Pseudomonas aeruginosa: una bella oportunista / Pseudomonas aeruginosa: a beautiful opportunist

Las bacterias son infinitamente más antiguas que el hombre y se reproducen más rápido, cada quince minutos y en una hora tienen cuatro generaciones, mientras que el hombre necesita un siglo para ello, de modo que en la larga existencia bacteriana somos apenas un minúsculo accidente. Toda la maravillosa maquinaria reunida en una sola bacteria de la especie Pseudomonas aeruginosa no fue planeada contra nosotros, incluyendo señales de quorum, bombas de expulsión, integrones, biofilm y piocinas, ya presentes en su vida natural o planctónica. Su adaptación a la vida nosocomial forzó a estudiarla y la organización de sus múltiples capacidades hace plantear que en su vida hay un propósito, una suerte de "inteligencia bacteriana" en contraposición a la tesis de Jacques Monod que estima la vida en este planeta como fruto del azar y de la necesidad.

Bacteria are infinitely older tan man and reproduce faster, every fifteen minutes and in one hour they have four generations, while man needs a century for have the same, so that in the long bacterial existence we are just a tiny accident. All the wonderful machinery assembled in a single bacterium of the species Pseudomonas aeruginosa it was not planned against us, including quorum sensing, efflux pumps, integrons, biofilm and pyocins, already presents in their natural or planktonic life. Her adaptation to hospital life forced to study this wonderful creature, and the organization of such multiple capacities suggests the existence of a vital purpose, a kind of bacterial intelligence, contrary to Jacques Monod's thesis, which estimate life in this planet as the result of chance and necessity.

Respuesta de procalcitonina ante co-infección e infección secundaria por bacterias multirresistentes en pacientes COVID -19 / Procalcitonin response in co-infection and secondary infection by multidrug resistant bacteria in COVID -19 patients

INTRODUCCIÓN. La procalcitonina, es un biomarcador que puede usarse como apoyo diagnóstico en infecciones bacterianas y la monitorización del tratamiento antibiótico, sobre todo en pacientes con sepsis. De ahí que, fue utilizado durante la pandemia COVID-19 OBJETIVO. Determinar los valores de procalcitonina en pacientes con COVID-19 y definir una p osible correlación entre su incremento y vinculación en coinfección o infección secundaria por Klebsiella pneumoniae y Pseudomonas aeruginosa con multidrogo resistencia y resistencia extendida a los antibióticos. MATERIALES Y MÉTODOS. Estudio retrospectivo observacional, descriptivo transversal, realizado del 1 de mayo al 31 de octubre del 2020 en el Hospital de Especialidades Carlos Andrade Marín sobre 7028 pacientes adultos, hospitalizados, con diagnóstico de COVID-19, y resultados de procalcitonina, cuyas muestras de secreción traqueal y/o hemocultivo presentaron desarrollo de Klebsiella pneumoniae y Pseudomonas aeruginosa. Su análisis estadístico fue desarrollado mediante la prueba Chi Cuadrado de Pearson. RESULTADOS. Se recibieron 861 muestras de hemocultivo y 391 de secreción traqueal, obteniéndose: 32% aislamientos de Klebsiella pneumoniae y Pseudomonas aeruginosa multidrogo y extremadamente resistente. Entre los pacientes COVID-19 que fallecieron, 34,4% mostraron incrementos de procalcitonina. Al contrario, entre los pacientes que sobrevivieron sólo en 8,8% se observó incrementos de procalcitonina evidenciándose un vínculo entre el incremento de procalcitonina y mortalidad. CONCLUSIONES. No existe diferencia en relación al incremento en los valores de procalcitonina en pacientes COVID-19 con co-infección o infección secundaria por Klebsiella pneumoniae y Pseudomonas aeruginosa multidrogo y extremadamente resistente y los valores de procalcitonina en pacientes con coinfección e infección secundaria con otro tipo de aislamientos bacterianos.

INTRODUCTION. Procalcitonin is a biomarker that can be used as a diagnostic support in bacterial infections and the monitoring of antibiotic treatment, especially in patients with sepsis. Hence, it was used during the COVID-19 pandemic OBJECTIVE. To determine the values of procalcitonin in patients with COVID-19 and to define a possible correlation between its increase and linkage in co-infection or secondary infection by Klebsiella pneumoniae and Pseudomonas aeruginosa with multidrug resistance and extended resistance to antibiotics. MATERIALS AND METHODS. Retrospective observational, descriptive cross-sectional study, conducted from May 1 to October 31, 2020 at the Hospital de Especialidades Carlos Andrade Marín on 7028 adult patients, hospitalized, with diagnosis of COVID-19, and procalcitonin results, whose tracheal secretion and/or blood culture samples presented development of Klebsiella pneumoniae and Pseudomonas aeruginosa. Their statistical analysis was developed using Pearson's Chi-squared test. RESULTS. We received 861 blood culture and 391 tracheal secretion samples, obtaining: 32% isolates of Klebsiella pneumoniae and multidrug-resistant and extremely resistant Pseudomonas aeruginosa. Among the COVID-19 patients who died, 34.4% showed increased procalcitonin levels. On the contrary, among patients who survived, only 8.8% showed increased procalcitonin levels, showing a link between increased procalcitonin levels and mortality. CONCLUSIONS. There is no difference in relation to the increase in procalcitonin values in COVID-19 patients with co-infection or secondary infection by Klebsiella pneumoniae and multidrug-resistant and extremely resistant Pseudomonas aeruginosa and procalcitonin values in patients with co-infection and secondary infection with other types of bacterial isolates.

Development of a multiplex PCR assay for the detection of metallo-beta-lactamase genes in Pseudomonas aeruginosa / Desarrollo de un PCR múltiple para la detección de genes metalo-beta-lactamasa en Pseudomonas aeruginosa

SUMMARY: The appearance of Pseudomonas aeruginosa strains with multi-resistance to antibiotics is a clinical problem of great relevance. The methods for detecting these resistances are laborious and slow, which is a complication when treating patients promptly. In this work, we developed a simple method for simultaneous detection of several carbapenem resistance genes using a multiplex PCR assay. The PCR assay developed, followed by electrophoretic separation of fragments, allows to simultaneously identify the presence of 6 antibiotic resistance genes: bla-VIM (261 bp), bla-IMP (587 bp), bla-SPM (648 bp), bla-GIM-1 (753 bp), bla-NDM-1 (813 bp) and bla-KPC (882 bp). We analyzed 7 clinical isolates of P. aeruginosa obtained in Chile, finding the resistance genes bla-VIM, bla-IMP, bla-SPM, bla-GIM, and bla-NDM in 5 of them. We found a perfect correlation between the detection of various resistance genes by PCR and the results obtained by antibiograms. Interestingly, 2 of the strains possessed 3 different resistance genes simultaneously. Finally, in this work, we found the presence of 3 genes never described before in clinical isolates of P. aeruginosa in Chile (bla-IMP, bla-SPM, and bla-GIM-1). We developed a rapid multiplex PCR test for the simultaneous detection of up to 6 antibiotic resistance genes of the metallo-β-lactamase family in P. aeruginosa.

