In vitro investigation of antibacterial efficacy of propofol and midazolam on acinetobacteri baumannii

Sedoanalgesics are frequently used to treat anxiety, agitation, and delirium in patients who are hospitalized in intensive care units due to sepsis, septic shock, and the necessity for long-term treatment. Acinetobacteri baumannii is the most typical sepsis agent in our intensive care units, and the antibiotic colistin sulfate is favored in resistant agents. Our study's objective was to determine whether propofol and midazolam have any antimicrobial effects on Acinetobacter baumannii, as well as whether they have any effects on colistin sulfate sensitivity in vitro. 24 Acinetobacter baumanni isolates from our hospital's intensive care units that were brought to the microbiology laboratory between 01.02.2022 and 15.05.2022 were studied in the study after receiving ethics committee approval. Propofol, midazolam, and saline made under rigorous sterile conditions were evaluated to identify the possibility of contamination. Samples were taken from the tubes in which we incubated at various temperatures (4°C, 22°C, 35°C) at 0, 30, 60, 120, and 240 minutes and evaluated by colony counting after 24 hours of culture on blood agar plates in order to investigate the antimicrobial properties of propofol and midazolam on Acinetobacter baumanni. The change in the minimum inhibitory concentration (MIC) of colistin sulfate and the number of resistant isolates were examined by the liquid microdilution method in order to determine the impact of propofol and midazolam on colistin sulfate susceptibility. The medications examined for contamination risk showed no growth. The growth of Acinetobacter baumanni was shown to be substantially encouraged by propofol, and this effect was stronger in the group that was incubated at 35°C for 240 minutes. It was shown that increasing the amount of time that bacteria were exposed to high temperatures and propofol had a large and statistically significant impact on their ability to multiply (p 0.001). Contrarily, midazolam prevented the growth of Acinetobacter baumani, and at the 60th and following minutes, there was no bacterial growth in the cultured plates. As a result, it was found that midazolam's antimicrobial action increased with exposure duration (p 0.001). Colistin sulfate has a mean MIC value of 1.57–2.31 g/ml, a mean MIC value of 2.93–4.58 g/ml when combined with propofol, and a mean MIC value of 1.06–1.71 g/ml when combined with midazolam. There was a substantial difference between them (p 0.001) when it was computed as g/ml. According to MIC values, the level of resistance (colistin, isolates with MIC 2 g/ml susceptible, isolates >2 g/ml resistant) was determined. Likewise, a significant difference was found between colistin sulfate resistance of 20.8% (5 isolates), colistin sulfate resistance of 25% (6 isolates), colistin sulfate resistance of propofol, and colistin sulfate resistance of 9.1% (2 isolates). (p<0.039). Acinetobacter baumanni raises morbidity, mortality, and cost and can result in serious infections such sepsis and septic shock. Given the rise in colistin sulfate resistance, sedative medications with antibacterial activity may be favored in critically sick patients, and sedation therapy may have additional advantages. In our study, propofol promoted the growth of Acinetobacter baumanni, colistin sulfate increased the MIC value and the quantity of resistant isolates, and midazolam had an antimicrobial effect on Acinetobacter baumanni while lowering the MIC value of colistin sulfate and the quantity of resistant isolates. Due to its potential antibacterial impact, midazolam was found to be superior than propofol in critically ill patients with sepsis brought on by Acinetobacter baumanni, despite the fact that the study was conducted in vitro. However, more research on the impact of sedoanalgesic medicines on microbes is required. Keywords: Sepsis, Propofol, Midazolam, Acinetobacter baumanin, Colistin sulfate.