Antimicrobials cetylpyridinium-chloride and miramistin demonstrate non-inferiority and no “protein-error” compared to established wound care antiseptics <i>in vitro</i>

Julian-Dario Rembe; Vivian-Denise Thompson; Ewa Klara Stuermer; Julian-Dario Rembe; Vivian-Denise Thompson; Ewa Klara Stuermer

doi:10.3934/microbiol.2022026

AIMS Microbiology

2022, Volume 8, Issue 4: 372-387. doi: 10.3934/microbiol.2022026

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Antimicrobials cetylpyridinium-chloride and miramistin demonstrate non-inferiority and no “protein-error” compared to established wound care antiseptics in vitro

1.
Department of Vascular and Endovascular Surgery, Medical Faculty and University Hospital Duesseldorf, Heinrich-Heine-University, Duesseldorf, North-Rhine Westphalia, Germany
2.
Chair for Translational Wound Research, Center for Biomedical Education and Research, Witten/Herdecke University, Witten, North-Rhine Westphalia, Germany
3.
Department of Vascular Medicine, University Heart Center, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany

Received: 26 July 2022 Revised: 02 October 2022 Accepted: 17 October 2022 Published: 24 October 2022

Concern about microbial tolerance and resistance to established antimicrobials drives research into alternatives for local antiseptic wound treatment. Precise efficacy profiles are thereby important in the evaluation of potential alternative antimicrobials, and protein interference (“protein error”) is a key factor.

Here, the antimicrobial efficacy of cetylpyridinium chloride (CPC) and miramistin (MST) was compared to the established antimicrobials octenidine (OCT), povidon-iodine (PVP-I), polyhexamethylene-biguanide (PHMB) and chlorhexidine (CHX). Efficacy was evaluated after 0.5, 1, 3, 5 and 10 min against Staphylococcus aureus, Pseudomonas aeruginosa, Escherichia coli, Enterococcus faecium and Candida albicans using an in vitro quantitative suspension method (based on DIN EN 13727). To investigate protein interference, 0.3% or 3% bovine albumin was used as the challenge.

OCT and PVP-I demonstrated a significant efficacy within 0.5 min, regardless of the microbial organism and protein challenge (p < 0.01). CPC and MST showed no inferiority in efficacy, with only MST needing up to 3 min to achieve the same microbial reduction. PHMB and CHX also achieved significant reduction rates over the tested time-course, yet demonstrated a necessity for prolonged exposure (up to 10 min) for comparable reduction. A protein interference was predominantly observed for PHMB against S. aureus, but without statistically significant differences in antimicrobial efficacy between the 0.3% and 3% protein challenges. All other tested agents showed no relevant interference with the presence of protein.

CPC and MST proved to be non-inferior to established wound antiseptics agents in vitro. In fact, CPC showed a more efficient reduction than PHMB and CHX despite there being an introduced protein challenge. Both agents demonstrated no significant “protein error” under challenging conditions (3% albumin), posing them as valid potential candidates for alternative antimicrobials in wound management.
- cetylpyridinium chloride,
- miramistin,
- antimicrobials,
- antiseptics,
- wound infection
Citation: Julian-Dario Rembe, Vivian-Denise Thompson, Ewa Klara Stuermer. Antimicrobials cetylpyridinium-chloride and miramistin demonstrate non-inferiority and no “protein-error” compared to established wound care antiseptics in vitro[J]. AIMS Microbiology, 2022, 8(4): 372-387. doi: 10.3934/microbiol.2022026

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Abstract

Concern about microbial tolerance and resistance to established antimicrobials drives research into alternatives for local antiseptic wound treatment. Precise efficacy profiles are thereby important in the evaluation of potential alternative antimicrobials, and protein interference (“protein error”) is a key factor.

Here, the antimicrobial efficacy of cetylpyridinium chloride (CPC) and miramistin (MST) was compared to the established antimicrobials octenidine (OCT), povidon-iodine (PVP-I), polyhexamethylene-biguanide (PHMB) and chlorhexidine (CHX). Efficacy was evaluated after 0.5, 1, 3, 5 and 10 min against Staphylococcus aureus, Pseudomonas aeruginosa, Escherichia coli, Enterococcus faecium and Candida albicans using an in vitro quantitative suspension method (based on DIN EN 13727). To investigate protein interference, 0.3% or 3% bovine albumin was used as the challenge.

OCT and PVP-I demonstrated a significant efficacy within 0.5 min, regardless of the microbial organism and protein challenge (p < 0.01). CPC and MST showed no inferiority in efficacy, with only MST needing up to 3 min to achieve the same microbial reduction. PHMB and CHX also achieved significant reduction rates over the tested time-course, yet demonstrated a necessity for prolonged exposure (up to 10 min) for comparable reduction. A protein interference was predominantly observed for PHMB against S. aureus, but without statistically significant differences in antimicrobial efficacy between the 0.3% and 3% protein challenges. All other tested agents showed no relevant interference with the presence of protein.

CPC and MST proved to be non-inferior to established wound antiseptics agents in vitro. In fact, CPC showed a more efficient reduction than PHMB and CHX despite there being an introduced protein challenge. Both agents demonstrated no significant “protein error” under challenging conditions (3% albumin), posing them as valid potential candidates for alternative antimicrobials in wound management.

Acknowledgments

This work was supported by internal funding of the University of Witten/Herdecke. The Chair for Translational Wound Research is generally an endowed chair funded by Dr. Ausbüttel & Co. GmbH. For the presented work, no type of benefit, directly or indirectly, was received.
The authors would like to thank Univ.-Prof. Dr. rer. nat. Frank Krummenauer, former Head of the Institute for Medical Biometry and Epidemiology (IMBE) at the Faculty of Health, Witten/Herdecke University, and especially his research associate Sabrina Tulka, M.Sc., for advice and support regarding statistical analysis.

Conflict of interest

All authors declare no conflict of interest regarding this paper.

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