La aparición de cepas de Pseudomonas aeruginosa con resistencias a diversos antibióticos es un problema clínico de gran relevancia. Los métodos de detección de dichas resistencias son laboriosos y lentos, lo que genera una complicación al momento de tratar a los pacientes oportunamente. En este trabajo desarrollamos un método simple de detección simultánea de varios genes de resistencia a carbapenem, mediante un sistema de PCR múltiple. El ensayo de PCR desarrollado, seguido de una separación electroforética de los amplicones, permite distinguir simultáneamente la presencia de 6 genes de resistencia a antibióticos: bla-VIM (261 pb), bla-IMP (587 pb), bla-SPM (648 pb), bla-GIM-1 (753 pb), bla-NDM-1 (813 pb) y bla-KPC (882 pb). Analizamos 7 aislados clínicos obtenidos en Chile, encontrando en 5 de ellos los genes de resistencia bla-VIM, bla-IMP, bla-SPM, bla-GIM y bla-NDM. Encontramos una perfecta correlación entre la detección de diversos genes de resistencia y los resultados obtenidos mediante antibiogramas. Interesantemente, 2 de las cepas mostraron poseer simultáneamente 3 genes de resistencia distintos. Por último, en este trabajo encontramos la presencia de 3 genes nunca antes descritos en aislados clínicos de P. aeruginosa en Chile (bla-IMP, bla-SPM y bla-GIM-1). Hemos desarrollado un test rápido de PCR múltiple, para la detección simultánea de hasta 6 genes de resistencia a antibióticos de la familia.a de las metallo-b-lactamases en P. aeruginosa.

Absceso en miocardio secundario a neumonía adquirida en la comunidad por Pseudomona aeruginosa en lactante inmunocompetente: reporte de caso / Myocardial abscess secondary to community acquired Pseudomona aeruginosa pneumonia in an immunocompetent infant: case report

La Pseudomona aeruginosa es una causa importante de infecciones asociadas a la atención de la salud y en las neumonías adquiridas en la comunidad, rara vez se identifica como el agente patógeno, siendo estas de progresión rápida y de mal pronóstico. Se trata de un menor de un año de edad inmunocompetente el cual fallece en casa una semana después de una lesión en la planta del pie derecho que según familiares le sacaron "pus", tratado con antinflamatorios y analgésicos. Se le realizó necropsia que evidenció cicatriz en planta de pie derecho sin lesiones traumáticas. Pulmones de consistencia indurada, con adherencias y áreas que impresionan necróticas, asociada a efusión pleural. El estudio histológico reportó un proceso infeccioso pulmonar agudo abscedado que se diseminó por continuidad a tejido cardiaco y en estudios microbiológicos de pulmón y bazo se reportó Pseudomona aeruginosa.

Pseudomona aeruginosa is an important cause of health care-associated infections and in community-acquired pneumonias, it is rarely identified as the pathogenic agent, being of rapid progression and poor prognosis. This is a one-year-old immunocompetent minor who died at home one week after a lesion in the sole of the right foot which, according to family members, caused "pus", treated with anti-inflammatory and analgesic drugs. A necropsy was performed, which showed a scar on the sole of the right foot with no traumatic lesions. Lungs of indurated consistency, with adhesions and areas that appear necrotic, associated with pleural effusion. The histological study reported an abscessed acute pulmonary infectious process that spread by continuity to cardiac tissue and microbiological studies of lung and spleen reported Pseudomona aeruginosa.

Atividade in vitro de extratos e frações de Copernicia prunifera (Arecaceae) contra bactérias de importância clínica em saúde pública / In vitro activity of extracts and fractions of Copernicia prunifera (Arecaceae) against bacteria of clinical importance in public health / Actividad in vitro de extractos y fracciones de Copernicia prunifera (Arecaceae) frente a bacterias de importancia clínica en salud pública

Introdução: O aumento contínuo da resistência bacteriana aos antibióticos convencionais é um problema de importância global. Encontrar produtos como alternativas terapêuticas naturais é essencial. As plantas medicinais possuem uma composição química muito rica, que podem ser estruturalmente otimizadas e processadas em novos antimicrobianos. Objetivo: Avaliar o potencial antibacteriano frente a microrganismos humanos potencialmente patogênicos do extrato etanólico e frações de Copernicia prunifera. Metodologia: A triagem fitoquímica de plantas foi realizada usando métodos de precipitação e coloração e a atividade antibacteriana utilizando o método de difusão em disco e microdiluição em caldo contra cepas padronizadas de Klebsiella pneumoniae, Escherichia coli, Pseudomonas aeruginosa e Staphylococcus aureus. Resultados: A triagem fitoquímica revela a presença de taninos, flavonoides, esteroides, triterpernóides, saponinas e alcaloides. Os extratos etanólico e frações da casca do caule e folhas tiveram atividade inibitória contra S. aureus e K. pneumonie com zona de inibição que variou de 7,0±1,73 a 9,33±0,58 mm pelo método de difusão em disco. Pelo método de microdiluição em caldo os extratos foram satisfatórios somente contra K. pneumoniae (CIM = 125 a 1000 µg/mL) S. aureus, P. aeruginosa e E. coli se mostraram resistentes aos testes (CIM > 1000 µg/mL). Conclusão: Esses resultados fornecem uma base para futuras investigações em modelos in vivo, para que os compostos de C. prunifera possam ser aplicados no desenvolvimento de novos agentes antimicrobianos contra K. pneumoniae.

