The emergence of antimicrobial resistance raises the fear of untreatable diseases. Antimicrobial resistance is a multifaceted and dynamic phenomenon that is the cumulative result of different factors. While Gram-positive pathogens, such as methicillin-resistant Staphylococcus aureus and Clostridium difficile, were previously the most concerning issues in the field of public health, Gram-negative pathogens are now of prime importance. The World Health Organization’s priority list of pathogens mostly includes multidrug-resistant Gram-negative organisms particularly carbapenem-resistant Enterobacterales, carbapenem-resistant Pseudomonas aeruginosa, and extensively drug-resistant Acinetobacter baumannii. The spread of Gram-negative bacterial resistance is a global issue, involving a variety of mechanisms. Several strategies have been proposed to control resistant Gram-negative bacteria, such as the development of antimicrobial auxiliary agents and research into chemical compounds with new modes of action. Another emerging trend is the development of naturally derived antibacterial compounds that aim for targets novel areas, including engineered bacteriophages, probiotics, metal-based antibacterial agents, odilorhabdins, quorum sensing inhibitors, and microbiome-modifying agents. This review focuses on the current status of alternative treatment regimens against multidrug-resistant Gram-negative bacteria, aiming to provide a snapshot of the situation and some information on the broader context.
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Objectives
To screen methanolic leaf extracts of 21 timber-yielding plants for antibacterial activity against nine species of uropathogenic bacteria isolated from clinical samples of a hospital (<i>Enterococcus faecalis, Staphylococcus aureus</i>, <i>Acinetobacter baumannii, Citrobacter freundii, Enterobacter aerogenes, Escherichia coli, Klebsiella pneumoniae, Proteus mirabilis,</i> and <i>Pseudomonas aeruginosa</i>). Methods
Bacterial strains were subjected to antibiotic sensitivity tests by the Kirby–Bauer's disc diffusion method. The antibacterial potentiality of leaf extracts was monitored by the agar-well diffusion method with multidrug-resistant (MDR) strains of nine uropathogens. Results
Two Gram-positive isolates, <i>E. faecalis</i> and <i>S. aureus</i>, were resistant to 14 of the 18 antibiotics used. Gram-negative isolates <i>A. baumannii</i>, <i>C. freundii</i>, <i>E. aerogenes</i>, <i>E. coli</i>, <i>K. pneumoniae</i>, <i>P. mirabilis</i>, and <i>P. aeruginosa</i> were resistant to 10, 12, 9, 11, 11, 10, and 11 antibiotics, respectively, of the 14 antibiotics used. Methanolic leaf extracts of <i>Anogeissus acuminata</i> had the maximum zone of inhibition size—29 mm against <i>S. aureus</i> and 28 mm against <i>E. faecalis</i> and <i>P. aeruginosa. Cassia tora</i> had 29 mm as the zone of inhibition size for <i>E. faecalis, E. aerogenes</i>, and <i>P. aeruginosa</i>. Based on the minimum inhibitory concentration and minimum bactericidal concentration values, the most effective 10 plants against uropathogens could be arranged in decreasing order as follows: <i>C. tora</i> > <i>A. acuminata</i> > <i>Schleichera oleosa</i> > <i>Pterocarpus santalinus</i> > <i>Eugenia jambolana</i> > <i>Bridelia retusa</i> > <i>Mimusops elengi</i> > <i>Stereospermum kunthianum</i> > <i>Tectona grandis</i> > <i>Anthocephalus cadamba.</i> The following eight plants had moderate control capacity: <i>Artocarpus heterophyllus</i>, <i>Azadirachta indica</i>, <i>Dalbergia latifolia</i>, <i>Eucalyptus citriodora</i>, <i>Gmelina arborea</i>, <i>Pongamia pinnata</i>, <i>Pterocarpus marsupium</i>, and <i>Shorea robusta</i>. <i>E. coli</i>, followed by <i>A. baumannii</i>, <i>C. freundii</i>, <i>E. aerogenes</i>, <i>P. mirabilis</i>, and <i>P. aeruginosa</i> were controlled by higher amounts/levels of leaf extracts. Phytochemicals of all plants were qualitatively estimated. Conclusions
A majority of timber-yielding plants studied had <i>in vitro</i> control capacity against MDR uropathogenic bacteria.
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