Synergistic effect of 2% chlorhexidine combined with proteolytic enzymes on biofilm disruption and killing

Niazi, Sadia; Al-Ali, W. M.; Patel, Shanon; Foschi, Federico; Mannocci, Francesco

doi:10.1111/iej.12420

Cited by 31 publications

(22 citation statements)

References 60 publications

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“…In another study, the same authors examined the synergistic effect of a disinfection regimen consisting of trypsin and proteinase K in combination with chlorhexidine on an endodontic multispecies biofilm model. Chlorhexidine used in combination with trypsin and proteinase K enhanced the biofilm killing effect of the entire disinfection regime [64]. In our study, proteinase K was able to remove most of the extracellular proteins and the treatment resulted in less dense biofilms compared to the control biofilm.…”

Section: Discussionmentioning

confidence: 46%

Combined DNase and Proteinase Treatment Interferes with Composition and Structural Integrity of Multispecies Oral Biofilms

Karygianni

Attin

Thurnheer

2020

JCM

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Modification of oral biofilms adhering to dental hard tissues could lead to new treatment approaches in cariology and periodontology. In this study the impact of DNase I and/or proteinase K on the formation of a simulated supragingival biofilm was investigated in vitro. Six-species biofilms were grown anaerobically in the presence of DNase I and proteinase K. After 64 h biofilms were either harvested and quantified by culture analysis or proceeded to staining followed by confocal laser scanning microscopy. Microbial cells were stained using DNA-dyes or fluorescent in situ hybridization. Exopolysaccharides, eDNA and exoproteins were stained with Calcofluor, anti-DNA-antibody, and SyproTM Ruby, respectively. Overall, results showed that neither DNase I nor proteinase K had an impact on total colony-forming units (CFUs) compared to the control without enzymes. However, DNase I significantly suppressed the growth of Actinomyces oris, Fusobacterium nucleatum, Streptococcus mutans, Streptococcus oralis and Candida albicans. Proteinase K treatment induced significant increase in S. mutans and S. oralis CFUs (p < 0.001), whereas C. albicans and V. dispar showed lower CFUs compared to the control. Interestingly, confocal images visualized the biofilm degradation caused by DNase I and proteinase K. Thus, enzymatic treatment should be combined with conventional antimicrobial agents aiming at both bactericidal effectiveness and biofilm dispersal.

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Section: Discussionmentioning

confidence: 46%

Combined DNase and Proteinase Treatment Interferes with Composition and Structural Integrity of Multispecies Oral Biofilms

Karygianni

Attin

Thurnheer

2020

JCM

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“…5 Other studies have shown that other topical preparations can be used to augment chlorhexidine as an antiseptic. Niazi et al 15 showed that the addition of a protease, (1% trypsin) with chlorhexidine was more effective at reducing biofilm production. We used aqueous chlorhexidine because of concerns about the cytotoxic effect of using an alcoholic antiseptic on the dermis.…”

Section: Discussionmentioning

confidence: 99%

Application of dermal chlorhexidine antisepsis is ineffective at reducing Proprionibacterium acnes colonization in shoulder surgery

MacLean

Phadnis²,

Ling

et al. 2018

Shoulder & Elbow

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Background: Chlorhexidine as a skin surface antiseptic has been shown to be ineffective with respect to reducing Proprionibacterium acnes colonization within the dermis. The purpose of the present study was to determine whether the application of aqueous chlorhexidine solution to the dermal layer decreased P. acnes colonization during open shoulder surgery. Methods: The present study enrolled 50 patients who were undergoing open shoulder surgery. Patients received standard antimicrobial preparation. Three dermal swabs were taken from each patient: swab 1 following skin incision; swab taken 2 minutes to 5 minutes post-application of aqueous chlorhexidine to the dermis; and swab 3 taken 60 minutes post-application. Results: Mean age was 57.5 years (22 males, 28 females). There were 21 patients (42%) with P. acnes present on any dermal swab. There were significantly more P. acnes positive cultures identified at swab 3 compared to swab 1 (p ¼ 0.043). In nine patients with positive P. acnes at cultures swab 1, eight also isolated P. acnes after at swabs 2 or 3. Males were significantly more likely to have P. acnes on any swab (p < 0.001). Positive P. acnes cultures were significantly more common in patients 50 years (p < .001). None of the patients had any clinical signs of infection at a minimum of 1 year following surgery. Conclusions: Dermal application of aqueous chlorhexidine during open shoulder surgery fails to eradicate or reduce P. acnes on deep cultures.

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“…Some authors have included species that are not typically found in primary or secondary/persistent infections, for example Staphylococcus epidermidis (Niazi et al . , ). It seems of limited relevance to include these strains in an endodontic biofilm model.…”

Section: Root Canal Biofilm Model Systems: Factors To Considermentioning

confidence: 99%

Biofilm model systems for root canal disinfection: a literature review

et al. 2018

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The aim of this review was to present an overview of laboratory root canal biofilm model systems described in the endodontic literature and to critically appraise the various factors that constitute these models. The electronic databases MEDLINE, Web of Science and EMBASE were searched up to and including December 2016 to identify laboratory studies using endodontic biofilm models. The following search terms were used in various combinations: biofilm, root canal, in vitro, endodontic, bacteria, root canal infection model, colony‐forming unit. Only English papers from journals with an impact factor were selected. The records were screened by two reviewers, and full‐text articles were assessed according to pre‐defined criteria. The following data were extracted from the included studies: the microbial composition of the biofilm, the substrate, growth conditions, validation and quantification. Seventy‐seven articles met the inclusion criteria. In the majority (86%) of the studies, a monospecies biofilm was cultured. In two studies, a dual‐species biofilm was grown; others cultivated a multispecies biofilm, containing at least three species. Enterococcus faecalis was the most frequently used test species (in 79% of all studies, 92% of the monospecies studies). Four studies used an inoculum derived directly from the oral cavity. Human dentine was the most frequently used substratum (88% of the studies). Incubation times differed considerably, ranging from one to seventy days. The most common quantification method (in 87% of the studies) was bacterial culturing, followed by microscopy techniques. The variation in laboratory root canal biofilm model systems is notable. Because of substantial variation in experimental parameters, it is difficult to compare results between studies. This demonstrates the need for a more standardized approach and a validated endodontic biofilm model.

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Synergistic effect of 2% chlorhexidine combined with proteolytic enzymes on biofilm disruption and killing

Abstract: The trypsin and CHX group with ultrasonics was significantly more effective at reducing bacterial viable counts and disrupting biofilm.

Cited by 31 publications

References 60 publications

Combined DNase and Proteinase Treatment Interferes with Composition and Structural Integrity of Multispecies Oral Biofilms

Combined DNase and Proteinase Treatment Interferes with Composition and Structural Integrity of Multispecies Oral Biofilms

Application of dermal chlorhexidine antisepsis is ineffective at reducing Proprionibacterium acnes colonization in shoulder surgery

Biofilm model systems for root canal disinfection: a literature review

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