Introduction: The continuous increase in bacterial resistance to conventional antibiotics is a problem of global importance. Finding products as natural therapeutic alternatives is essential. Medicinal plants have a very rich chemical composition, which can be structurally optimized and processed into novel antimicrobials. Objective: To evaluate the antibacterial potential against potentially pathogenic human microorganisms of the ethanolic extract and fractions of Copernicia prunifera. Methodology: Phytochemical screening of plants was performed using precipitation and staining methods and antibacterial activity using the disk diffusion and broth microdilution method against standardized strains of Klebsiella pneumoniae, Escherichia coli, Pseudomonas aeruginosa and Staphylococcus aureus. Results: Phytochemical screening reveals the presence of tannins, flavonoids, steroids, triterpernoids, saponins and alkaloids. The ethanolic extracts and fractions of stem bark and leaves had inhibitory activity against S. aureus and K. pneumonie with zone of inhibition ranging from 7.0±1.73 to 9.33±0.58 mm by disc diffusion method. By broth microdilution method the extracts were satisfactory only against K. pneumoniae (MIC = 125 to 1000 µg/mL) S. aureus, P. aeruginosa and E. coli were resistant to the tests (MIC > 1000 µg/mL). Conclusion: These results provide a basis for further investigation in in vivo models, so that compounds from C. prunifera can be applied in the development of new antimicrobial agents against K. pneumoniae.

Introducción: El continuo aumento de la resistencia bacteriana a los antibióticos convencionales es un problema de importancia mundial. Es esencial encontrar productos como alternativas terapéuticas naturales. Las plantas medicinales tienen una composición química muy rica, que puede optimizarse estructuralmente y transformarse en nuevos antimicrobianos. Objetivo: Evaluar el potencial antibacteriano frente a microorganismos humanos potencialmente patógenos del extracto etanólico y fracciones de Copernicia prunifera. Metodología: Se realizó el cribado fitoquímico de las plantas mediante los métodos de precipitación y tinción y la actividad antibacteriana mediante el método de difusión en disco y microdilución en caldo frente a cepas estandarizadas de Klebsiella pneumoniae, Escherichia coli, Pseudomonas aeruginosa y Staphylococcus aureus. Resultados: El cribado fitoquímico revela la presencia de taninos, flavonoides, esteroides, triterpernoides, saponinas y alcaloides. Los extractos etanólicos y las fracciones de la corteza del tallo y las hojas presentaron actividad inhibitoria contra S. aureus y K. pneumonie con una zona de inhibición que osciló entre 7,0±1,73 y 9,33±0,58 mm por el método de difusión en disco. Por el método de microdilución en caldo, los extractos sólo fueron satisfactorios frente a K. pneumoniae (CMI = 125 a 1000 µg/mL). S. aureus, P. aeruginosa y E. coli fueron resistentes a las pruebas (CMI > 1000 µg/mL). Conclusiones: Estos resultados proporcionan una base para futuras investigaciones en modelos in vivo, de modo que los compuestos de C. prunifera puedan aplicarse en el desarrollo de nuevos agentes antimicrobianos contra K. pneumoniae.

Prevalence of multi-drug resistant Pseudomonas aeruginosa isolated from selected residential sewages in Dutsin-Ma, Katsina State, Nigeria

The global surge in Multidrug resistant (MDR) bacteria is an issue of great concern. Pseudomonas aeruginosa has been implicated in several nosocomial infections, where it has caused grave complications in immunocompromised patients. This is the first study to report the prevalence of MDR P. aeruginosa isolated from residential sewage in Dutsin-Ma, Katsina State, Nigeria. Pseudomonads count, isolation, biochemical characterization and antibiogram were carried out using standard microbiological procedures. This study examined sixty (60) samples from selected residential sewage in the study site collected at different intervals between July and September 2021. A total of 40 (66.7%) P. aeruginosa were isolated from the analyzed sewage samples. The highest (2.84x104) pseudomonad count was recorded from sewage samples collected from Kadangaru. Pseudomonas aeruginosa isolates from this sample site showed the highest (100%) resistance to cephalosporins (cefuroxime) and nitrofurantoin. Similarly, isolates from Miami area also demonstrated the highest (95%) resistance to a cephalosporin (ceftazidime). All (100%) isolates used in this study showed MDR resistance to tested antibiotics. The occurrence of MDR P. aeruginosa from a residential sewage site that may contaminate drinking water sources in the study area is of public health threat to the inhabitants. Surveillance and molecular epidemiology of antibiotics resistant bacteria are urgently needed in the study area.

Pseudomonas aeruginosa-induced mitochondrial dysfunction inhibits proinflammatory cytokine secretion and enhances cytotoxicity in mouse macrophages in a reactive oxygen species (ROS)-dependent way / 浙江大学学报（英文版）（B辑：生物医学和生物技术）

随着铜绿假单胞菌（铜绿）的耐药性逐年增强，铜绿感染已经成为公共医疗卫生的重点关注问题。线粒体自噬及其介导的线粒体功能障碍在多种细菌感染中已被报道，但线粒体功能障碍在宿主调控铜绿感染中的作用尚不明确。因此，本研究建立铜绿刺激小鼠巨噬细胞感染模型和小鼠急性铜绿感染模型，探讨铜绿是否通过诱导线粒体自噬改变线粒体功能，进而影响宿主免疫炎症反应和细胞毒性，并通过监测生存率和肺组织病理学变化进一步确定线粒体自噬在小鼠铜绿体内感染模型中的作用。结果表明，铜绿引起小鼠腹腔巨噬细胞线粒体功能障碍，并通过线粒体自噬途径清除铜绿刺激引起的活性氧（ROS）累积，从而抑制铜绿引起的促炎性细胞因子分泌并增强细胞毒性。体内实验进一步确认线粒体自噬在铜绿体内感染中的作用。

Characterization and application of several lysis cassettes / 生物工程学报

Lysis is a common functional module in synthetic biology and is widely used in genetic circuit design. Lysis could be achieved by inducing expression of lysis cassettes originated from phages. However, detailed characterization of lysis cassettes hasn't been reported yet. Here, we first adopted arabinose- and rhamnose-inducible systems to develop inducible expression of five lysis cassettes (S105, A52G, C51S S76C, LKD, LUZ) in Escherichia coli Top10. By measuring OD600, we characterized the lysis behavior of strains harboring different lysis cassettes. These strains were harvested at different growth stages, induced with different concentrations of chemical inducers, or contained plasmids with different copy numbers. We found that although all five lysis cassettes could induce bacterial lysis in Top10, lysis behaviors differed a lot at various conditions. We further found that due to the difference in background expression levels between strain Top10 and Pseudomonas aeruginosa PAO1, it was hard to construct inducible lysis systems in strain PAO1. The lysis cassette controlled by rhamnose-inducible system was finally inserted into the chromosome of strain PAO1 to construct lysis strains after careful screen. The results indicated that LUZ and LKD were more effective in strain PAO1 than S105, A52G and C51S S76C. At last, we constructed an engineered bacteria Q16 using an optogenetic module BphS and the lysis cassette LUZ. The engineered strain was capable of adhering to target surface and achieving light-induced lysis by tuning the strength of ribosome binding sites (RBSs), showing great potential in surface modification.

