Holarrhena antidysenterica as a resistance modifying agent against Acinetobacter baumannii: Its effects on bacterial outer membrane permeability and efflux pumps.

Increasing rates of infections caused by multidrug resistant Acinetobacter baumannii (MDRAB) and extensively drug resistant A. baumannii (XDRAB) have caused the need for searching alternative agents. The purposed of this project was to search plant-derived natural products that act as resistant modifying agents (RMAs) against A. baumannii. In this study, we further evaluated the activity of Holarrhena antidysenterica that has been previously proposed as RMA of novobiocin for a model strain, A. baumannii ATCC 19606 on clinically isolated non-MDRAB, MDRAB, and XDRAB. Effects of H. antidysenterica on outer membrane permeability and efflux pumps of the pathogen were conducted to preliminary elucidate mechanisms of this resistant modifier. Novobiocin was selected as a model antibiotic because it is well-established as an effective agent against Gram-positive pathogens. But, it possessed low level of antibacterial activity against Gram-negative pathogens due to an effective permeability barrier of these pathogens. H. antidysenterica ethanol extract possessed weak intrinsic antibacterial activity with minimum inhibitory concentration (MIC) more than 1000 μg/mL. The extract, at concentrations of 250, 125, and 62.5 μg/mL, remarkably enhanced the inhibitory effects of novobiocin (1/4 × MIC; 1-4 μg/mL) against XDRAB isolates. Synergistic effects of novobiocin at 1/4 × MIC and 1/8 × MIC in combination with H. antidysenterica either at 31.2, 15.6, or 7.8 μg/mL against clinical isolates non-MDRAB, MDRAB, and XDRAB were evidenced for 80% of the combinations (189 out of 234 combinations). Although, no enhancement of the accumulation of ethidium bromide was observed after treated with H. antidysenterica, this plant extract weakened the outer membrane of the pathogen as indicated by an increase in the N-phenyl-1-naphthylamine uptake. Our results suggested that H. antidysenterica which primarily interrupts membrane permeability should be further investigated as a promising resistant modifier for A. baumannii.