Investigation of Antimicrobial Effect of Berberine on Ciprofloxacin and Imipenem Resistance Acinetobacter baumannii Isolated from Hamadan Hospitals

Mahmoudi, Hassan; Zare Fahim, Nayreh; Alikhani, Mohammad Yousef; Shokoohizadeh, Leili

doi:10.30699/ijmm.14.1.44

year 14, Issue 1 (January - February 2020) Iran J Med Microbiol 2020, 14(1): 44-54 | Back to browse issues page

‎ 10.30699/ijmm.14.1.44

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Mahmoudi H, Zare Fahim N, Alikhani M Y, Shokoohizadeh L. Investigation of Antimicrobial Effect of Berberine on Ciprofloxacin and Imipenem Resistance Acinetobacter baumannii Isolated from Hamadan Hospitals. Iran J Med Microbiol 2020; 14 (1) :44-54
URL: http://ijmm.ir/article-1-957-en.html

Investigation of Antimicrobial Effect of Berberine on Ciprofloxacin and Imipenem Resistance Acinetobacter baumannii Isolated from Hamadan Hospitals

Hassan Mahmoudi¹

, Nayreh Zare Fahim¹

, Mohammad Yousef Alikhani²

, Leili Shokoohizadeh

1- Student Research Committee, Hamadan University of Medical Sciences, Hamadan, Iran
2- Department of Medical Microbiology, Faculty of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran
3- Department of Medical Microbiology, Faculty of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran , leilishokoohizadeh@gmail.com

Keywords: Acinetobacter baumannii, Ciprofloxacin, Imipenem, Berberine

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Introduction

Acinetobacter baumannii, is a crucial opportunistic bacterium and common cause of various nosocomial infections such as pneumonia, bacteremia, surgical wound infections, secondary meningitis, and urinary tract infections. One of the problems with A. baumannii is the emergence of multidrug resistance (MDR) strains (1). Different mechanisms cause antibiotic resistance of A. baumannii, including the production of beta-lactamase enzymes, aminoglycoside-modifying enzymes, and increased expression of efflux pumps. One way to deal with the antibiotic resistance in bacteria is to use medicinal herbs instead of antibiotics. Among the benefits of using medicinal herbs are fewer side effects as well as reduced risk of resistance to these compounds. Many studies have investigated the therapeutic and useful effects of medicinal plants and their derivatives on bacteria. Berberine has antibacterial properties against many bacteria, including Escherichia coli, Brucella abortus, Staphylococcus aureus, Pseudomonas aeruginosa, and some fungi. Berberine, as a plant derivative, is a natural alkaloid found in the roots, and rhizomes of Barberry (Berberis vulgaris) and studies have shown that it has therapeutic and antioxidant properties (2, 3). Given the importance of treatment for nosocomial infections caused by A. baumannii, the availability of Barberry vulgaris and its oral and therapeutic use, this study aimed to evaluate the antibacterial effect of berberine on imipenem and ciprofloxacin- resistant isolates of A. baumannii.

Materials and Methods

Collection of Clinical Isolates
This research was approved by the Ethics Committee in Research of Hamadan University of Medical Sciences under the specific code of ID IR.UMSHA.REC.1397.238. A total of 70 clinical isolates of A. baumannii were collected from sputum, bronchoalveolar lavage, and endotracheal aspirate specimens of patients admitted to ICU for nine months in 2018, from three educational hospitals of Hamadan University of Medical Sciences. A. baumannii isolates were detected using various biochemical and microbiological tests (4).

Antimicrobial Susceptibility of Acinetobacter baumannii Isolates to Berberine
Berberine was prepared as berberine hydrochloride powder (Sigma Co., Germany). Berberine solution was made in a 1 mg/mL initial solution in dimethyl sulfoxide (DMSO). Ten microliters of this solution were inoculated on Blank paper disks and then placed on a fresh culture of A. baumannii comparable to 0.5 McFarland standard, and incubated at 37°C for 24 h and the effect of berberine was investigated as growth inhibition zones around disks (5).

Antimicrobial Susceptibility Testing
Antimicrobial susceptibility of A. baumannii isolates to imipenem (10 µg) and ciprofloxacin (5 µg) (Mast Co, UK) was determined, by disk diffusion method according to Clinical & Laboratory Standards Institute (CLSI 2017).