Distribution and Drug Sensitivity Analysis of Pathogenic Bacteria Isolated from Patients in Hematology Department / 中国实验血液学杂志

OBJECTIVE@#To investigate the distribution and drug sensitivity of pathogenic bacteria isolated from patients in hematology department, in order to provide evidence for rational use of antibiotics in clinic.@*METHODS@#The distribution of pathogenic bacteria and drug sensitivity data of patients in the hematology department of The First Affiliated Hospital of Nanjing Medical University from 2015 to 2020 were retrospectively analyzed, and the pathogens isolated from different specimen types were compared.@*RESULTS@#A total of 2 029 strains of pathogenic bacteria were isolated from 1 501 patients in the hematology department from 2015 to 2020, and 62.2% of which were Gram-negative bacilli, mainly Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa, Stenotrophomonas maltophilia and Acinetobacter baumannii. Gram-positive coccus accounted for 18.8%, mainly Coagulase-negative staphylococcus (CoNS) and Staphylococcus aureus. Fungi (17.4%) were mainly candida. The 2 029 strains were mainly isolated from respiratory tract (35.1%), blood (31.8%) and urine (19.2%) specimens. Gram-negative bacilli were the main pathogenic bacteria in different specimen types (>60%). K. pneumoniae, S. maltophilia and A. baumannii were the most common pathogens in respiratory specimens, E. coli, CoNS, K. pneumoniae and P. aeruginosa were common in blood samples, and E. coli and Enterococcus were most common in urine samples. Enterobacteriaceae had the highest susceptibility to amikacin and carbapenems (>90.0%), followed by piperacillin/tazobactam. P. aeruginosa strains had high sensitivity to antibiotics except aztreonam (<50.0%). The susceptibility of A. baumannii to multiple antibiotics was less than 70.0%. The antimicrobial resistance rates of E. coli and K. pneumoniae in respiratory tract specimens were higher than those in blood specimens and urine specimens.@*CONCLUSION@#Gram-negative bacilli are the main pathogenic bacteria isolated from patients in hematology department. The distribution of pathogens is different in different types of specimens, and the sensitivity of each strain to antibiotics is different. The rational use of antibiotics should be based on different parts of infection to prevent the occurrence of drug resistance.

Development and application of a rapid gene manipulating toolbox for Pseudomonas aeruginosa / 生物工程学报

Manipulation of genes, including knock-out or knock-in, replacement of gene elements (such as promoters), fusion with a fluorescent protein gene, and construction of in situ gene reporter, is required in most of the biotechnological laboratories. The widely used gene manipulating methods based on two-step allelic exchange are cumbersome in terms of constructing plasmids, transforming and screening. In addition, the efficiency of using this method for long fragment knockout is low. To simplify the process of gene manipulation, we constructed a minimized integrative vector pln2. When a gene needs to be inactivated, an internal fragment of the target gene (non-frameshift) is cloned into the pln2 plasmid. Once the single-crossover recombination between genome and the constructed plasmid occurs, the endogenous gene is segmented by the plasmid backbone and thus inactivated. We developed a toolbox based on pln2 that can be used for different genomic operation mentioned above. With the help of this toolbox, we successfully knocked out large fragments of 20-270 kb.

Functional synergism of pyoverdine and the S-type pyocins of Pseudomonas aeruginosa / 生物工程学报

Pyocin S2 and S4 in Pseudomonas aeruginosa use the same uptake channels as the pyoverdine does in bacteria, indicating a possible connection between them. In this study, we characterized the single bacterial gene expression distribution of three S-type pyocins (Pys2, PA3866, and PyoS5) and examined the impact of pyocin S2 on bacterial uptake of pyoverdine. The findings demonstrated that the expression of the S-type pyocin genes was highly differentiated in bacterial population under DNAdamage stress. Moreover, exogenous addition of pyocin S2 reduces the bacterial uptake of pyoverdine so that the presence of pyocin S2 prevents the uptake of environmental pyoverdine by non-pyoverdine synthesizing 'cheaters', thereby reducing their resistance to oxidative stress. Furthermore, we discovered that overexpression of the SOS response regulator PrtN in bacteria significantly decreased the expression of genes involved in the synthesis of pyoverdine, significantly decreasing the overall synthesis and exocytosis of pyoverdine. These findings imply a connection between the function of the iron absorption system and the SOS stress response mechanism in bacteria.

Constructions and advances of animal models of Pseudomonas aeruginosa infection / 中华预防医学杂志

Pseudomonas aeruginosa (P. aeruginosa) is an opportunistic pathogenic bacterium with complex pathogenesis and drug resistance mechanisms. It has high morbidity and mortality and can cause acute and chronic infections in immunocompromised individuals, with lung infections, wound infections, and bloodstream infections being the most common. The animal infection model of P. aeruginosa is of great value for in-depth research on the pathogenicity, drug resistance, and therapeutic measures of P. aeruginosa by simulating the pathways of human bacterial infections. This article firstly summarizes the selection, anesthesia, and disposal of experimental animals in the construction of animal models of P. aeruginosa infection, and then reviews the methods of construction, model evaluation, and applications of animal models of P. aeruginosa pulmonary infection, wound infection, and bloodstream infection, in order to provide a reference for scientific research related to P. aeruginosa infectious diseases.

A case of green nail syndrome secondary to P. aeruginosa and C. parapsilosis treated with topical nadifloxacin and oral fluconazole in a 31-year-old Filipino female

Introduction@#Pseudomonas aeruginosa is an opportunistic, gram-negative bacillus that can contaminate skin or open wounds to cause skin infections that are historically difficult to manage. The pathogenesis of green nail syndrome (GNS) begins with hyperhydration (occlusion, sweating, maceration) or destruction (microtrauma, dermatitis) of the epidermis thus disrupting the physical barrier, leading to the colonization and proliferation of P. aeruginosa. This case explores the off-label use of nadifloxacin, a fluoroquinolone approved for acne and bacterial skin infections in some countries, to treat a case of GNS. @*Case Report@#This is a case of a 31-year-old Filipino female who presented with a four-month history of green discoloration of the lateral portion of the right thumbnail with a medical history of antiphospholipid antibody syndrome and rheumatoid arthritis. Clinical examination showed a dystrophic thumbnail with greenish discoloration, erythema and swelling around the base of the cuticle, and distal onycholysis. Laboratory findings revealed co-infection of P. aeruginosa and Candida parapsilosis. The patient was effectively treated with topical nadifloxacin and oral fluconazole.@*Conclusion@#This case highlights the possibility of fungal and polymicrobial infections in GNS and suggests a novel, easy-to-use, and cost-effective alternative treatment to GNS secondary to P. aeruginosa in the form of topical nadifloxacin.

