Multidrug
resistant (MDR) bacteria have become an extremely serious
public health concern. Bacteria can develop resistance through various
mechanisms. Drug extrusion by the multidrug efflux pumps represents
an important mechanism of antimicrobial resistance. Inhibitors of
bacterial efflux pumps as adjuvants in antibacterial therapy are a
reasonable and cost-effective pursuit since the shortage of antibiotics
threatens global human health. Combined use of inorganic nanoparticles
(NPs) with conventional antibiotics constitutes a promising alternative
for fighting antibiotic resistance as NPs could restore the activity
of the existing antibiotics. In the present study, the potential role
of polyol-coated CuO, ZnO, and CuZn NPs as efflux pump inhibitors
has been investigated against MDR clinical strains of Pseudomonas aeruginosa. The mode of action of the
NPs was evaluated by studying their synergistic activity in combination
with the antibiotics meropenem and ciprofloxacin, and their efflux
inhibitory activity was studied by real-time fluorometry and a cartwheel
assay. The results showed that the NPs act synergistically, in a concentration-dependent
manner, with antibiotics known to be subject to efflux. Furthermore,
the killing effect of the synergistic combinations over time was determined
by time–kill studies. All the NPs at the lowest tested concentration
enhanced the antibacterial activity of ciprofloxacin, as it was evidenced
by both checkerboard and time–kill assays. Real-time fluorometric
analyses revealed that NPs at sub-inhibitory concentrations promote
the intracellular accumulation of ethidium bromide (EtBr). The EtBr
agar cartwheel method showed that the NPs at the sub-minimum inhibitory
concentration increased the fluorescence even at lower concentrations
of EtBr, whereas in the absence of NPs, there was a much lower fluorescence.
These results suggest that NPs may serve as potential sources of efflux
pump inhibitors in order to tackle antimicrobial resistance.