title: Antimicrobial and toxicological profile of the new biocide Akacid plus.
abstract: OBJECTIVE
  Akacid plus is a new member of the polymeric guanidine family of disinfectants. It was especially developed to enhance the antimicrobial activity of this class with significantly less toxicity. The in vitro activity of Akacid plus compared with chlorhexidine digluconate and mupirocin was tested against a total of 369 recent clinical isolates.
  
  
  METHODS
  The organisms tested by CLSI reference methods included the following: Staphylococcus aureus (98), Staphylococcus epidermidis (9), Bacillus spp. (2), Enterococcus faecalis (32), Klebsiella spp. (45), Enterobacter spp. (20), Escherichia coli (65), Salmonella spp. (6), Shigella spp. (2), Yersinia enterocolitica (1), Acinetobacter spp. (4), Proteus spp. (7), Pseudomonas aeruginosa (59), Stenotrophomonas maltophilia (4), Candida spp. (10) and Aspergillus spp. (7). In vitro selection of resistance to Akacid plus was carried out on 24 strains. Toxicological analyses were also performed.
  
  
  RESULTS
  All tested agents were more effective against Staphylococcus spp. and Bacillus spp. than against E. faecalis and Gram-negative bacteria. The MIC90s of chlorhexidine and mupirocin showed a 4-fold and 32-fold increase for methicillin-resistant S. aureus in comparison with methicillin-susceptible strains, while MIC values of Akacid plus were similar for antibiotic-susceptible and multiresistant strains. Bactericidal action of Akacid plus was observed at 1-2x MIC. The in vitro selection of resistance test showed no increase in MIC values of Akacid plus for any isolate after 30 passages. In addition, Akacid plus showed low oral and dermal toxicity.
  
  
  CONCLUSIONS
  These preliminary results demonstrate the broad antimicrobial properties of Akacid plus, which makes it a promising tool for topical application in the prophylaxis and treatment of bacterial and fungal infections.
authors.affiliation: Department of Internal Medicine I, Division of Infectious Diseases and Chemotherapy, Medical University of Vienna Vienna, Austria.
authors.forename: Astrid
authors.initials: A
authors.lastname: Buxbaum
authors.forename: Christina
authors.initials: C
authors.lastname: Kratzer
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Graninger
authors.forename: Apostolos
authors.initials: A
authors.lastname: Georgopoulos
mesh_terms: D000900:Anti-Bacterial Agents / Q000494:pharmacology; D001419:Bacteria / Q000187:drug effects*; D002710:Chlorhexidine / Q000031:analogs & derivatives / Q000494:pharmacology; D004202:Disinfectants / Q000494:pharmacology*; D006146:Guanidines / Q000494:pharmacology*; D008826:Microbial Sensitivity Tests; D016712:Mupirocin / Q000494:pharmacology; D011108:Polymers / Q000494:pharmacology*
chemical_list: C512857:AKACID Plus; D000900:Anti-Bacterial Agents; D004202:Disinfectants; D006146:Guanidines; D011108:Polymers; D016712:Mupirocin; C010882:chlorhexidine gluconate; D002710:Chlorhexidine