hematocrit, erythrocytes, lymphocytes, monocytes, SGOT, and sodium levels, while HbA1c, random, fasting, and 2 HPP glucose levels were high. Reactive Anti-HSV-1 IgG and rheumatoid factor. KOH examination showed positive spores, hyphae, pseudohypha, and budding cells. The diagnosis was SJS-associated oral lesions with HSV-1 virus infection, oral candidiasis accompanied with diabetes mellitus. For diabetes mellitus treatment, he was referred to the internal medicine department. Case Management: The therapy was 0.9% NaCl for lip compress, acyclovir tablet, nystatin oral suspension, chlorhexidine digluconate 0,12% mouthwash, folic acid, and vitamin B12. Oral lesions were improved significantly after diabetes mellitus was treated. Conclusion: The SJS patient was susceptible to complications in the oral cavity, especially fungal and viral infections due to the received medication.

Mangostanin hyaluronic acid hydrogel as an effective biocompatible alternative to chlorhexidine

Periodontal disease (PD) prevention and treatment products typically demonstrate excellent antibacterial activity, but recent studies have raised concerns about their toxicity on oral tissues. Therefore, finding a biocompatible alternative that retains antimicrobial properties is imperative. In this study, a chemically modified hyaluronic acid (HA) hydrogel containing mangostanin (MGTN) was developed. Native HA was chemically modified, incorporating amino and aldehyde groups in different batches of HA, allowing spontaneous crosslinking and gelation when combined at room temperature. MGTN at different concentrations was incorporated before gelation. The structure, swelling characteristics MGTN release, rheological parameters, and in vitro degradation performance of the loaded hydrogel were first evaluated in the study. Then, antimicrobial properties were tested on Porphyromonas gingivalis and its biocompatibility in 3D-engineered human gingiva. HA hydrogel was very stable and showed a sustained release for MGTN for at least 7 days. MGTN-loaded HA hydrogel showed equivalent antimicrobial activity compared to a commercial gel of HA containing 0.2 % chlorhexidine (CHX). In contrast, while MGTN HA hydrogel was biocompatible, CHX gel showed high cytotoxicity, causing cell death and tissue damage. Modified HA hydrogel allows controlled release of MGTN, resulting in a highly biocompatible hydrogel with antibacterial properties. This hydrogel is a suitable alternative therapy to prevent and treat PD.

Mussel-inspired adhesive drug-loaded hydrogels for oral ulcers treatment

Oral aphthous ulcers are common mucosal lesions that cause pain and discomfort. There are diverse biomaterials and drug treatments for oral ulcers used in both research and clinical settings. However, the complex oral environment often results in low adhesion and short drug retention times, which lead to poor drug availability and treatment outcomes. In this study, a mussel-inspired adhesive hydrogel was developed by grafting catechol onto hyaluronic acid (C-HA), and dopamine was added for oxidative pre-polymerization to form modified hyaluronic acid (M-HA), which remarkably increased the adhesion of the hydrogels. Then, M-HA was interpenetrated into the gelatin methacryloyl (GelMA) network. Chlorhexidine gluconate (CHG) was then incorporated into the hydrogel to enhance its availability and therapeutic effect through its sustained-release capability. The GelMA/M-HA hydrogel demonstrated strong adhesion to wet tissues, antibacterial and anti-inflammatory properties, and good biocompatibility. In both rat oral ulcers and infected wounds, the adhesive hydrogel significantly accelerated the healing of the ulcers and infected wounds. These results indicated that this adhesive hydrogel offers a promising new strategy for the treatment of oral ulcers in clinical practice. Statement of significanceOral ulcers are a common and high-incidence mucosal condition that seriously affect people's daily lives, often making it difficult for patients to chew and speak. However, a dynamic oral environment with various types of bacteria influences drug availability and treatment effects in clinical settings. To address this challenge, an adhesive, mussel-inspired, drug-loaded hydrogel was constructed using natural macromolecules (hyaluronic acid and gelatin) with good biocompatibility. Chlorhexidine gluconate (CHG), with its broad-spectrum antibacterial activity, has been incorporated to synergistically promote oral ulcer healing. The splendid adhesion, antibacterial, and therapeutic effects of this hydrogel demonstrated a new strategy for treating oral ulcers.

