Efeito do Sistema de Secreção do Tipo VI de Pseudomonas aeruginosa em modelo murino de pneumonia aguda

O Sistema de Secreção do Tipo VI (SST6), o mais recente maquinário de secreção descrito em bactérias Gram-negativas, é amplamente distribuído entre as diversas espécies deste grupo de microrganismos. Esse aparato de secreção é capaz de injetar efetores proteicos em células alvo, eucarióticas e procarióticas. Estudos sobre o papel do SST6 na virulência microbiana revelaram que este sistema secretório participa ativamente do estabelecimento de infecções, contribuindo para a sobrevivência das bactérias no interior de fagócitos. O genoma da cepa PAO1 de Pseudomonas aeruginosa apresenta três loci que codificam aparatos de SST6, denominados de H1-SST6, H2-SST6 e H3-SST6, Porém, pouco se sabe sobre a participação do SST6 na patogênese de infecções por P. aeruginosa. Assim, o presente estudo investigou o papel de H1-SST6, H2-SST6 e H3-SST6 durante a infecção pulmonar aguda de camundongos. Para isso, camundongos C57/BL6 foram infectados com diferentes doses de bactérias da cepa selvagem PAO1 ou das cepas mutantes PAO1∆H1, PAO1∆H2, PAO1∆H3 ou PAO1∆H1∆H2∆H3. Após 24 horas, os lavados broncoalveolares (LBAs) de animais controle e infectados foram recuperados para a contagem de leucócitos totais e polimorfonucleares e para a quantificação, por ELISA, da quimiocina para neutrófilos, KC, e das citocinas pró-inflamatórias IL-1β e TNF-α. Em outros experimentos, os pulmões, fígados, baços e rins dos animais foram macerados para a pesquisa da carga bacteriana e da disseminação sistêmica das bactérias. A citotoxicidade do SST6 foi determinada, in vitro, em neutrófilos humanos, pela marcação com iodeto de propídeo (PI) e anexina-V seguida da análise em citometria de fluxo. Os resultados mostraram que a inativação dos três SST6 reduziu significativamente a concentração de neutrófilos nos LBAs quando os animais foram infectados com 10⁷ Unidades Formadoras de Colônias de P. aeruginosa. Nesta dose, foi observado que as medianas do número de bactérias detectadas nos animais infectados com as mutantes no SST6 foram menores do que as detectadas nos animais infectados com a cepa parental PAO1. As mutações no SST6 não afetaram a disseminação sistêmica da bactéria. A pesquisa da secreção de citocinas pró-inflamatórias mostrou que, embora tenha sido observada uma redução nas medianas das concentrações de TNF-α nos LBAs de camundongos infectados com a cepa PAO1∆H1∆H2∆H3, em relação aos LBAs de camundongos infectados com a cepa parental, essa diferença não foi significativa. Como a pesquisa de IL-1β e KC não contribuiu para a elucidação dos mecanismos envolvidos na redução da concentração de neutrófilos nos LBAs dos camundongos infectados pela cepa tripla mutante, foi pesquisado o possível efeito do SST6 na morte de neutrófilos humanos. Os resultados mostraram que não houve diferenças significativas quando as diferentes amostras de células infectadas foram comparedas entre si. Em conclusão, os resultados do presente estudo mostraram que o SST6 pode interferir na resposta de neutrófilos durante a pneumonia aguda, mas estudos adicionais são necessários para determinar o papel deste mecanismo de secreção na patogênese de P. aeruginosa.

Nitrogen fixing bacteria, Azotobacter sp. in aquatic sediment

Non-symbiotic, free living, nitrogen fixing bacteria, Azotobacter sp. was estimated in sediments of estuarine, marine, backwater and mangrove environments of Portonovo. Number of colony forming units (CFU) of Azotobacter sp. was less (5 to 27 cells/g of dry sediment). CFU of total heterotrophic bacteria (THB), actinomycetes and fungi were between 4.1x10 super(6) and 4.5x10 super (7), 0.8x10 super(5) and 4.9x10 super(5), 1.1x10 super(5) and 3.8x10 super(5)/g respectively. Mangrove sediments contained more CFU of the above microbial groups.

Bioburden after Staphylococcus aureus inoculation in type 1 diabetic rats undergoing internal fixation.