Evaluation of anti-quorum sensing potential of Averrhoa bilimbi (Kamias) against Pseudomonas aeruginosa ATCC 27853

BACKGROUND AND OBJECTIVE@#Many opportunistic and nosocomial pathogens like Pseudomonas aeruginosa are very reliant on a bacterium-to-bacterium communication system called quorum sensing (QS). Without the aforementioned process, gene expressions associated with virulence factors will not be produced. In this study, the sub-inhibitory concentrations (sub-MICs) of methanolic leaf extract and obtained fractions from Averrhoa bilimbi (kamias) were screened for ability to inhibit quorum sensing-controlled phenotypes of P. aeruginosa ATCC 27853.@*METHODOLOGY@#A. bilimbi crude extract was fractionated through liquid-liquid extraction, producing four (4) fractions: hexane fraction, dichloromethane (DCM) fraction, ethyl acetate (EtOAc) fraction, and water (H2O) fraction. Among the sub-MICs obtained from resazurin-based fluorimetric microtiter assay, only 50 μg/mL was utilized in evaluating the anti-QS properties of crude extract and fr@*RESULTS@# In the swarming motility assay, hexane fraction (9.39 mm ± 0.67) and DCM fraction (10.82 mm ± 0.95) displayed restriction in the treated P. aeruginosa ATCC 27853 swarms against the control (16.20 mm ± 2.55). In the anti-pyocyanin production assay, hexane fraction exhibited an inhibition of 42.66 % ± 12.94. TLC analysis and phytochemical screening revealed that hexane fraction contains steroids, terpenes, triterpenes, and glycolipids; and DCM fraction contains cardiac glycosides, triterpenoids, terpenes, triterpenes, steroids, alkaloids, and glycolipids.@*CONCLUSION@#Hexane and DCM fractions obtained from A. bilimbi significantly inhibited swarming of P. aeruginosa ATCC 27853 while none of the extracts were able to significantly inhibit pyocyanin formation of P. aeruginosa ATCC 27853.

Clinical Characteristics and Survival Analysis of Carbapenem-Resistant Pseudomonas Aeruginosa Colonized or Infected Patients with Hematological Disorders / 中国实验血液学杂志

OBJECTIVE@#To observe the clinical characteristics and impact on mortality of carbapenem-resistant Pseudomonas aeruginosa (CRPA) colonized or infected patients with hematological disorders in order to provide evidence for the prevention and treatment of CRPA.@*METHODS@#The patients who were colonized or infected with CRPA in the Department of Hematology of The First Affiliated Hospital of Zhejiang Chinese Medical University from January 2020 to March 2021 were selected as the research subjects, the clinical data such as hospitalization time, primary disease treatment regimen, granulocyte count, previous infection and antibiotic regimen of these patients were analyzed, meanwhile, antibiotic regimen and efficacy during CRPA infection, 30-day and long-term survival were also analyzed.@*RESULTS@#A total of 59 patients were included in this study, and divided into CRPA infection group (43 cases) and CRPA colonization group (16 cases). Univariate logistic regression analysis showed that ECOG score (P =0.003), agranulocytosis (P <0.001), and exposure to upper than 3rd generations of cephalosporins and tigecycline within 30 days (P =0.035, P =0.017) were the high-risk factors for CRPA infection. Multivariate logistic regression analysis showed that ECOG score of 3/4 ( OR=10.815, 95%CI: 1.260-92.820, P =0.030) and agranulocytosis ( OR=13.82, 95%CI: 2.243-85.176, P =0.005) were independent risk factors for CRPA infection. There was a statistically significant difference in cumulative survival rate between CRPA colonization group and CRPA infection group ( χ2=14.134, P < 0.001). Kaplan-Meier survival analysis showed that the influencing factors of 30-day survival in patients with CRPA infection were agranulocytosis (P =0.022), soft tissue infection (P =0.03), and time of hospitalization before CRPA infection (P =0.041). Cox regression analysis showed that agranulocytosis was an independent risk factor affecting 30-day survival of patients with CRPA infection (HR=3.229, 95%CI :1.093-3.548, P =0.034).@*CONCLUSIONS@#Patients with hematological disorders have high mortality and poor prognosis after CRPA infection. Bloodstream infection and soft tissue infection are the main causes of death. Patients with high suspicion of CRPA infection and high-risk should be treated as soon as possible.

Evaluation of antibacterial activity of vitamin C against human bacterial pathogens / Avaliação da atividade antibacteriana da vitamina C contra patógenos bacterianos humanos

Now a day’s multidrug resistance phenomenon has become the main cause for concern and there has been an inadequate achievement in the development of novel antibiotics to treat the bacterial infections. Therefore, there is an unmet need to search for novel adjuvant. Vitamin C is one such promising adjuvant. The present study was aimed to elucidate the antibacterial effect of vitamin C at various temperatures (4°C, 37°C and 50°C) and pH (3, 8, and 11), against Gram-positive and Gram-negative bacteria at various concentrations (5-20 mg/ml) through agar well diffusion method. Growth inhibition of all bacterial strains by vitamin C was concentration-dependent. Vitamin C significantly inhibited the growth of Gram-positive bacteria: Bacillus licheniformis (25.3 ± 0.9 mm), Staphylococcus aureus (22.0 ± 0.6 mm), Bacillus subtilis (19.3 ± 0.3 mm) and Gram-negative bacteria: Proteus mirabilis (27.67 ± 0.882 mm), Klebsiella pneumoniae (21.33±0.9 mm), Pseudomonas aeruginosa (18.0 ± 1.5 mm) and Escherichia coli (18.3 ± 0.3 mm). The stability of vitamin C was observed at various pH values and various temperatures. Vitamin C showed significant antibacterial activity at acidic pH against all bacterial strains. Vitamin C remained the stable at different temperatures. It was concluded that vitamin C is an effective and safe antibacterial agent that can be used in the future as an adjunct treatment option to combat infections in humans.

