Alcohol treatment enhances<i>Staphylococcus aureus</i>biofilm development

Redelman, Carly V.; Maduakolam, Chike; Anderson, Gregory G.

doi:10.1111/1574-695x.12005

Cited by 39 publications

(24 citation statements)

References 37 publications

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“…The synergy of the triple combination of agents in the NiCE lock solution was further investigated to determine the optimal concentrations of nitroglycerin and ethanol in the triple combination (nitroglycerin [Baxter, Deerfield IL], citrate [Sigma-Aldrich, St. Louis, MO], ethanol [Sigma-Aldrich, St. Louis, MO]) against MRSA and VRE biofilms. These organisms were selected for this assessment because of the reported resistance of their biofilms to ethanol (22).…”

Section: Methodsmentioning

confidence: 99%

In Vitro Assessment of the Antimicrobial Efficacy of Optimized Nitroglycerin-Citrate-Ethanol as a Nonantibiotic, Antimicrobial Catheter Lock Solution for Prevention of Central Line-Associated Bloodstream Infections

Reitzel

Rosenblatt

Hirsh-Ginsberg

et al. 2016

Antimicrob Agents Chemother

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cThe rapid, broad-spectrum, biofilm-eradicating activity of the combination of 0.01% nitroglycerin, 7% citrate, and 20% ethanol and its potential as a nonantibiotic, antimicrobial catheter lock solution (ACLS) were previously reported. Here, a nitroglycerincitrate-ethanol (NiCE) ACLS optimized for clinical assessment was developed by reducing the nitroglycerin and citrate concentrations and increasing the ethanol concentration. Biofilm-eradicating activity was sustained when the ethanol concentration was increased from 20 to 22% which fully compensated for reducing the citrate concentration from 7% to 4% as well as the nitroglycerin concentration from 0.01% to 0.0015% or 0. C entral line-associated bloodstream infections (CLABSIs) pose a significant public health problem in the United States. More than 7 million patients require central venous access each year, resulting in an estimated 250,000 CLABSIs, approximately 30,000 attributable deaths (1), and substantial treatment costs of at least $45,000 per infection (2). The majority of CLABSIs occur in chronically catheterized patients, such as cancer, hemodialysis, or critical care patients. Long-term catheters, such as central venous catheters (CVCs), peripherally inserted central catheters (PICCs), ports, and dialysis catheters, are susceptible to internal colonization of the catheter lumens due to repeated catheter manipulation and infusions. Biofilm formation on the catheter surfaces can serve as the primary source of CLABSI and can be highly resistant to eradication by systemic antibiotic therapy. Several bundled measures have been proposed for both treatment and prevention of CLABSIs, most of which center around reducing and preventing colonization at the skin insertion site or at connections (3). While bundles have been shown to decrease the risk of CLABSI in short-term CVCs (Ͻ30 days of dwell time), approximately 90% of CLABSIs in longer-term catheters are luminally sourced (4, 5). While antimicrobial coatings exist that do cover luminal surfaces, the duration of protection is limited to only a few weeks (6). Because disinfecting antimicrobial catheter lock solutions (ACLSs) can be repetitively instilled, they have emerged as another approach to prevent luminally sourced CLABSIs.Antimicrobial lock therapy solutions for preventing CLABSI have been reported to include prophylactic applications of antibiotics, antifungals, or antiseptics such as ethanol (EtOH) (7,8). The development of microbial resistance is of great concern with prophylactic antibiotic ACLSs (9). Alternatively, high-concentration antiseptic ethanol ACLSs have been studied. An ACLS consisting of 70% ethanol was not effective in decreasing intraluminal CLABSI and was associated with adverse events such as dizziness (10). Ethanol ACLSs with concentrations of greater than 30% have also been associated with clotting, transient dizziness, and compromising catheter integrity in polyurethane catheters (11). Use of ethanol locks with ethanol concentrations greater than 28% has been further advised ...

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Section: Methodsmentioning

confidence: 99%

In Vitro Assessment of the Antimicrobial Efficacy of Optimized Nitroglycerin-Citrate-Ethanol as a Nonantibiotic, Antimicrobial Catheter Lock Solution for Prevention of Central Line-Associated Bloodstream Infections

Reitzel

Rosenblatt

Hirsh-Ginsberg

et al. 2016

Antimicrob Agents Chemother

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“…Testing of the latter is particularly important given historical speculation that bacterial exposure to biocides may lead to the induction or development of coping mechanism/s that are responsible for cross-resistance to certain antibiotics [32] and the surge in research interest and international debate in this area over recent years [33,34].…”

Section: Resultsmentioning

confidence: 99%

“…Particularly interesting is data from that study that indicate a significant increase in biofilm proliferation following the treatment of preformed biofilms with very high (80-100%) concentrations of ethanol; the lowest ethanol concentration tested (20%) did not promote biofilm development (Figure 1) [34]. It is possible that higher concentrations of ethanol impose stronger selection pressure toward the survival and proliferation of biofilm-forming cells (killing susceptible/non film forming cells) and that this selection is less pronounced at lower concentrations.…”