Determination of MICs of Berberine and Imipenem and Ciprofloxacin
Minimum Inhibitory Concentration (MIC) of imipenem and ciprofloxacin was determined by broth micro-dilution method in 96-well microplates according to standard CLSI protocol (6). Dilution serials of 0.125 µg/mL to 256 µg/mL were prepared from berberine, imipenem, and ciprofloxacin. 100 µL of bacterial suspension was added to the wells. The microplates were then incubated at 37°C for 24 h. Standard strains of P. aeruginosa ATCC 27853 and E. coli ATCC 25922 were used as control strains.

Results

Frequency of A. baumannii Isolates
In this study, 70 (28.1%) A. baumannii isolates were isolated from 249 positive cultures of respiratory tracts of patients in ICUs. The highest rate of isolation of A. baumannii was from endotracheal aspirate samples (57.14%, n=40) and the lowest rate was from Bronchoalveolar Lavage samples (17.14%, n=12).

Ciprofloxacin and Imipenem Resistance Rates
Antibiogram results showed that high level resistance to ciprofloxacin and imipenem; 97.4% and 94.7%, respectively.

Imipenem and Ciprofloxacin MICs
Minimum Inhibitory Concentration (MIC) was determined for all clinical isolates (70 isolates) resistant to imipenem and ciprofloxacin by broth microdilution. The MIC values of the strains were committed from 8 to 28 µg/mL. Results showed 94.7% of clinical isolates were resistant to imipenem. MIC values of ciprofloxacin-resistant isolates were 4 to 32 µg/mL and 97.4% of isolates were resistant to ciprofloxacin (Table 1).

Antibacterial Effect of Berberine
The antibacterial effect of berberine was evaluated by the disk diffusion method, and the mean inhibition zone around the berberine disks showed the antibacterial effect of berberine on A. baumannii isolates.

MIC of Imipenem in Combination with Berberine
The MIC of Berberine and imipenem alone and in combination with berberine (50% imipenem and 50% berberine) was performed on imipenem-resistant strains by broth microdilution method. The combination of berberine and imipenem reduced the MIC levels of imipenem in (60%, n=42) of isolates and decreased the MIC between zero to 2-fold (Table 2).

MIC of Ciprofloxacin in Combination with Berberine
The MIC of Berberine and ciprofloxacin alone and in combination (50% berberine and 50% ciprofloxacin) were determined by broth microdilution on ciprofloxacin-resistant isolates. The combination of berberine and ciprofloxacin decreased the MIC levels of ciprofloxacin in (31.4%, n=22) A. baumannii isolates and decreased the MIC between zero to 1-fold (Table 3).

Table 1. Frequency MICs (µg/mL) of imipenem and ciprofloxacin of Acinetobacter baumannii isolates

MIC (µg/mL)	2	4	8	16	32	64	128
Imipenem	-	-	5(7.14%)	2 (2.8)	35(50)	12(17.1)	16(22.8)
Ciprofloxacin	-	31 (44.2)	10 (14.2)	17(24.2)	12 (17.1)	-	-

Table 2. MIC levels of imipenem in combination with berberine

MIC Imipenem (µg/mL)	MIC Berberine (µg/mL)	MIC Imipenem + Berberine	decrease MIC Imipenem+ Berberine	Frequency (%)No
8	0. 5	1	0-1	(7.1)5
16	1	2	0-1	(2.8)2
32	1	4	0-1	(50)35
64	4	8	0-1	(17.1)12
128	8	16	0-2	16 (22.8)

Table 3. MIC levels of ciprofloxacin in combination with berberine

MIC ciprofloxacin (µg/mL)	MIC Berberine (µg/mL)	MIC Ciprofloxacin + Berberine	decrease MIC Ciprofloxacin+ Berberine	Frequency (%)No
4	2	2	0-1	(14.2)10
8	4	2	0-1	(24.2)17
16	8	8	0-1	(44.2)31
32	16	16	0-1	(17.44)12