Agora, a resistência antimicrobiana de um dia em patógenos aos antibióticos tornou-se a principal causa de preocupação e houve uma realização inadequada no desenvolvimento de novos antibióticos para tratar infecções bacterianas. Portanto, há uma necessidade de pesquisar um novo adjuvante, e a vitamina C é um desses adjuvantes promissores. O objetivo do presente estudo foi elucidar o efeito antibacteriano da vitamina C em diferentes temperaturas (4 °C, 37 °C e 50 °C) e pH (3, 8 e 11), contra Gram-positivos e Gram-cepas bacterianas negativas em várias concentrações (5-20 mg / ml) através do método de difusão em ágar bem. A inibição do crescimento de todas as cepas bacterianas pela vitamina C era dependente da concentração. A vitamina C inibiu significativamente o crescimento de bactérias Gram-positivas: Bacillus licheniformis (25,3 ± 0,9 mm), Staphylococcus aureus (22,0 ± 0,6 mm), Bacillus subtilis (19,3 ± 0,3 mm) e bactérias Gram- negativas: Proteus mirabilis (27,7 ± 0,9 mm), Klebsiella pneumoniae (21,3 ± 0,9 mm), Pseudomonas aeruginosa (18,0 ± 1,5 mm) e Escherichia coli (18,3 ± 0,3 mm). A estabilidade da vitamina C foi observada em vários valores de pH e várias temperaturas. A vitamina C mostrou atividade antibacteriana significativa em pH ácido contra todas as cepas bacterianas. A estabilidade da vitamina C permaneceu nas mesmas diferentes temperaturas (4 °C, 37 °C e 50 °C). Concluímos que a vitamina C é um agente antibacteriano eficaz e seguro que pode ser usado no futuro como uma opção de tratamento auxiliar para combater infecções em humanos, pois pode apoiar o sistema imunológico diretamente.

Extratos hidroetanólicos de canela (Cinnamomum verum) e romã (Punica granatum L) promovem ação antibacteriana frente cepas resistentes a antibióticos de Acinetobacter baumannii e Pseudomonas aeruginosa / Cinnamon (Cinnamomum verum) and pomegranate (Punica granatum L) hydroethanolic extracts promote antibacterial action against antibiotic-resistant strains of Acinetobacter baumannii and Pseudomonas aeruginosa

A resistência bacteriana tem aumentado progressivamente no mundo, assim, há necessidade de novas opções de tratamentos. A fitoterapia tem ganhado notoriedade para combater infecções, principalmente as causadas por bactérias resistentes aos antibacterianos disponíveis. Diante do exposto, o presente estudo teve como objetivo preparar e analisar a composição fitoquímica e a ação antibacteriana dos extratos hidroetanólicos de canela (EHC) e romã (EHR) isolados e associados frente culturas planctônicas e biofilmes de cepas padrão e clínicas de Acinetobacter baumannii e Pseudomonas aeruginosa, além disso, analisar a ação citotóxica dos extratos em queratinócitos humanos (HaCat). Para isso, os EHC e EHR foram preparados e quantificado o teor de sólidos solúveis. Posteriormente, foi quantificado o teor de flavonoides e fenóis totais, análise antioxidante por meio da redução do radical 2,2'-difenil-1-picrilhidrazila (DPPH), e a fitoquímica por cromatografia líquida (HPLC). Em relação a ação antibacteriana dos extratos, foi aplicado o teste de microdiluição em caldo (CLSI ­ M7-A9) e a ação sinérgica realizada por meio do ensaio de checkerboard. As concentrações mais efetivas foram analisadas sobre biofilmes em formação (prevenção) e biofilmes formados (tratamento de 24 h), e quantificada a viabilidade por meio do teste colorimétrico MTT. Para avaliar a citotoxidade, os tratamentos foram aplicados sobre cultura celular de HaCat por 24 h e analisados por meio do teste colorimétrico MTT. A análise estatística foi realizada com 5% de significância (p<0.05), analisados pelo método ANOVA complementado pelo Teste de Tukey. Os resultados demonstraram que os EHC e EHR possuem ação antioxidante e presença de fitocompostos. Os extratos apresentaram ação antibacteriana para todas as cepas avaliadas, quando os mesmos foram associados, obteve-se concentrações sinérgicas para as cepas clínicas de A. baumannii. Em relação a ação antibiofilme, o EHC inibiu a formação em 95% e EHR em 96% do biofilme de #Ab 1, enquanto a cepa #Pa 2 teve 92% e 93% de inibição quando em contato com EHC e EHR, respectivamente. Após tratamento de 24 h em biofilmes formados, as reduções da viabilidade foram de 72% para as cepas #Ab 2 e #Ab 3 quando em contato com o EHC, já EHR inibiu em 83% a viabilidade da cepa #Ab ATCC. Para P. aeruginosa (#Pa 2), as reduções da viabilidade foram de 84% e 88,5% quando tratados com EHC e EHR, respectivamente. A avaliação da citotoxicidade em HaCat demonstrou que após tratamentos com diferentes concentrações dos extratos a viabilidade celular se manteve acima de 70% em todos os grupos. Diante disso, conclui-se que os EHC e EHR apresentam importante ação antioxidante e antibacteriana, tanto em culturas planctônicas quanto em biofilmes, e não apresentaram efeitos citotóxicos na faixa de concentração testada. (AU)

Bacterial resistance has progressively increased in the world, thus, there is a need for new treatment options. Phytotherapy has gained notoriety for fighting infections, mainly those caused by bacteria resistant to available antibacterials. In view of the above, the present study aimed to prepare and analyze the phytochemical composition and antimicrobial action of hydroethanolic extracts of cinnamon (EHC) and pomegranate (EHR) isolated and associated against planktonic cultures and biofilms of standard and clinical strains of Acinetobacter baumannii and Pseudomonas aeruginosa, in addition, analyze the cytotoxic action of the extracts on human keratinocytes (HaCat). For this, the EHC and EHR were prepared and the soluble solids content was quantified. Subsequently, the content of flavonoids and total phenols, antioxidant analysis through the reduction of the radical 2,2'-diphenyl1-picrylhydrazyl (DPPH), and phytochemistry by liquid chromatography (HPLC) were quantified. Regarding the antimicrobial action of the extracts, the broth microdilution test (CLSI ­ M7-A9) was applied and the synergistic action was performed through the checkerboard test. The most effective concentrations were analyzed on forming biofilms (prevention) and formed biofilms (24 h treatment), and viability was quantified using the MTT colorimetric test. To evaluate the cytotoxicity, the treatments were applied on HaCat cell culture for 24 h and analyzed using the MTT colorimetric test. Statistical analysis was performed with 5% significance (p<0.05), analyzed by the ANOVA method complemented by the Tukey test. The results showed that the EHC and EHR have antioxidant action and presence of phytocompounds. The extracts showed antibacterial action for all evaluated strains, when they were associated, synergistic concentrations were obtained for the clinical strains of A. baumannii. Regarding the antibiofilm action, EHC inhibited formation by 95% and EHR by 96% of the #Ab 1 biofilm, while the #Pa 2 strain had 92% and 93% inhibition when in contact with EHC and EHR, respectively. After 24 h treatment in formed biofilms, viability reductions were 72% for strains #Ab 2 and #Ab 3 when in contact with EHC, whereas EHR inhibited the viability of strain #Ab ATCC by 83%. For P. aeruginosa (#Pa 2), viability reductions were 84% and 88.5% when treated with EHC and EHR, respectively. The evaluation of cytotoxicity in HaCat showed that after treatments with different concentrations of extracts, cell viability remained above 70% in all groups. Therefore, it is concluded that EHC and EHR have important antioxidant and antibacterial action, both in planktonic cultures and in biofilms, and did not show cytotoxic effects in the tested concentration range. (AU)