Secondary Healing Following Trauma-Induced Partial Glossectomy: Case Report of an Arabian Horse

The tongue serves as an organ of food prehension, mastication, grooming, deglutition, taste, and vocalization, and is suspected to play a role in upper airway stability. A seven-year-old riding horse, weighing 350 kg and employed for load-carrying purposes, was brought to Atatürk University Faculty of Veterinary Medicine Hospital due to a transversal injury in the rostral part of the tongue caused by trauma from the bridle's rope. During the general examination, it was observed that the tongue protruded outside the mouth, there was a presence of necrotic odor, paralysis in the apex lingualis region, and bloodstains on the mouth corner and front limbs. After the removal of the tongue tissue, debridement of the necrotic areas in the remaining caudal portion was performed, and it was left for secondary wound healing. Postoperatively, intramuscular injections of 200,000 IU benzylpenicillin procaine were administered every 24 hours for 7 days, along with flunixin meglumine given for 3 days. Additionally, a 0.12% chlorhexidine gluconate solution was used as an oral antiseptic three times daily for a duration of 7 days. Daily phone calls were made to the patient owner to inquire about the overall condition of the patient. Upon the follow-up appointment on the seventh day, improvement in the healing of the tongue was observed.

Long-Term Stability, Sterility, And Cost-Effectiveness of 0.05% Chlorhexidine Gluconate as Antisepsis for Intravitreal Injection.

Purpose: Commercially available chlorhexidine gluconate (CHG) has a beyond-use date of 24 h. This study evaluated the stability and sterility of 0.05% CHG for 30 days after opening and compared its cost to povidone iodine (PI) for intravitreal injection antisepsis. Methods: 0.05% CHG was aliquoted into 1-mL syringes and stored at room temperature or refrigerated. Turbidity, pH, high-performance liquid chromatography (HPLC), and sterility testing were performed. A cost analysis was conducted. Results: 0.05% CHG remained stable for at least 30 days. All samples had measured turbidity <0.5 nephelometric turbidity units. The pH of all samples remained between 5.0 and 7.0. HPLC demonstrated CHG concentration at day 30 relative to day 0 of 98.52% ± 4.16% at room temperature and 99.99% ± 3.38% at 2°C -6°C. The cost per week to perform 150 injections using 0.05% CHG was $463.25 when opening a new bottle daily compared with $16.73 for 5% PI. This cost decreased to $23.16 when utilizing a bottle of CHG for 30 days. Conclusion: 0.05% CHG remains stable and sterile for at least 30 days after opening. The ability to use CHG for at least 30 days after its opening significantly decreases its utilization expense.

Chlorhexidine gluconate versus povidone-iodine for nasal bacteria decolonization before transsphenoidal surgery in patients with pituitary neuroendocrine tumors: A prospective, randomized, double-blind, non-inferiority trial.

This study aimed to compare the nasal decolonization efficacy and comfort between chlorhexidine gluconate (CHG) and povidone-iodine (PVP) to provide an evidence basis for clinical guidance. A prospective, randomized, single-blinded, noninferior clinical trial was conducted in 174 patients with pituitary neuroendocrine tumors (PitNETs) who were scheduled to undergo transsphenoidal surgery. The noninferiority margin was δ=-0.1. The primary outcome was the effective rate of disinfection. The secondary outcomes included post-operative inflammatory indicators, the intracranial infection rate, and the proportion of intracranial infection. The effective clearance rate of post-operative nasal bacteria was nonsignificantly different between the CHG and PVP groups (88.64% vs. 82.56%; between-group difference 6.10%; 95% CI [-5.30 to 17.50]). There was no significant difference in the incidence of post-operative central nervous system infections or serum inflammation-related indications between the two groups, but sterilization tended to occur quicker and last longer in the CHG group. CHG seemed to have advantages in terms of comfort, including less nasal irritation, less pungency, and better intranasal coloration. CHG and PVP have equal efficacy in nasal decolonization before transsphenoidal surgery, but CHG seems to have comfort-related advantages in terms of less nasal irritation, less pungency, and better intranasal coloration.