SUMMARY: Fracture stabilization in the diabetic patient is associated with higher complication rates, particularly infection and impaired wound healing, which can lead to major tissue damage, osteomyelitis, and higher amputation rates. With an increasing prevalence of diabetes and an aging population, the risks of infection of internal fixation devices are expected to grow. Although numerous retrospective clinical studies have identified a relationship between diabetes and infection, currently there are few animal models that have been used to investigate postoperative surgical-site infections associated with internal fixator implantation and diabetes. The authors therefore refined the protocol for inducing hyperglycemia and compared the bacterial burden in controls to pharmacologically induced type 1 diabetic rats after undergoing internal fracture plate fixation and Staphylococcus aureus surgical-site inoculation. Using an initial series of streptozotocin doses, followed by optional additional doses to reach a target blood glucose range of 300 to 600 mg/dl, the authors reliably induced diabetes in 100 percent of the rats (n = 16), in which a narrow hyperglycemic range was maintained 14 days after onset of diabetes (mean ± SEM, 466 ± 16 mg/dl; coefficient of variation, 0.15). With respect to their primary endpoint, the authors quantified a significantly higher infectious burden in inoculated diabetic animals (median, 3.2 × 10 colony-forming units/mg dry tissue) compared with inoculated nondiabetic animals (7.2 × 10 colony-forming units/mg dry tissue). These data support the authors' hypothesis that uncontrolled diabetes adversely affects the immune system's ability to clear Staphylococcus aureus associated with internal hardware.

A practical miniature long-term bone marrow culture system for investigating early myelodysplasia

A method was devised to grow haemopoietic cells in long-term bone marrow culture (LTBMC) which requires only 1 x 10(6) cells/culture. Such miniature cultures were used to study growth patterns of marrow from patients with myelodysplastic syndromes (MDS). Consistent differences in LTBMC cellularity and cellular composition were noted between MDS and normal marrow. These differences were accentuated by rGM-CSF. The criteria which distinguished between and MDS marrows were: cell count at weeks 1 and 4, % neutrophils and % blasts. In 10 patients with unexplained macrocytosis or pancytopenia miniature LTBMC results clearly segregated into either 'normal' or 'MDS' growth patterns. Miniature LTBMC with rGM-CSF may therefore be a useful diagnostic test for early MDS.

Gentamicin-loaded nanoparticles show improved antimicrobial effects towards Pseudomonas aeruginosa infection

Gentamicin is an aminoglycoside antibiotic commonly used for treating Pseudomonas infections, but its use is limited by a relatively short half-life. In this investigation, developed a controlled-release gentamicin formulation using poly(lactide-co-glycolide) (PLGA) nanoparticles. We demonstrate that entrapment of the hydrophilic drug into a hydrophobic PLGA polymer can be improved by increasing the pH of the formulation, reducing the hydrophilicity of the drug and thus enhancing entrapment, achieving levels of up to 22.4 µg/mg PLGA. Under standard incubation conditions, these particles exhibited controlled release of gentamicin for up to 16 days. These particles were tested against both planktonic and biofilm cultures of P. aeruginosa PA01 in vitro, as well as in a 96-hour peritoneal murine infection model. In this model, the particles elicited significantly improved antimicrobial effects as determined by lower plasma and peritoneal lavage colony-forming units and corresponding reductions of the surrogate inflammatory indicators interleukin-6 and myeloperoxidase compared to free drug administration by 96 hours. These data highlight that the controlled release of gentamicin may be applicable for treating Pseudomonas infections.

Human mesenchymal stem cells reduce mortality and bacteremia in gram-negative sepsis in mice in part by enhancing the phagocytic activity of blood monocytes

The potential therapeutic value of cell-based therapy with mesenchymal stem cells (MSC) has been reported in mouse models of polymicrobial peritoneal sepsis. However, the mechanisms responsible for the beneficial effects of MSC have not been well defined. Therefore, we tested the therapeutic effect of intravenous bone marrow-derived human MSC in peritoneal sepsis induced by gram-negative bacteria. At 48 h, survival was significantly increased in mice treated with intravenous MSC compared with control mice treated with intravenous fibroblasts (3T3) or intravenous PBS. There were no significant differences in the levels of TNF-a, macrophage inflammatory protein 2, or IL-10 in the plasma. However, there was a marked reduction in the number of bacterial colony-forming units of Pseudomonas aeruginosa in the blood of MSC-treated mice compared with the 3T3 and PBS control groups. In addition, phagocytic activity was increased in blood monocytes isolated from mice treated with MSC compared with the 3T3 and PBS groups. Furthermore, levels of C5a anaphylotoxin were elevated in the blood of mice treated with MSC, a finding that was associated with upregulation of the phagocytosis receptor CD11b on monocytes. The phagocytic activity of neutrophils was not different among the groups. There was also an increase in alternately activated monocytes/macrophages (CD163- and CD206-positive) in the spleen of the MSC-treated mice compared with the two controls. Thus intravenous MSC increased survival from gram-negative peritoneal sepsis, in part by a monocyte-dependent increase in bacterial phagocytosis.