Ação antimicrobiana e antibiofilme dos extratos combinados de canela e própolis sobre cepas clínicas de Acinetobacter baumannii e Pseudomonas aeruginosa multirresistentes / Antimicrobial and antibiofilm action of combined extracts of cinnamon and propolis on multiresistant clinical strains of Acinetobacter baumannii and Pseudomonas aeruginosa

Os microrganismos resistentes a diferentes classes de agentes antimicrobianos têm se tornado cada vez mais comuns e atualmente são denominados como multirresistentes. Nos hospitais, tais microrganismos apresentam maior perigo, pois são causadores de infecções nosocomiais e a higienização bucal deficiente dos pacientes internados pode tornar a cavidade bucal um sítio para proliferação desses microrganismos multirresistentes. Diante do exposto, novos compostos com ação antimicrobiana precisam ser estudados. O objetivo deste estudo foi avaliar quimicamente o extrato hidroalcóolico de própolis verde de Baccharis dracunculifolia e de Cinnamomum verum (canela) que foram obtidos a partir da extração da matériaprima, analisar a atividade antimicrobiana e antibiofilme dos extratos isolados e combinados contra quatro cepas clínicas multirresistentes de Pseudomonas aeruginosa e Acinetobacter baumannii e verificar a citotoxicidade dos produtos vegetais in vitro em linhagem celular de queratinócitos humanos (HaCat). Para tanto, os extratos vegetais foram preparados a partir da matéria-prima da canela em casca e da própolis bruta. Em seguida, foram caracterizados quimicamente por cromatografia líquida de alta eficiência (HPLC-DAD) para identificação dos principais compostos e a análise do teor de sólidos solúveis dos extratos vegetais também foi realizada. Para avaliação antimicrobiana, foram performados o teste de microdiluição em caldo de acordo com a Clinical and Laboratory Standards Institute (CLSI) e a análise de Checkerboard, para avaliar o efeito combinado dos extratos. A atividade antibiofilme dos extratos combinados foi realizada por meio do teste de MTT, no qual diferentes tempos de contato (5 e 30 min) e diferentes modalidades (inibição na formação do biofilme bacteriano e erradicação do biofilme bacteriano já formado) foram testadas. Para ação citotóxica, as células foram cultivadas em meio DMEM e semeadas na placa de 96 poços. Após aderência inicial, aplicou-se os extratos em diferentes concentrações baseadas nas análises microbiológicas para avaliação da viabilidade celular por meio do teste de MTT. Os dados foram analisados por ANOVA e teste de Tukey, ou Kruskal-Wallis e Dunn, considerando um nível de significância de 5%. Os compostos identificados no extrato de própolis verde de B. dracunculifolia foram ácido clorogênico, derivado do ácido cinâmico e apigenina. O aldeído cinâmico foi o principal composto identificado no extrato de C. verum. Os extratos vegetais apresentaram ação bactericida sobre todas as cepas analisadas e, quando combinados, os extratos atuaram de modo aditivo e algumas combinações sinérgicas foram encontradas. O protocolo de inibição da formação do biofilme promoveu percentuais de redução superiores quando comparado ao protocolo de erradicação. Valores expressivos de 83,86% (p < 0,05) de inibição da formação de biofilme de uma cepa clínica de A. baumannii e 89,31% (p < 0,05) de inibição em uma cepa clínica de P. aeruginosa foram encontrados com a aplicação dos extratos combinados. A atuação dos produtos vegetais foi estatisticamente semelhante a atuação da clorexidina 0,12%. Em conclusão, os extratos de própolis verde e canela na forma isolada ou combinada apresentaram ação antimicrobiana e antibiofilme sobre cepas clínicas de A. baumannii e P. aeruginosa multirresistentes. Dessa forma, os produtos vegetais são promissores agentes antissépticos para futuras formulações odontológicas. (AU)

Microorganisms resistant to different classes of antimicrobial agents have become increasingly common and are currently called multidrug resistant. In hospitals, such microorganisms are more dangerous, as they cause nosocomial infections and poor oral hygiene in hospitalized patients can make the oral cavity a site for the proliferation of these multiresistant microorganisms. Given the above, new compounds with antimicrobial action need to be studied. The objective of this study was to chemically evaluate the hydroalcoholic extract of green propolis from Baccharis dracunculifolia and Cinnamomum verum (cinnamon) that were obtained from the extraction of the raw material, to analyze the antimicrobial and antibiofilm activity of the isolated and combined extracts against four clinical strains multiresistant strains of Pseudomonas aeruginosa and Acinetobacter baumannii and verify the cytotoxicity of plant products in vitro in human keratinocyte cell lineage (HaCat). For this purpose, plant extracts were prepared from raw cinnamon bark and raw propolis. Then, they were chemically characterized by high performance liquid chromatography (HPLC-DAD) to identify the main compounds and the analysis of the soluble solids content of the plant extracts was also performed. For antimicrobial evaluation, the broth microdilution test according to the Clinical and Laboratory Standards Institute (CLSI) and the Checkerboard analysis were performed to evaluate the combined effect of the extracts. The antibiofilm activity of the combined extracts was performed using the MTT test, in which different contact times (5 and 30 min) and different modalities (inhibition of bacterial biofilm formation and eradication of already formed bacterial biofilms) were tested. For cytotoxic action, cells were cultured in DMEM medium and seeded in the 96-well plate. After initial adhesion, the extracts were applied at different concentrations based on microbiological analyzes to assess cell viability through the MTT test. Data were analyzed by ANOVA and Tukey's test, or Kruskal-Wallis and Dunn, considering a significance level of 5%. The compounds identified in the green propolis extract of B. dracunculifolia were chlorogenic acid, cinnamic acid derivative and apigenin. Cinnamic aldehyde was the main compound identified in the C. verum extract. The plant extracts showed bactericidal action on all strains analyzed and, when combined, the extracts acted additively and some synergistic combinations were found. The biofilm formation inhibition protocol promoted higher reduction percentages when compared to the eradication protocol. Significant values of 83.86% (p < 0.05) inhibition of biofilm formation in a clinical strain of A. baumannii and 89.31% (p < 0.05) inhibition in a clinical strain of P. aeruginosa were found with the application of the combined extracts. The performance of plant products was statistically similar to the performance of 0.12% chlorhexidine. In conclusion, extracts of green propolis and cinnamon, in isolated or combined form, showed antimicrobial and antibiofilm action on multiresistant clinical strains of A. baumannii and P. aeruginosa. Thus, plant products are promising antiseptic agents for future dental formulations. (AU)