Section: Conclusion and Future Perspectivementioning

confidence: 97%

“…With mechanisms of antimicrobial resistance in mind, it is significant that alcohol treatment has been reported to promote S. aureus biofilm development resulting in speculation that alcohols might be of limited use for the eradication of preformed S. aureus biofilms [34]. Particularly interesting is data from that study that indicate a significant increase in biofilm proliferation following the treatment of preformed biofilms with very high (80-100%) concentrations of ethanol; the lowest ethanol concentration tested (20%) did not promote biofilm development (Figure 1) [34].…”

Section: Conclusion and Future Perspectivementioning

confidence: 99%

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Use of 70% Alcohol for the Routine Removal of Microbial Hard Surface Bioburden in Life Science Cleanrooms

et al. 2014

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Alcohol-based disinfectants are used for the removal of microbial hard surface bioburden in Life science Cleanrooms. Evidence for using formulations containing 70% alcohol has been lost over time but probably originates from historical observations of the activity of 60-70% alcohol. Tradition is no longer adequate to inform contemporary cleaning practice. We evaluated the efficacy of ethanol, isopropanol and trade-specific denatured alcohol 7 against vegetative Pseudomonas aeruginosa, Staphylococcus aureus, Escherichia coli and Enterococcus hirae using standardized European Suspension and Hard Surface tests. All three alcohols were effective at lower concentrations than the 70% standard. This constitutes the first evaluation of disinfectant formulations containing ≤70% alcohol using standard methodology. The utility of trade-specific denatured alcohol #7 and evidence-based cleanroom practice warrant further validation.

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“…The combination of 30% ethanol and 4% citrate has been shown to eradicate planktonic organisms in vitro (26); however, its performance against biofilm requires further study. It has even been reported that ethanol treatment can enhance biofilm formation for Staphylococcus aureus biofilms (27).…”

Section: Discussionmentioning

confidence: 99%

Glyceryl Trinitrate Complements Citrate and Ethanol in a Novel Antimicrobial Catheter Lock Solution To Eradicate Biofilm Organisms

Rosenblatt

Reitzel

Dvorak

et al. 2013

Antimicrob Agents Chemother

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Antimicrobial catheter lock therapy is practiced to prevent lumenal-sourced infections of central venous catheters. Citrate has been used clinically as an anticoagulant in heparin-free catheter locks. Ethanol has also been widely studied as an antimicrobial lock solution component. This study reports on the synergy of glyceryl trinitrate (GTN) with citrate and ethanol in rapidly eradicating methicillin-resistant Staphylococcus aureus, methicillin-resistant Staphylococcus epidermidis, Pseudomonas aeruginosa, and Candida albicans biofilms in an in vitro model for catheter biofilm colonization. GTN has a long history of intravenous use as a hypotensive agent. It is potentially attractive as a component of a catheter lock solution because its physiologic half-life is quite short and its metabolic pathways are known. A lock containing 7% citrate and 20% ethanol required 0.01% GTN to fully eradicate biofilms of all test organisms within 2 h in the model. This GTN concentration is below the levels where clinically significant hypotensive effects are expected. Central line-associated bloodstream infections (CLABSIs) have declined over the past decade but remain a significant medical problem, with a substantial cost burden to the health care system. There are an estimated 250,000 CLABSIs in the United States (1), with an estimated treatment cost of $45,000 or more per infection (2). Significant portions of CLABSIs annually are associated with hemodialysis treatment (3) and treatment of critically ill patients. CLABSIs that present after the first week of catheterization tend to be associated with colonization of the catheter lumenal surfaces (4, 5) and biofilm formation on those surfaces. Colonizing organisms organize within hours into biofilm structures which can serve as a source of CLABSI and can be highly resistant to eradication by antibiotic treatments. Approaches to reducing lumenal colonization include rigorous provider hygiene and use of antimicrobial swabs when connectors are manipulated. Even with these precautions, much of the lumenal surfaces remain vulnerable to colonization. Another approach to combatting lumenal infections has been the use of antimicrobial lock therapy (ALT). Catheter lumens are hydraulically locked when not in use. Typically, lock solutions include anticoagulants to inhibit the formation of blood clots, which can occlude flow through catheters. Heparin has traditionally been used as an anticoagulant; however, there have been concerns about its purity (6), as well as its potential to promote bacterial biofilm colonization (7). Antimicrobial locks have generally fallen into the categories of antibiotic locks and nonantibiotic, antiseptic locks. Antibiotic locks have been pursued both for catheter salvage and for infection prevention. Antibiotic catheter locks have recently been reviewed (8). Significant issues limiting the use of antibiotic locks for prevention are their higher costs and potential to promote the development of antibiotic resistance. We report here on the utility of glycery...

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Alcohol treatment enhancesStaphylococcus aureusbiofilm development

Cited by 39 publications

References 37 publications

In Vitro Assessment of the Antimicrobial Efficacy of Optimized Nitroglycerin-Citrate-Ethanol as a Nonantibiotic, Antimicrobial Catheter Lock Solution for Prevention of Central Line-Associated Bloodstream Infections

In Vitro Assessment of the Antimicrobial Efficacy of Optimized Nitroglycerin-Citrate-Ethanol as a Nonantibiotic, Antimicrobial Catheter Lock Solution for Prevention of Central Line-Associated Bloodstream Infections

Use of 70% Alcohol for the Routine Removal of Microbial Hard Surface Bioburden in Life Science Cleanrooms

Glyceryl Trinitrate Complements Citrate and Ethanol in a Novel Antimicrobial Catheter Lock Solution To Eradicate Biofilm Organisms

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