Photodynamic antimicrobial polymers for infection control

Hospital-acquired infections pose both a major risk to patient wellbeing and an economic burden on global healthcare systems, with the problem compounded by the emergence of multidrug resistant and biocide tolerant bacterial pathogens. Many inanimate surfaces can act as a reservoir for infection, and adequate disinfection is difficult to achieve and requires direct intervention. In this study we demonstrate the preparation and performance of materials with inherent photodynamic, surface-active, persistent antimicrobial properties through the incorporation of photosensitizers into high density poly(ethylene) (HDPE) using hot-melt extrusion, which require no external intervention except a source of visible light. Our aim is to prevent bacterial adherence to these surfaces and eliminate them as reservoirs of nosocomial pathogens, thus presenting a valuable advance in infection control. A two-layer system with one layer comprising photosensitizer-incorporated HDPE, and one layer comprising HDPE alone is also described to demonstrate the versatility of our approach. The photosensitizer-incorporated materials are capable of reducing the adherence of viable bacteria by up to 3.62 Log colony forming units (CFU) per square centimeter of material surface for methicillin resistant Staphylococcus aureus (MRSA), and by up to 1.51 Log CFU/cm2 for Escherichia coli. Potential applications for the technology are in antimicrobial coatings for, or materials comprising objects, such as tubing, collection bags, handrails, finger-plates on hospital doors, or medical equipment found in the healthcare setting.

Diagnostic accuracy of pulmonary host inflammatory mediators in the exclusion of ventilator-acquired pneumonia

Background: Excessive use of empirical antibiotics is common in critically ill patients. Rapid biomarker-based exclusion of infection may improve antibiotic stewardship in ventilator-acquired pneumonia (VAP). However, successful validation of the usefulness of potential markers in this setting is exceptionally rare.

Objectives: We sought to validate the capacity for specific host inflammatory mediators to exclude pneumonia in patients with suspected VAP. 

Methods: A prospective, multicentre, validation study of patients with suspected VAP was conducted in 12 intensive care units. VAP was confirmed following bronchoscopy by culture of a potential pathogen in bronchoalveolar lavage fluid (BALF) at >10⁴ colony forming units per millilitre (cfu/mL). Interleukin-1 beta (IL-1β), IL-8, matrix metalloproteinase-8 (MMP-8), MMP-9 and human neutrophil elastase (HNE) were quantified in BALF. Diagnostic utility was determined for biomarkers individually and in combination. 

Results: Paired BALF culture and biomarker results were available for 150 patients. 53 patients (35%) had VAP and 97 (65%) patients formed the non-VAP group. All biomarkers were significantly higher in the VAP group (p<0.001). The area under the receiver operator characteristic curve for IL-1β was 0.81; IL-8, 0.74; MMP-8, 0.76; MMP-9, 0.79 and HNE, 0.78. A combination of IL-1β and IL-8, at the optimal cut-point, excluded VAP with a sensitivity of 100%, a specificity of 44.3% and a post-test probability of 0% (95% CI 0% to 9.2%). 

Conclusions: Low BALF IL-1β in combination with IL-8 confidently excludes VAP and could form a rapid biomarker-based rule-out test, with the potential to improve antibiotic stewardship.

Hydrogel antimicrobial capture coatings for endotracheal tubes; a pharmaceutical strategy designed to prevent ventilator-associated pneumonia.