Comparison of the anti-plaque and anti-gingivitis efficacy of Chlorhexidine and Malva mouthwashes: Randomized crossover clinical trial

ObjectivesAlthough mechanical oral hygiene is widely practiced, it faces several challenges. Mouthwashes, such as chlorhexidine (CHX), are being explored as adjuncts to biofilm control, but their prolonged use has several side effects. Consequently, there is ongoing research into natural alternatives. This randomized crossover clinical study aimed to compare the antiplaque and antigingivitis efficacy of 0.12 % CHX and a 5 % Malva sylvestris. MethodsForty-four participants were involved in two phases, each comprising three stages with variations in the mouthwash solution used only. During the study, participants refrained from mechanical plaque removal for seven days. At first day, they received whole-mouth prophylaxis and oral health assessment. After three days, gingival inflammation assessment and prophylaxis in were performed in contralateral quadrants. Participants then used a randomly assigned mouthwash solution for four days. On the 7th day, they completed a questionnaire about their perception and appreciation of the mouthwash. Additionally, gingival inflammation and plaque index were also performed by a calibrated examiner. After a minimum 21-day washout period, participants entered the second phase, repeating the three stages. ResultsResults showed no statistically significant differences between the Malva sylvestris and CHX groups regarding inflammation and plaque formation. However, CHX demonstrated a significantly greater mean reduction (7th – 4th day) in gingival inflammation compared to Malva (p = 0.02) (0.01 ± 0.19 and 0.00 ± 0.19, respectively). Additionally, participants using CHX reported a more pleasant taste and considered higher plaque control perception (p < 0.05). ConclusionsIn conclusion, both products exhibited similar antiplaque effects, but CHX outperformed Malva in controlling gingival inflammation. Clinical SignificanceMouthwashes with Malva sylvestris may be a good alternative, in a short-term period, to control biofilm. However, lower antigingivitis efficacy may be expected when compared to chlorhexidine.

The Effect of Chlorhexidine Gluconate Mouthwash in Comparing OHI-S Scores in Students of the Karya Adi Husada Mataram Dental Health Academy

The overall health of the body includes oral and dental health. The aftereffects of the 2018 Riskesdas show that most of the Indonesian populace (94.7%) has great tooth brushing propensities, specifically they have carried out the way of behaving of cleaning their teeth consistently. Sadly, however, only 2.8% of this number brush their teeth correctly, at least twice per day—in the morning after breakfast and at night before bed. The use of chlorhexidine as a mouthwash is a periodontal treatment because it has antiseptic properties, inhibiting plaque formation. The aim of this study was to determine the difference between gargling using Chlorhexidine Gluconate after brushing your teeth and not rinsing your mouth. The research process was carried out at the Karya Adi Husada Mataram Dental Health Academy and was carried out by observing samples between those who gargled using Chlorhexidine gluconate and those who did not gargle. The research results show significant results in the univariate analysis statistical test, namely from the results of statistical tests using the univariate analysis test, the count is 85,154 tables with α0.05, which is 14,6114, meaning the count is greater than the table so Ho is rejected. So it can be concluded that there is a difference in OHIS values ​​between those who gargle Chlorhexidine gluconate and those who do not gargle Chlorhexidine gluconate, where the OHIS value of Chlorhexidine gluconate mouthwash users is better than the OHIS value of students who do not gargle Chlorhexidine gluconate.

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

With the widespread misuse of disinfectants, the clinical susceptibility of Klebsiella pneumoniae (K. pneumoniae) to chlorhexidine (CHX) has gradually diminished, posing significant challenges to clinical disinfection and infection control. K. pneumoniae 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 K. pneumoniae 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 log10 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, Klebsiella pneumoniae, 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 K. pneumoniae to CHX, highlighting the urgent need for novel strategies to address this issue. In light of this, our research is meaningful.