Discussion

In the present study, 70 (28.1%) of cultures of respiratory tract samples were positive for A. baumannii. Similarly, Ebrahimi et al. reported that A. baumannii isolates were the most common (35%, n=56) bacterial pathogen isolated from respiratory tract samples collected from ICUs in Arak hospitals (10).
In a study by El-Saed et al., 2013 in Saudi Arabia, 457 cultures were collected from the respiratory tract of ICU patients, the most common isolate was A. baumannii (26.5%, n=121). These results indicated a high prevalence of A. baumannii is in ICUs (9).
In the present study, the results of disk diffusion and broth microdilution tests showed high-level resistance (more than 90%) to ciprofloxacin and imipenem antibiotics. In a study conducted in Turkey, resistance to piperacillin, piperacillin-tazobactam, ciprofloxacin and ceftazidime were 100%, 92.4%, 83.3%, and 74.2%, respectively, and high levels of resistance to other antibiotics were detected (15). Consistent with our study in the study of Vazirizadeh et al., the rates of antibiotic resistance to ciprofloxacin, and imipenem were 96% and 98%, respectively, in Isfahan hospitals (16).
In our study, berberine was found to be active on A. baumannii and inhibition zone was observed around the disks containing berberine and berberine in combination with imipenem and ciprofloxacin reduced the MIC of these antibiotics. Consistent with the present study, in 2017, Aghayan et al. showed that palmatine and berberine had decreased the MIC and MBC levels of ciprofloxacin in ciprofloxacin-resistant isolates of P. aeruginosa and there was no significant difference between the effect of palmatine and berberine (17).
In a study by Musumeci et al. from Italy, the bactericidal effect of the methanolic extract of Barberry (Berberis aetnensis) on S. aureus was investigated. The results showed that MIC decreased considerably when using the combination of extract and antibiotic compared to ciprofloxacin alone and the plant extract. Barberry and ciprofloxacin antibiotics showed a synergistic effect (18).
In 2014, Wojtyczka et al. in Poland reported the antimicrobial effect as well as the synergistic effect of berberine and some of antibiotics on coagulase-negative Staphylococci including Staphylococcus epidermidis, Staphylococcus capitis, Staphylococcus gallinarum, Staphylococcus hominis and Staphylococcus intermedius (19).
The results of this study and other studies showed that berberine has antibacterial properties and can be used as a cheap and available source for therapeutic use in some bacterial infections. In other words, berberine can be considered as a suitable alternative or supplement to synthetic antibiotics against A. baumannii isolates.

Conclusion

The findings of this study showed the antibacterial effects of berberine, and that it can increase the effectiveness of antibiotics against imipenem and ciprofloxacin-resistant isolates of A. baumannii. Berberine can be used in the future by optimizing the methods for the treatment of infectious diseases caused by A. baumannii.

Acknowledgements

This article is taken from a student research project No. 9704192213 approved by the Student Research Committee of Hamadan University of Medical Sciences. The authors of this article would like to extend their gratitude to Hamadan University of Medical Sciences for their financial support as well as to the staff of intensive care units in Besat, Sina and, Shahid Beheshti hospitals in Hamadan.

Conflicts of Interest

Authors declared no conflict of interests.

Type of Study: Original Research Article | Subject: Antimicrobial Substances
Received: 2019/08/18 | Accepted: 2019/12/30 | ePublished: 2020/03/14

References

1. Navidinia M. The clinical importance of emerging ESKAPE pathogens in nosocomial infections. Archives of Advanced in Bioscience. 2016;7(3):43-57.

2. Gao WW, Gopala L, Bheemanaboina RRY, Zhang GB, Li S, Zhou CH. Discovery of 2-aminothiazolyl berberine derivatives as effectively antibacterial agents toward clinically drug-resistant Gram-negative Acinetobacter baumanii. European journal of medicinal chemistry. 2018;146:15-37. [DOI:10.1016/j.ejmech.2018.01.038] [PMID]

3. Jung J, Park W. Acinetobacter species as model microorganisms in environmental microbiology: current state and perspectives. Applied microbiology and biotechnology. 2015;99(6):2533-48. [DOI:10.1007/s00253-015-6439-y] [PMID]

4. Winn WC, Allen SD, Janda WM, Koneman EW, Procop GW, Schreckenberger PC, et al. Taxonomy, biochemical characteristics and clinical significance of medically important nonfermenters. In: Darcy P, Peterson N, editors. Koneman's Colour Atlas and Textbook of Diagnostic Microbiology. 6th ed. Philadelphia: Lippincott Williams and Wilkins; 2006. pp. 353-5

5. Makvandi M, Shokoohizadeh L. Antibacterial and Drug Synergistic Activities of Mentha longifolia Essential Oil Against Shigella flexneri and Shigella sonnei. Int J Enteric Pathog. 2017;5(3):92-5. [DOI:10.15171/ijep.2017.21]

6. Clinical and Laboratory Standards Institute [CLSI] CaL, Standards Institute. : Twenty seventh Informational Supplement M100eS27 CLSI C, Wayne P. Performance Standards for Antimicrobial Susceptibility

7. Oddo A, Thomsen TT, Kjelstrup S, Gorey C, Franzyk H, Frimodt-Møller N, et al. An amphipathic undecapeptide with all d-amino acids shows promising activity against colistin-resistant strains of acinetobacter baumannii and a dual mode of action. 2016;60(1):592-9. [DOI:10.1128/AAC.01966-15] [PMID] [PMCID]