This paper presents a novel strategy for the prevention of ventilator-associatedpneumonia that involves coating poly(vinyl chloride, PVC) endotracheal tubes (ET) withhydrogels that may be subsequently used to entrap nebulized antimicrobial solutions. Candidatehydrogels were prepared containing a range of ratios of hydroxyethyl methacrylate (HEMA) andmethacrylic acid (MAA) from 100:0 to 70:30 using free radical polymerization and, whenrequired, simultaneous attachment to PVC was performed. The mechanical properties, glasstransition temperatures, swelling kinetics, uptake of gentamicin from an aqueous medium, andgentamicin release were characterized. Increasing the MAA content of the hydrogels significantlydecreased the ultimate tensile strength, % elongation at break, Young’s modulus, and increasedthe glass transition temperature, the swelling ratio, and gentamicin uptake. Microbial(Staphylococcus aureus and Pseudomonas aeruginosa) adherence to control (drug-free) hydrogelswas observed; however, while adherence to gentamicin-containing p(HEMA) occurred, noadherence occurred to gentamicin-containing HEMA:MAA copolymers. Antimicrobialpersistence of gentamicin-containing hydrogels was examined by determining the zone ofinhibition against each microorganism on successive days. Hydrogel composition affected the observed antimicrobial persistence,with the hydrogel composed of 70:30 HEMA:MAA exhibiting >20 days persistence against S. aureus and P. aeruginosa,respectively. To simulate clinical use, the hydrogels (coated onto PVC) were first exposed to a nebulized solution of gentamicin(4 mL, 80 mg for 20 min), and then to nebulized bacteria (4 mL ca. 1 × 109 colony forming units mL−1, 30 min). Viable bacteriawere not observed on the gentamicin-treated p(HEMA: MAA) copolymers, whereas growth was observed on gentamicin-treatedp(HEMA). In light of the excellent antimicrobial activity and physicochemical properties, p(HEMA: MAA) copolymerscomposed of ratios of 80:20 or 70:30 HEMA: MAA were identified as potentially useful coatings of endotracheal tubes to be usedin conjunction with the clinical nebulization of gentamicin and designed for the prevention of ventilator-associated pneumonia

Effect of ultraviolet-B light on lymphocyte activity at doses at which normal bone marrow stem cells are preserved

Ultraviolet B (UVB) light is known to be immunosuppressive, but, probably because of a small UVC component in the emission spectra of some of the UVB lamps used, reports vary on effective dose levels. To prevent potentially lethal graft-versus-host disease (GVHD) after allogeneic bone marrow transplantation, alloreactive donor T-cell activity must be suppressed. In this study, a narrow wavelength UVB lamp (TL01, 312 nm peak emission) was used to determine what doses of UVB were required to abolish rat lymphocyte proliferation while simultaneously preserving rat bone marrow progenitor cell and primitive hematopoietic stem cell viability. Lymphocyte proliferation, as measured by 3H-Thymidine incorporation, in response to lectin stimulation was abolished below detection at doses greater than 3,500 J/m2. When T-cell clonogenicity was measured in a limiting dilution assay, a small fraction (0.6%) was maintained at doses up to 4,000 J/m2. Cytotoxic T-lymphocyte (CTL) activity was reduced after treatment with 4,000 J/m2, but a significant level of cytotoxicity was still maintained. Natural killer cell cytolytic activity was not affected by doses up to 4,000 J/m2. At 4,000 J+m2 there was a 10% survival of colony-forming units-granulocyte-macrophage; a 1% and 4% survival of day-8 and day-12 colony-forming units-spleen, respectively; and 11% survival of marrow repopulating ability cells. Up to 25% of late cobblestone area forming cells (4 to 5 weeks), reflecting the more immature hematopoietic stem cells, were preserved in bone marrow treated with 4,000 J/m2, indicating that early stem cells are less sensitive to UVB damage than are more committed progenitor cells. Thus, a potential therapeutic window was established at approximately 4,000 J/m2 using this light source, whereby the potentially GVHD-inducing T cells were suppressed, but a sufficient proportion of the cells responsible for engraftment was maintained.

The dual EGFR/HER-2 tyrosine kinase inhibitor lapatinib sensitizes colon and gastric cancer cells to the irinotecan active metabolite SN-38

Members of the human epidermal receptor (HER) family are frequently associated with aggressive disease and poor prognosis in multiple malignancies. Lapatinib is a dual tyrosine kinase inhibitor targeting the epidermal growth factor receptor (EGFR) and HER-2. This study evaluated the therapeutic potential of lapatinib, alone and in combination with SN-38, the active metabolite of irinotecan (CPT-11), in colon and gastric cancer cell lines. Concentration-dependent antiproliferative effects of both lapatinib and SN-38 were observed in all colon and gastric cancer cell lines tested but varied significantly between individual cell lines (lapatinib range 0.08-11.7 muM; SN-38 range 3.6-256 nM). Lapatinib potently inhibited the growth of a HER-2 overexpressing gastric cancer cell line and demonstrated moderate activity in gastric and colon cancer cells with detectable HER-2 expression. The combination of lapatinib and SN-38 interacted synergistically to inhibit cell proliferation in all colon and gastric cancer cell lines tested. Cotreatment with lapatinib and SN-38 also resulted in enhanced cell cycle arrest and the induction of apoptosis with subsequent cellular pharmacokinetic analysis demonstrating that lapatinib promoted the increased intracellular accumulation and retention of SN-38 when compared to SN-38 treatment alone. Finally, the combination of lapatinib and CPT-11 demonstrated synergistic antitumor efficacy in the LoVo colon cancer mouse xenograft model with no apparent increase in toxicity compared to CPT-11 monotherapy. These results provide compelling preclinical rationale indicating lapatinib to be a potentially efficacious chemotherapeutic combination partner for irinotecan in the treatment of gastrointestinal carcinomas.

