Klebsiella pneumoniae (KP) remains the most prevalent nosocomial pathogen and carries the carbapenemase ( KPC ) gene which confers resistance towards carbapenem. Thus, it is necessary to discover novel antimicrobials to address the issue of antimicrobial resistance in such pathogens. Natural products such as essential oils are a promising source due to their complex composition. Essential oils have been shown to be effective against pathogens, but the overall mechanisms have yet to be fully explained. Understanding the molecular mechanisms of essential oil towards KPC-KP cells would provide a deeper understanding of their potential use in clinical settings. Therefore, we aimed to investigate the mode of action of essential oil against KPC-KP cells from a proteomic perspective by comparing the overall proteome profile of KPC-KP cells treated with cinnamon bark ( Cinnamomum verum J. Presl) essential oil (CBO) at their sub-inhibitory concentration of 0.08% (v/v). A total of 384 proteins were successfully identified from the non-treated cells, whereas only 242 proteins were identified from the CBO-treated cells. Proteins were then categorized based on their biological processes, cellular components and molecular function prior to pathway analysis. Pathway analysis showed that CBO induced oxidative stress in the KPC-KP cells as indicated by the abundance of oxidative stress regulator proteins such as glycyl radical cofactor, catalase peroxidase and DNA mismatch repair protein. Oxidative stress is likely to oxidize and disrupt the bacterial membrane as shown by the loss of major membrane proteins. Several genes selected for qRT-PCR analysis validated the proteomic profile and were congruent with the proteomic abundance profiles. In conclusion, KPC-KP cells exposed to CBO undergo oxidative stress that eventually disrupts the bacterial membrane possibly via interaction with the phospholipid bilayer. Interestingly, several pathways involved in the bacterial membrane repair system were also affected by oxidative stress, contributing to the loss of cells viability.

Misuse of antibiotics in the clinical and agricultural sectors has caused the emergence of multidrugresistant (MDR) Klebsiella pneumoniae which contributes a threat to human health. in this study, we assessed the feasibility of lavender essential oil (LVo) as an antimicrobial agent in combinatory therapy with meropenem in suppressing the growth of carbapenemase-producing K. pneumoniae (Kpc-Kp). Synergistic interactions between LVO and meropenem were detected, which significantly reduce the inhibitory concentration of both LVO and meropenem by 15 and 4-fold respectively. Comparative proteomic profiling identified a disruption in the bacterial membrane via oxidative stress that was indicated by loss of membrane and cytoplasmic proteins and the upregulation of oxidative regulators. As a proof of concept, zeta potential measurements showed a change in cell surface charge while outer membrane permeability measurement indicated an increase in membrane permeability following exposure to LVO. This was indicative of a disrupted outer membrane. Ethidium bromide influx/efflux assays demonstrated no significant efflux pump inhibition by LVO, and scanning electron microscopy revealed irregularities on the cell surface after exposure to LVo. oxidative stress was also detected with increased level of RoS and lipid peroxidation in LVo-treated cells. in conclusion, our data suggest that LVo induced oxidative stress in K. pneumoniae which oxidizes the outer membrane, enabling the influx of generated ROS, LVO and meropenem into the bacterial cells, causing damage to the cells and eventually death. Klebsiella pneumoniae, a Gram-negative rod-shaped bacterium is one of the leading causes of hospital acquired infections, and is especially implicated in bacterial pneumonia 1,2. Misuse of antibiotics in the clinical and agricultural sectors has brought about the emergence of multidrug-resistant (MDR) K. pneumoniae, which is a threat to human health, especially in vulnerable groups such as neonates, the elderly and the immunocompromised 3,4. Carbapenems are now considered as the last resort antibiotics for treating severe MDR K. pneumoniae infections. However, resistance towards carbapenems was soon documented in K. pneumoniae due to increased reliance upon this line of antibiotics 5,6. Carbapenem-resistant K. pneumoniae produces carbapenemase, the most evolved β-lactamase currently in evidence, which can inactivate almost all classes of β-lactam antibiotics 7,8. Other antibiotic resistance mechanisms such as the overproduction of class C beta-lactamases, expression of the MDR efflux pump or an ESBL coupled with bacterial membrane permeability defects are sufficient to confer a carbapenem resistance phenotype to K. pneumonia 9-11. It has been reported that certain isolated carbapenem-resistant K. pneumoniae overexpress AcrAB pumps which remove a variety of antibiotics that penetrate the bacterial cell wall and membranes 12,13. Another study confirmed reduction in expression of porin proteins which reduces

No abstract

No abstract

Introductions: The Electronic Medical Records (EMR) system is a longitudinal electronic record consisting of all the information relevant to a patients’ health and well-being, generated by at least one encounter in a healthcare setting. It can be accessed within an institution with multi-level accessibility based on authentication customized to the type of user. Since the EMR system potentiates an organised and holistic medical history specific to a patient, it enables medical professionals to deliver a higher quality of healthcare services. Aims: The aims of this study were to understand the global perspective of EMR and its implementation as well as to locate the gaps of knowledge that still existed in the understanding and definition of EMR amongst patients and hospital staff. Methods: All major bibliographic databases such as PubMed and Google Scholar and several specialist datasets such as PsycINFO, MEDLINE and EBSCOhost from the previous 10 years (2007-2017) were employed in our search. Paper citations which utilised a reference standard were incorporated for quality assessment. An initial search found 2700 articles however after factoring in the inclusion and exclusion criteria, only 78 articles were included in this review. Results: Our findings indicated a discrepancy between the expectation of patients and what was actually practiced. Patient concerns mainly involved easy access of healthcare professionals other than doctors to their EMR in addition to non-medical information. The assumption of confidentiality was expected to be maintained by indifference; however, a good face-to-face explanation cannot be substituted with control over content and access to EMR. In the event of a breach in patient confidentiality, lawsuits against healthcare providers will rise exponentially as patients are now well-informed and more empowered to ask questions regarding the care they are receiving and information being disclosed to other parties. Conclusion: Security of information can be attained with better modelling protocols, end-user training and refresher courses done on a regular basis. Finally, controls of access will need to be implemented via passwords and digital signatures.