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The Antimicrobial Activity of Ciprofloxacin-Loaded Niosomes against Ciprofloxacin-Resistant and Biofilm-Forming Staphylococcus aureus

Authors Kashef MT, Saleh NM, Assar NH, Ramadan MA

Received 13 February 2020

Accepted for publication 9 May 2020

Published 8 June 2020 Volume 2020:13 Pages 1619—1629


Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 2

Editor who approved publication: Dr Eric Nulens

Mona T Kashef,1 Nehal M Saleh,2 Nouran H Assar,2 Mohammed A Ramadan1

1Department of Microbiology and Immunology, Faculty of Pharmacy, Cairo University, Cairo, Egypt; 2Department of Microbiology, National Organization for Drug Control and Research, Giza, Egypt

Correspondence: Mona T Kashef
Department of Microbiology and Immunology, Faculty of Pharmacy, Cairo University, Kasr El-Eini St, Cairo 11562, Egypt
Tel +20 2 2363 9307
Fax +20 2 2362 8426

Purpose: The threat of Staphylococcus aureus antimicrobial resistance is increasing worldwide. Niosomes are a new drug delivery system that enhances the antimicrobial potential of antibiotics. We hereby aim to evaluate the antimicrobial and antibiofilm activity of ciprofloxacin-loaded niosomes.
Methods: The antimicrobial susceptibility of clinical S. aureus isolates (n=59) was determined by Kirby–Bauer disk diffusion method. Their biofilm formation activity was tested by Christensen’s method. Two ciprofloxacin-loaded niosomal formulations were prepared by thin-film hydration method, and their minimum inhibitory concentrations (MIC) were determined by agar dilution method, against ciprofloxacin-resistant and biofilm-forming isolates (n=24). Their ability to inhibit biofilm formation and eradicate already formed biofilms was evaluated and further confirmed by scanning electron microscope images. Non-synonymous mutations, in a quinolone resistance-determining regions of S. aureus isolates, were detected by polymerase chain reaction.
Results: Most of the isolates were methicillin- (47/59) and ciprofloxacin-resistant (45/59). All except two isolates were capable of biofilm production. Niosomal preparation I reduced ciprofloxacin MIC by twofold in four isolates, whereas preparation II reduced ciprofloxacin MIC of most isolates by 8- to 32-fold, with three isolates that became ciprofloxacin-susceptible. Non-synonymous mutations were detected in isolates that maintained phenotypic ciprofloxacin resistance against ciprofloxacin-loaded niosomal preparation II. Ciprofloxacin-loaded niosomes reduced the minimum biofilm inhibitory concentration and the minimum biofilm eradication concentration in 58% and 62% of the tested isolates, respectively.
Conclusion: Ciprofloxacin-loaded niosomes can restore ciprofloxacin activity against resistant S. aureus isolates. To our knowledge, this is the first report on the inhibition of biofilm formation and eradication of formed biofilms by ciprofloxacin-loaded niosomes.

Keywords: biofilm, ciprofloxacin, niosomes, Staphylococcus aureus, resistance

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