8. Cherkaoui A, Emonet S, Renzi G, Schrenzel J. Characteristics of multidrug-resistant Acinetobacter baumannii strains isolated in Geneva during colonization or infection. Annals of clinical microbiology and antimicrobials. 2015;14:42-. [DOI:10.1186/s12941-015-0103-3] [PMID] [PMCID]

9. El-Saed A, Balkhy HH, Al-Dorzi HM, Khan R, Rishu AH, Arabi YM. Acinetobacter is the most common pathogen associated with late-onset and recurrent ventilator-associated pneumonia in an adult intensive care unit in Saudi Arabia. International journal of infectious diseases : IJID : official publication of the International Society for Infectious Diseases. 2013;17(9):e696-701. [DOI:10.1016/j.ijid.2013.02.004] [PMID]

10. Ebrahimi M, Khansari-nejad B, Ghaznavi-Rad E. High Frequency of Ventilator Associated Pneumonia Nosocomial Co-Infection Causedby Methicillin Resistant Staphylococcusaureus and Carbapenem Resistant Acinetobacter baumannii in Intensive Care Unit. JOURNAL OF IRANIAN CLINICAL RESEARCH. 2015;1:67-71.

11. El-Saed A, Balkhy HH, Al-Dorzi HM, Khan R, Rishu AH, Arabi YMJIJoID. Acinetobacter is the most common pathogen associated with late-onset and recurrent ventilator-associated pneumonia in an adult intensive care unit in Saudi Arabia. 2013;17(9):e696-e701. [DOI:10.1016/j.ijid.2013.02.004] [PMID]

12. Safari M, Mozaffari Nejad AS, Bahador A, Jafari R, Alikhani MY. Prevalence of ESBL and MBL encoding genes in Acinetobacter baumannii strains isolated from patients of intensive care units (ICU). Saudi journal of biological sciences. 2015;22(4):424-9. [DOI:10.1016/j.sjbs.2015.01.004] [PMID] [PMCID]

13. Vahdani P, Yaghoubi T, Aminzadeh Z. Hospital acquired antibiotic-resistant Acinetobacter baumannii infections in a 400-bed hospital in Tehran, Iran. International journal of preventive medicine. 2011 Jul;2(3):127.

14. Shahcheraghi F, Abbasalipour M, Feizabadi MM, Ebrahimipour GH, Akbari N. Isolation and genetic characterization of metallo-β-lactamase and carbapenamase producing strains of Acinetobacter baumannii from patients at Tehran hospitals. Iranian journal of microbiology. 2011 Jun;3(2):68.

15. Baran G, Erbay A, Bodur H, Öngürü P, Akıncı E, Balaban N, Çevik MA. Risk factors for nosocomial imipenem-resistant Acinetobacter baumannii infections. International Journal of Infectious Diseases. 2008;12(1):16-21. [DOI:10.1016/j.ijid.2007.03.005] [PMID]

16. Vazirzadeh J, Behshood P, Heidari L, Ghajav H. Frequency of metallo-β-lactamase and antimicrobial resistance patterns of Acinetobacter baumannii in carbapenem-resistant isolates in intensive care units. Journal of Isfahan Medical School. 2015;32(312):2094-103.

17. Aghayan SS, Mogadam HK, Fazli M, Darban-Sarokhalil D, Khoramrooz SS, Jabalameli F, Yaslianifard S, Mirzaii M. The effects of berberine and palmatine on efflux pumps inhibition with different gene patterns in Pseudomonas Aeruginosa isolated from burn infections. Avicenna journal of medical biotechnology. 2017 Jan;9(1):2.

18. Musumeci R, Speciale A, Costanzo R, Annino A, Ragusa S, Rapisarda A, Pappalardo MS, Iauk L. Berberis aetnensis C. Presl. extracts: antimicrobial properties and interaction with ciprofloxacin. International journal of antimicrobial agents. 2003 Jul 1;22(1):48-53. [DOI:10.1016/S0924-8579(03)00085-2]

19. Wojtyczka R, Dziedzic A, Kępa M, Kubina R, Kabała-Dzik A, Mularz T, Idzik D. Berberine enhances the antibacterial activity of selected antibiotics against coagulase-negative Staphylococcus strains in vitro. Molecules. 2014;19(5):6583-96. [DOI:10.3390/molecules19056583] [PMID] [PMCID]