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Study on synergistic effect of 2-phenylethanol and clotrimazole on candida species isolated from patients with chronic vulvovaginal candidiasis
Niloufar Majdabadi, Mehraban Falahati , Fariba Heidarie-Kohan , Shirin Farahyar , Parvaneh Rahimi-Moghaddam, Mahtab Ashrafi-Khozani ,
Volume 75, Issue 11 (February 2018)
Abstract
Background: 2-phenylethanol is a colorless and aromatic compound with antimicrobial effects which is used extensively in perfumes and cosmetics, as well as in the food industry. Chronic vulvovaginal candidiasis is a vulvovaginal inflammation which is caused by Candida spp. Resistance to clotrimazole which is one of the most common drugs in the treatment of this disease was reported in many patients. In order to improve the treatment, the effect of 2-phenyl ethanol was investigated in combination with clotrimazole on Candida species isolated from chronic vulvovaginal candidiasis.
Methods: This interventional study was performed in Iran University of Medical Sciences from February, 2016 until December, 2016 on Candida species isolated from women with chronic candidial vulvovaginitis who had been referred to Lolagar Hospital of Tehran. All specimens were examined by direct microscopy, culturing on Candida CHROMagar medium (to primary identification), sabouraud dextrose agar medium) to preservation the isolates) and determining the internal transcribed spacer (ITS) sequence (in order to final determination of Candida species). Then clotrimazole and 2-phenyl ethanol alone and in combination, was examined on isolated species, according to Clinical and Laboratory Standards Institute (CLSI) M27-A3 protocol (micro-broth dilution method). Finally, findings were analyzed.
Results: From 40 detected strains of Candida species in this study, 95% were Candida albicans and 5% were Candida africana. The mean minimum inhibitory concentration (MIC) and minimum fungicidal concentration (MFC) of clotrimazole were 24.73±28.87 µg/ml and 30.18±33.004 µg/ml, respectively and the mean MIC and MFC of 2-phenylethanol were 2580±932.38 µg/ml and 3200±1403.29 µg/ml, respectively. The MIC50 and MIC90 of clotrimazole were 16 and 64 µg/ml, respectively. The MIC50 and MIC90 of 2-phenylethanol were both 3200 µg/ml. Most of the isolates were resistant to clotrimazole (82.5%). In combination test, the mean MIC of 2-phenylethanol and clotrimazole alone were 3200±0 µg/ml and 56±40.16 µg/ml, respectively. The fractional inhibitory concentration index (FICI) range was 0.14-0.37. Also, there was a significant difference between clotrimazole MIC values alone and in combination (P= 0.021).
Conclusion: The synergistic effect was observed in combination of clotrimazole and 2-phenylethanol.

Efficacy of chlorhexidine solution on oropharyngeal bacterial colonization in hospitalized patients of intensive care units
Hesamodin Askari Majdabadi , Mohsen Soleimani , Majid Mirmohammadkhani , Elham Zamanipoor,
Volume 78, Issue 11 (February 2021)
Abstract
Background: Infection is a vital problem in intensive care units. Currently, chlorhexidine solution is used to reduce oral colonization. This study aimed to determine the efficacy of chlorhexidine solution on oropharyngeal bacterial colonization in hospitalized patients in the intensive care units.
Methods: This descriptive study (from August 2018 to May 2019) was performed on 60 patients who administered in medical and surgical intensive care units (ICUs) in one of the university hospitals in Semnan city. Patients admitted to (ICUs) were selected according to inclusion criteria. At the time of admission to the intensive care unit, oropharyngeal colonization of patients was assessed. Forty-eight hours after admission and using the chlorhexidine solution 0.2% three times a day, oropharyngeal colonization was assessed again. Data analysis was performed with SPSS software, version. 22 in the significant level of 0.05.
Results: This study showed most of the patients in this study were male (80%) with mean age of 45.23±15.19 years. Most patients were transferred from the emergency department to intensive care units and had endotracheal tubes. At the time of admission to the intensive care unit, 8 patients were infected with E. coli and 6 patients were infected with Klebsiella. The results also showed that the use of chlorhexidine 0.2% had no significant effect on the reduction of micro-organisms in the oropharyngeal area. Forty-eight hours after admission to ICUs, the incidence of E. coli infection increased (P=0.01) but there was no significant increase in the klebsiella infection rate (P=0.25).
Conclusion: This study showed that the use of chlorhexidine solution 0.2% did not affect the reduction of micro-organisms in the oropharyngeal areas of patients. Therefore, oral care protocols that include mechanical movements and toothbrushing should be considered to reduce the occurrence of micro-organisms. This study also found that most patients who were referred to the intensive care unit were contaminated with pathogenic micro-organisms. Therefore, consideration should be given to appropriate strategies to reduce infections in the emergency department.

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