Antimicrobial action of zinc oxide nanoparticles in combination with ciprofloxacin and ceftazidime against multidrug-resistant Acinetobacter baumannii

Acinetobacter baumannii is a serious concern amongst hospitalised patients worldwide and its resistance to antibiotics has emerged as a threat to public health in recent years. Metal oxide nanoparticles were found to be effective for overcoming bacterial resistance owing to their antibacterial activities. The aim of this study was to investigate the combined effects of zinc oxide nanoparticles (ZnO-NPs) and the conventional antibiotics ciprofloxacin and ceftazidime as well as their mechanisms of action against resistant A. baumannii. ZnO-NPs were prepared by the solvothermal method and were characterised by various methods. Broth microdilution and disk diffusion methods were used to determine the antibacterial activities of ciprofloxacin and ceftazidime antibiotics in the absence and presence of a subinhibitory concentration of ZnO-NPs. The mechanism of action of ZnO-NPs alone and in combination with these antibiotics was assessed by flow cytometry, DNA extraction, fluorescence and scanning electron microscopy. The results showed that the antibacterial activities of both antibiotics increased in the presence of a subinhibitory concentration of ZnO-NPs. Combination of ZnO-NPs with antibiotics increased the uptake of antibiotics and changed the bacterial cells from rod to cocci forms. Bacterial filamentation was also observed and exhibited no DNA fragmentation. In conclusion, the results of this study indicate that ZnO-NPs potentiate the antimicrobial action of ciprofloxacin and ceftazidime. A mechanism is proposed to explain this phenomenon.