Promising anti-microbial effect of apple vinegar as a natural decolonizing agent in healthcare workers

Figures & data

Table 1. Prevalence of nasal carriage S. aureus, methicillin-resistant Staphylococcus aureus (MRSA), and Vancomycin-Resistant Staphylococcus aureus (VRSA) in relation to different characteristics.

		S. aureus		MRSA		VRSA
	Number of nasal samples (%)	N (%)	P-value	N (%)	P-value	N (%)
Participants	124 (100%)	23 (18.5%)		14 (11.3%)		1 (0.8%)
Sex
Male	78 (62.9%)	14 (17.9%)	0.823 (NS)	9 (11.5%)	0.909 (NS)	0 (0.0%)
Female	46 (37.1%)	9 (19.6%)		5 (10.9%)		1 (2.2%)
Job
Physician	80 (64.5%)	7 (8.8%)		5 (6.3%)		0 (0.0%)
Nurse	34 (27.4%)	11 (32.4%)	0.0016* (S)	6 (17.6%)		1 (2.9%)
Worker	10 (8.1%)	5 (50%)	0.006* (S)	3 (30%)	0.013* (S)	0 (0.0%)
Ward
Gynecology	15 (12.1%)	0 (0.0%)	0.649^# (NS)	0 (0.0%)	0.839^## (NS)	0 (0.0%)
Anesthesia	19 (15.3%)	3 (15.8%)		3 (15.8%)		0 (0.0%)
Neurosurgery	7 (5.6%)	2 (28.6%)		2 (28.6%)		0 (0.0%)
Orthopedics	6 (4.8%)	0 (0.0%)		0 (0.0%)		0 (0.0%)
General. surgery	9 (7.3%)	2 (22.2%)		2 (22.2%)		0 (0.0%)
Urology	15 (12.1%)	1 (6.7%)		0 (0.0%)		0 (0.0%)
ENT	5 (4.0%)	1 (20.0%)		0 (0.0%)		0 (0.0%)
OR	19 (15.3%)	5 (26.3%)		2 (10.5%)		0 (0.0%)
Ophthalmology	29 (23.4%)	9 (31.0%)		5 (17.2%)		1 (3.4%)

*P value ≤0.017 indicated a statistically significant when compared to physicians.

#Gynecology and Orthopedics were excluded from the analysis.

##Gynecology, Orthopedics, urology, and ENT were excluded from the analysis.

Table 2. Prevalence of hand carriage (non-nasal) S. aureus and methicillin-Resistant Staphylococcus aureus (MRSA) according to different characteristics.

		S. aureus		MRSA
	Number of hand samples	N (%)	P-value	N (%)	P-value
Participants	124	15 (12.1%)		8 (6.5%)
Sex
Male	78	11 (14.1%)	0.372 (NS)	5 (6.4%)	1.000 (NS)
Female	46	4 (8.7%)		3 (6.5%)
Job
Physician	80	6 (7.5%)	0.168^# (NS)	4 (5.0%)	0.753^# (NS)
Nurse	34	6 (17.6%)		2 (5.9%)
Worker	10	3 (30%)		2 (20%)
Ward
Gynecology	15	0 (0.0%)	0.963^## (NS)	0 (0.0%)	0.446^### (NS)
Anesthesia	19	3 (15.8%)		3 (15.8%)
Neurosurgery	7	0 (0.0%)		0 (0.0%)
Orthopedics	6	0 (0.0%)		0 (0.0%)
General. surgery	9	1 (11.1%)		1 (11.1%)
Urology	15	2 (13.3%)		0 (0.0%)
ENT	5	0 (0.0%)		0 (0.0%)
OR	19	4 (21.1%)		3 (15.8%)
Ophthalmology	29	5 (17.2%)		1 (3.4%)

##Gynecology, Neurosurgery, Orthopedics, and ENT were excluded from the analysis.

###Gynecology, Neurosurgery, Orthopedics, urology, and ENT were excluded from the analysis.

Table 3. Antimicrobial susceptibility of methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant Staphylococcus aureus (VRSA) isolates collected from HCWs and workers.

	MRSA isolates N (22)		VRSA isolates N (1)
Antibiotics	Sensitive N* (%)	Resistant N* (%)	Sensitive N* (%)	Resistant N* (%)
Mupirocin R ≤ 13 mm	15 (68.2%)	7 (31.8%)	0 (0%)	1(100%)
Linezolid R ≤ 20 mm	22 (100%)	0 (0%)	1 (100%)	0 (0%)
Gentamycin R ≤ 12 mm	22 (100%)	0 (0%)	1 (100%)	0 (0%)
Erythromycin R ≤ 13 mm	14 (63.3%)	8 (36.4%)	0 (0%)	1 (100%)
Ciprofloxacin R ≤ 15 mm	22 (100%)	0 (0%)	1 (100%)	0 (0%)
Bacitracin R ≤ 10 mm	8 (36.4%)	14 (63.3%)	0 (0%)	1 (100%)

*N: number.

Table 4. Median and ranges of inhibition zone diameters of different vinegars and biocides against the studied isolates.

Substances	Median (mm)	Range (mm)	P-value
Ciprofloxacin (positive control)	3.0	2.0–4.0	<0.0001* (S)
Cholohexidine	2.0	0.0–3.8
Povidine-iodine	1.0	.0–2.20
Lemon vinegar	3.0	2.0–4.0
Grape vinegar	2.5	2.0–3.2
Apple vinegar	3.5	2.0–4.5

* P value ≤ 0.05 indicates statistically significance.

Table 5. Distribution of minimum inhibitory concentration (MIC), minimum bactericidal concentration (MBC) values, MIC50, MIC90, MBC50, andMBC9 for the studied isolates to different vinegars and biocides.

Substances	MICs 50 (µg/ml)	MICs 90 (µg/ml)	MICs Range (µg/ml)	P-value	MBC 50 (µg/ml)	MBC 90 (µg/ml)	MBCs range (µg/ml)	P-value
Vancomycin	0.5	4	0.125–32.0	<0.0001* (S)	2.0	8	0.25–64.0	<0.0001* (S)
Cholohexidine	0.078	0.125	0.039–5.0		0.156	5	0.078–10.0
Mupirocin	2.0	16	0.25–32.0		4	32	1–128
Grape vinegar	.4680	0.937	0.234–3.75		1.875	7.5	0.468–30.0
Apple vinegar	0.468	1.87	0.058–1.87		1.875	3.75	0.234–7.5

*P value ≤0.05 indicates statistically significance.

MIC – Minimum inhibitory concentration,

MBC – Minimum bactericidal concentration.

MIC 50: MIC, which inhibits 50% of isolates,

MIC 90: MIC which inhibits 90% of the isolates.

MBC 50: MBC which kill 50% of isolates,

MBC 90: MBC which kill 90% of isolates.