The Combined Antimicrobial Activity of Citrus Honey and Fosfomycin on Multidrug Resistant Pseudomonas aeruginosa Isolates

Abstract

. aeruginosa is an important pathogen in a broad range of hospital and community-acquired infections. MDR P. aeruginosa identified by the Infectious Diseases Society of America (IDSA) as one of the top six pathogens threatening healthcare systems. P. aeruginosa infections can be severe in people with a compromised immune system and impaired anatomical structures caused by, burns, CF or mechanical abrasions. Treatment of P. aeruginosa infections can be challenging due to the inherent antibiotic resistance (Walsh et al., 2015 and Subedi et al., 2018). One of the reasons for the poor clinical outcomes of P. aeruginosa infections is thought to be virulence factors, especially the T3SS which allows the delivery of various effector toxins as exoenzyme S, exoenzyme U, exoenzyme Y, and exoenzyme T into host cells, which can facilitate the pathogen cellular invasion. Various studies suggest that ExoU-producing strains are associated with poor outcomes, resistance to many antibiotics and high mortality rates (Hassuna, 2016 and Horna et al., 2019). The antibacterial properties of honey as naturally sourced antimicrobial agent are multifactorial, the high osmotic nature and naturally low pH (3.2–4.5) and ability to produce hydrogen peroxide play a key role in the antimicrobial activity of honey. Also, phytochemical factors such as tetracycline derivatives, peroxides, amylase, fatty acids, phenols, ascorbic acid, terpenes, benzyl alcohol and benzoic acid are factors attributed honey to have potent bactericidal and bacteriostatic activity against pathogenic bacteria (Wasihun and Kasa, 2016 and Cheesman et al., 2017).