Vaginal colonization with virulent and methicillin resistant Staphylococcus aureus among Ugandan women in Labour

BackgroundStaphylococcus aureus (S. aureus) often colonizes the human skin, upper respiratory and genital tracts. In the female genital tract, it can be passed on to the newborn during vaginal delivery leading to either ordinary colonization, or neonatal infections notably umbilical stump sepsis, scalded skin syndrome, arthritis, or bacteraemia/sepsis. These infections are mediated by staphylococcal virulence factors such as (i) Staphylococcal Enterotoxins A, B, C, D, and E encoded by the sea, seb, sec, sed, see genes, (ii) Exfoliative Toxins A and B encoded by the eta and etb genes, (iii) Toxic Shock Syndrome Toxin 1 (TSST-1) encoded by the tst gene, (iv) Panton-Valentine Leukocidin (PVL) encoded by the pvl gene, and (v) Hemolysins alpha and delta encoded by the hla and hld genes, respectively. We determined the prevalence of S. aureus possessing one or more virulence factor genes and of methicillin resistant Staphylococcus aureus (MRSA) in this population.MethodsThis was a cross-sectional study, which used 85 S. aureus isolates from the Chlorohexidine (CHX) clinical trial study in Uganda. The isolates had been obtained by culturing vaginal swabs (VS) from 1472 women in labour, frozen at minus 80oC, then thawed, sub-cultured, and tested for the selected virulence genes sea, seb, sec, sed, see eta, etb, tst, pvl, hla and hld, and for the methicillin resistance determining gene (mecA). Data were analyzed using SPSS version 20.ResultsOf the 85 S. aureus isolates 13 (15.3%) were positive for one or more virulence factor genes, as follows: pvl 9/85 (10.6%), hld 5/85 (5.9%), sea 1/85 (1.2%) and seb genes 1/85 (1.2%). The other virulence genes (sec, sed, see, eta, etb, hla and tst) were not detected in any of the isolates. MRSA was detected in 55.3% (47/85) of the isolates, but only two of these carried the pvl virulence gene.ConclusionThis study demonstrated that 15% of the S. aureus colonizing the female lower genital tract of mothers in labour in central Uganda carried one or more virulence genes, mostly pvl, indicating potential for newborn infection with S. aureus acquired in the maternal birth canal. More than half of the isolates were MRSA.

In vitro assessment of NaF/Chit supramolecular complex: Colloidal stability, antibacterial activity and enamel protection against S. mutans biofilm

ObjectivesThis study assessed the effect of NaF/Chit suspensions on enamel and on S. mutans biofilm, simulating application of a mouthrinse. MethodsThe NaF/Chit particle suspensions were prepared at molar ratio [NaF]/Chitmon]≈0.68 at nominal concentrations of 0.2 % and 0.05 % NaF and characterized by Fourier transform infrared spectroscopy (FTIR), dynamic light scattering and zeta potential. The minimum inhibitory concentration (MIC) and minimum bactericidal concentration (MBC) were measured. The S. mutans biofilm was formed for 7 days on eighty human enamel blocks that were divided into eight groups (n = 10/group): i) 0.05 % NaF solution; ii) 0.31 % Chit solution; iii) NaF/Chit(R=0.68) suspension at 0.05 % NaF; iv) 1.0 % HAc solution (Control); v) 0.2 % NaF solution; vi) 1.25 % Chit solution; vii) NaF/Chit(R=0.68) suspension at 0.2 % NaF; viii) 0.12 % chlorhexidine digluconate. The substances were applied daily for 90 s. S. mutans cell counts (CFU/mL) were performed, and the Knoop microhardness (KHN) of enamel samples were measured before and after biofilm formation. The KHN and CFU/mL data were analyzed by repeated measure ANOVA and Tukey's test (α = 0.05). ResultsInteractions between NaF and Chit were evidenced in solid state by FTIR spectra. The NaF/Chit complexes showed spontaneous microparticle formation and colloidal stability. The MIC and MBC ranged from 0.65 to 1.31 mg/mL. The NaF/Chit(R=0.68) suspension at 0.2 %NaF Group showed lower CFU/mL values than other groups. The NaF/Chit(R=0.68) suspensions Groups had the highest KHN values after biofilm formation. ConclusionsThe NaF/Chit(R=0.68) complexes exhibited an antibacterial effect against S. mutans biofilm and reduced the enamel hardness loss. Clinical significanceThe NaF/Chit(R=0.68) suspensions showed potential to be used as a mouthrinse for caries prevention.