Effectiveness of a biomarker-based exclusion of ventilator-acquired pneumonia to reduce antibiotic use: protocol for a randomised controlled trial (VAPrapid-2):Study protocol for a randomised controlled trial

Background Ventilator-acquired pneumonia (VAP) is a common reason for antimicrobial therapy in the intensive care unit (ICU). Biomarker-based diagnostics could improve antimicrobial stewardship through rapid exclusion of VAP. Bronchoalveloar lavage (BAL) fluid biomarkers have previously been shown to allow the exclusion of VAP with high confidence. Methods/Design This is a prospective, multi-centre, randomised, controlled trial to determine whether a rapid biomarker-based exclusion of VAP results in fewer antibiotics and improved antimicrobial management. Patients with clinically suspected VAP undergo BAL, and VAP is confirmed by growth of a potential pathogen at > 104 colony-forming units per millilitre (CFU/ml). Patients are randomised 1:1, to either a ‘biomarker-guided recommendation on antibiotics’ in which BAL fluid is tested for IL-1β and IL-8 in addition to routine microbiology testing, or to ‘routine use of antibiotics’ in which BAL undergoes routine microbiology testing only. Clinical teams are blinded to intervention until 6 hours after randomisation, when biomarker results are reported to the clinician. The primary outcome is a change in the frequency distribution of antibiotic-free days (AFD) in the 7 days following BAL. Secondary outcome measures include antibiotic use at 14 and 28 days; ventilator-free days; 28-day mortality and ICU mortality; sequential organ failure assessment (SOFA) at days 3, 7 and 14; duration of stay in critical care and the hospital; antibiotic-associated infections; and antibiotic-resistant pathogen cultures up to hospital discharge, death or 56 days. A healthcare-resource-utilisation analysis will be calculated from the duration of critical care and hospital stay. In addition, safety data will be collected with respect to performing BAL. A sample size of 210 will be required to detect a clinically significant shift in the distribution of AFD towards more patients having fewer antibiotics and therefore more AFD. Discussion This trial will test whether a rapid biomarker-based exclusion of VAP results in rapid discontinuation of antibiotics and therefore improves antibiotic management in patients with suspected VAP.

Low-pathogenicity Mycoplasma spp. alter human monocyte and macrophage function and are highly prevalent among patients with ventilator-acquired pneumonia

Background
Ventilator-acquired pneumonia (VAP) remains a significant problem within intensive care units (ICUs). There is a growing recognition of the impact of critical-illness-induced immunoparesis on the pathogenesis of VAP, but the mechanisms remain incompletely understood. We hypothesised that, because of limitations in their routine detection, Mycoplasmataceae are more prevalent among patients with VAP than previously recognised, and that these organisms potentially impair immune cell function.
Methods and setting
159 patients were recruited from 12 UK ICUs. All patients had suspected VAP and underwent bronchoscopy and bronchoalveolar lavage (BAL). VAP was defined as growth of organisms at >104 colony forming units per ml of BAL fluid on conventional culture. Samples were tested for Mycoplasmataceae (Mycoplasma and Ureaplasma spp.) by PCR, and positive samples underwent sequencing for speciation. 36 healthy donors underwent BAL for comparison. Additionally, healthy donor monocytes and macrophages were exposed to Mycoplasma salivarium and their ability to respond to lipopolysaccharide and undertake phagocytosis was assessed.

Results
Mycoplasmataceaewerefoundin49%(95%CI 33% to 65%) of patients with VAP, compared with 14% (95% CI 9% to 25%) of patients without VAP. Patients with sterile BAL fluid had a similar prevalence to healthy donor BAL fluid (10% (95% CI 4% to 20%) vs 8% (95% CI 2% to 22%)). The most common organism identified was M. salivarium. Blood monocytes from healthy volunteers incubated with M. salivarium displayed an impaired TNF-α response to lipopolysaccharide ( p=0.0003), as did monocyte-derived macrophages (MDMs) (p=0.024). MDM exposed to M. salivarium demonstrated impaired phagocytosis ( p=0.005).