Ação antimicrobiana de extratos de gengibre (Zingiber officinale) e quilaia (Quillaja saponaria) isolados e associados sobre Pseudomonas aeruginosa resistente a antibióticos / Antimicrobial action of isolated and associated extracts of ginger (Zingiber officinale) and quilaia (Quillaja saponaria) on antibiotic-resistant Pseudomonas aeruginosa

Extratos de plantas têm demonstrado diversos efeitos positivos para a saúde, incluindo ação antimicrobiana, no entanto, o uso clínico da fitoterapia ainda é discreto, de modo que mais estudos sobre os efeitos benéficos do sinergismo farmacológico de extratos poderiam contribuir para sua aplicação terapêutica. O objetivo deste estudo foi avaliar os efeitos dos extratos glicólicos de gengibre (EG) e quilaia (EQ) isolados e em associação sobre 7 cepas clínicas de Pseudomonas aeruginosa e uma cepa padrão em forma planctônica e biofilmes monotípicos. Para a análise antimicrobiana sobre cultura planctônica foram feitos testes para determinação de Concentração Inibitória Mínima (CIM) e Concentração Microbicida Mínima (CMM) (CLSI, M07-A9) dos extratos isolados, além do Índice de Concentração Inibitória Fracionada (ICIF) e do Índice de Concentração Microbicida Fracionada (ICMF) para os extratos combinados. A análise estatística foi feita com método ANOVA e teste de Tukey para dados com distribuição normal e Kruskall-Wallis com Teste de Comparação Múltipla de Dunn para dados sem distribuição normal (significância de 5%). Para cepa padrão foram determinadas CIM igual a 3,12 mg/mL e CMM igual a 6,25 mg/mL para ambos os extratos. Para cepas clínicas as CIM do EG foram 3,12 ou 6,25 mg/mL e de EQ 1,56 ou 3,12 mg/mL, enquanto os valores de CMM foram de 6,25 mg/mL para EG e de 1,56, 3,12 ou 6,25 mg/mL para EQ. Os resultados de ICIF indicaram 15 associações sinérgicas e 4 associações aditivas dos extratos contra a cepa padrão e, dentre cepas clínicas, foram obtidos 15 resultados aditivos. A partir dos resultados de ICMF foram identificadas 6 associações sinérgicas e 1 associação aditiva contra a cepa padrão, além de 8 associações com efeito aditivo contra cepas clínicas. A partir dos resultados de testes em culturas planctônicas foi avaliada a ação antibiofilme sobre as cepas em que foram observadas reduções de viabilidade de 36,7 e 34% para o EG (50 e 25 mg/mL) e 51,3 e 51,4% para EQ (25 e 12,5 mg/mL) contra cepa padrão. As reduções em cepas clínicas variaram de 43 a 73% com EG e de 36 a 79% para EQ. As associações dos extratos promoveram reduções de viabilidade de 8 a 35% contra 5 das 7 cepas clínicas. Conclui-se que os extratos glicólicos de gengibre e quilaia apresentam ação antimicrobiana de forma isolada e combinados com efeito aditivo sobre a forma planctônica de cepas clínicas resistentes de P. aeruginosa. De forma isolada, os extratos apresentaram importante ação preventiva na formação dos biofilmes dessas cepas, podendo ser considerados potenciais fitoterápicos com aplicações terapêuticas para o combate das infecções por P. aeruginosa. (AU)

Plant extracts have demonstrated several positive health effects, including antimicrobial action, however, the clinical use of phytotherapy is still discreet, so that more studies on the beneficial effects of pharmacological synergism of extracts could contribute to its therapeutic application. The aim of this study was to evaluate the effects of glycolic extracts of ginger (EG) and quilaia (EQ) alone and in combination on 7 clinical strains of Pseudomonas aeruginosa and a standard strain in planktonic form and monotypic biofilms. For the antimicrobial analysis on planktonic culture, tests were performed to determine the Minimum Inhibitory Concentration (MIC) and Minimum Microbicidal Concentration (MMC) (CLSI, M07-A9) of the isolated extracts, in addition to the Fractional Inhibitory Concentration Index (FICI) and the Fractionated Microbicidal Concentration Index (FICM) for the combined extracts. Statistical analysis was performed using the ANOVA method and Tukey's test for data with normal distribution and Kruskall-Wallis with Dunn's Multiple Comparison Test for data without normal distribution (5% significance). For the standard strain, MIC were determined equal to 3.12 mg/mL and MMC equal to 6.25 mg/mL for both extracts. For clinical strains the MIC of EG were 3.12 or 6.25 mg/mL and 1.56 or 3.12 mg/mL of EQ, while the MMC values were 6.25 mg/mL for EG and 1.56, 3.12 or 6.25 mg/ml for EQ. The FICI results indicated 15 synergistic and 4 additive associations of the extracts against the standard strain and, among clinical strains, 15 additive results were obtained. From the FICM results, 6 synergistic and 1 additive association against the standard strain were identified, in addition to 8 associations with additive effect against clinical strains. Based on the results of tests on planktonic cultures, the antibiofilm action were evaluated on the strains in which viability reductions of 36 and 34% were observed for EG (50 and 25 mg/mL) and 51% were observed for EQ (25 and 12, 5 mg/mL) against the standard strain. Reductions in clinical strains ranged from 43 to 73% with EG and from 36 to 79% for EQ. Associations of extracts promoted viability reductions of 8 to 35% against 5 out of 7 clinical strains. It is concluded that the glycolic extracts of ginger and quilaia have antimicrobial action in isolation and combined with additive effect on the planktonic form of resistant clinical strains of P. aeruginosa. Isolated, the extracts showed an important preventive action in the formation of biofilms of these strains and may be considered potential herbal medicines with therapeutic applications to combat P. aeruginosa infections. (AU)