Effectiveness of Chlorhexidine and Aloe Vera Mouthwash in Patients With Periodontal Disease: A Randomized Controlled Trial.

Aloe vera has gained significant attention in clinical research, and promoting natural substances is a prevailing trend in dentistry. This study compares the effectiveness of aloe vera mouthwash and 0.2% chlorhexidine gluconate mouthwash in reducing plaque accumulation and gingivitis. A single-masked trial included 270 volunteers who were systemically healthy and aged between 18 and 45 years. The participants were randomly assigned to three groups: Group A (the test group) received aloe vera mouth rinse, Group B (the positive control group) received a placebo (distilled water), and Group C (the negative control group) received 0.2% chlorhexidine. Clinical indicators, which include the plaque index (PI) by Sillness and Loe in 1964 and the gingival index (GI) by Loe and Sillness in 1963, were evaluated at baseline, day 15, and day 30 for all three groups. Participants were directed to rinse their mouths with the specified mouthwash twice daily for 30 days. Significant reductions in the GI and PI were observed in both aloe vera and chlorhexidine mouthwashes, with a statistical significance of p<0.001. The placebo mouthwash also showed reductions in both the GI and PI, with a significance level of p<0.001. Post hoc analysis revealed no significant differences between the aloe vera and chlorhexidine groups for the GI and PI, with p-values of 0.6 and 0.8, respectively. Aloe vera has proven equally effective as chlorhexidine in reducing plaque and gingivitis. This makes it a viable alternative for treating and preventing gingivitis, appealing to those preferring natural, holistic oral care. Incorporating aloe vera mouthwash into daily routines offers an effective, natural solution for maintaining gum health.

Microbial challenges and solutions in root canal therapy

Root canal therapy (RCT) faces significant challenges due to microbial invasion and biofilm formation within the root canal system. The intricate anatomy of root canals, including isthmuses, lateral canals, and apical deltas, provides a conducive environment for pathogenic microorganisms, complicating effective disinfection. Key pathogens such as Enterococcus faecalis and Candida albicans are highly resilient, capable of forming biofilms that protect them from antimicrobial agents and host defences. Current antimicrobial strategies in endodontics combine mechanical instrumentation with chemical disinfection. Mechanical debridement, though essential, often falls short of thoroughly cleaning the complex root canal anatomy. Sodium hypochlorite (NaOCl), the gold standard irrigant, exhibits broad-spectrum antimicrobial properties but struggles to penetrate biofilms and dentinal tubules fully. Adjunctive solutions like chlorhexidine (CHX) and ethylenediaminetetraacetic acid (EDTA) enhance the antimicrobial efficacy of NaOCl by providing prolonged action and removing the smear layer, respectively. Intracanal medicaments, such as calcium hydroxide (Ca(OH)2), are utilized to maintain antimicrobial activity between treatment sessions. Despite its high pH and effectiveness against a wide range of bacteria, Ca(OH)2 shows limited efficacy against biofilm-forming bacteria like Enterococcus faecalis. Innovations in irrigation techniques, such as passive ultrasonic irrigation (PUI) and laser-activated irrigation (LAI), have improved the delivery and activation of irrigants, enhancing their ability to disrupt biofilms and penetrate the root canal system. Nanoparticle-based irrigants and medicaments represent a promising advancement in endodontic disinfection. Their small size and large surface area allow for better penetration and interaction with bacterial cells, significantly reducing bacterial load in the root canal system. Combining traditional and advanced antimicrobial strategies is essential for overcoming the limitations of current methods and improving the success rates of endodontic therapy. Understanding the mechanisms of microbial invasion and biofilm formation, along with integrating emerging technologies, can lead to more effective disinfection protocols. This approach aims to enhance treatment outcomes and ultimately ensure the longevity of endodontically treated teeth.