Discussion and conclusions
This study demonstrates a high prevalence of Mycoplasmataceae among patients with VAP, with a markedly lower prevalence among patients with suspected VAP in whom subsequent cultures refuted the diagnosis. The most common organism found, M. salivarium, is able to alter the functions of key immune cells. Mycoplasmataceae may contribute to VAP pathogenesis.

Aplicação da terapia fotodinâmica no processo de esterilização de sangue

A importância médica do sangue associada ao risco de doenças infeciosas levou a um melhoramento das técnicas de rastreio de patogénicos no sangue doado. No entanto, devido aos períodos de "janela", durante o qual os agentes infeciosos não podem ser detetados, a desinfeção de sangue e seus derivados assume uma importância vital. Considerando que as técnicas convencionais de desinfeção (tratamento com solvente-detergente ou irradiação com UV ou radiação gama) pode ser empregue em concentrados de plasma ou de proteínas, o efeito colateral associado aos respetivos tratamentos não permite a sua utilização em frações celulares. Consequentemente, é necessário o desenvolvimento de uma nova alternativa eficaz para inativar microrganismos em sangue. Uma boa estratégia que merece ser considerada baseia-se na terapia fotodinâmica antimicrobiana (aPDT). aPDT envolve a interação entre a luz e um fotossensibilizador (PS) na presença de oxigénio molecular. Esta interação produz espécies reativas de oxigénio (ROS), que causam danos oxidativos às moléculas microbianas necessárias à sobrevivência do microrganismo. Em alguns países, esta metodologia já está aprovada para descontaminação de plasma, utilizando azul de metileno ou psoraleno como PSs. O objetivo deste estudo foi avaliar a adequação de de estrutura do tipo ftalocianina (Pc) e porfirina (Por) para desinfeção fotodinâmica de hemoderivados. Plasma e sangue total foram infetados com 108 unidades formadoras de colónias (CFU) / mL de Escherichia coli e após incubação com os derivados Pc e Por em estudo, expostos respetivamente a luz vermelha ou a luz branca com uma irradiância de 150 W/m2durante 270 min. As concentrações de E. coli viáveis foram determinadas a 0, 30, 60, 90, 180 e 270 min e comparadas com as obtidas nos controlos claro (amostras irradiadas na ausência de PS) e controlos escuro (amostras incubadas com PS mas não irradiadas). O efeito do tratamento aPDT nas células do sangue (glóbulos vermelhos e brancos) também foi avaliado. Os resultados obtidos mostram que, em todos os componentes do sangue, a Por em estudo é mais eficaz na inativação de E. coli que o derivado Pc. Após o tratamento aPDT, o número de células vermelhas e brancas no sangue é semelhante aos valores observados nas amostras de controlo. A eficiente inativação de células de E. coli e a ausência de efeito sobre as células de sangue transformam os derivados porfirínicos e ftalocianinas potenciais candidatos a serem utilizados com fotossensibilizadores na desinfeção fotodinâmica de produtos derivados do sangue.

Cinnamaldehyde increases the susceptibility of quorum-sensing-mediated biofilms to conventional antibiotics

The role of bacterial communication, also known as quorum sensing is an important mechanism in biofilm formation which is fundamental to the development of anti-biofilm strategies. In this current study, the synergy between a quorum sensing inhibitor (cinnamaldehyde) and two antibiotics (ceftazidime and levofloxacin) was evaluated in an attempt to develop a strategy for biofilm disruption using the high-throughput minimum biofilm eliminating concentration (MBEC) assay. Klebsiella pneumoniae and Proteus mirabilis biofilms of initial broth suspensions of 108 colony forming units (CFU) per mL, cultivated on the pegs of the MBEC device were challenged with 5120 µg/ml of ceftazidime and levofloxacin in a double dilution assay in the presence of 500 µM cinnamaldehyde. The minimum inhibitory concentrations (MIC) in the presence of cinnamaldehyde for ceftazidime and levofloxacin were 0.125% (640 µg/mL) and 0.0625% (320 µg/mL) respectively with no significant bacterial growth on LB agar. The MBECs for ceftazidime and levofloxacin were above 5120 and 2560 µg/mL respectively which yielded over 70% reduction in both Klebsiella pneumoniae and Proteus mirabilis biofilms. The above results indicate the possibility that the synergy between antimicrobial agents may lead to biofilm eradication.