Adjuvant antimicrobial activity and resensitization efficacy of geraniol in combination with antibiotics on Acinetobacter baumannii clinical isolates

Adjuvant use of geraniol, a plant essential oil component, is known to increase the efficacy of antibiotics by acting as a potent inhibitor of efflux mechanisms. In this study, we assessed the effect of a geraniol-antibiotic combination in 21 Acinetobacter baumannii clinical isolates consisting of high efflux (HE) and low efflux (LE) activity groups. We determined the MIC for geraniol and the four antibiotics and evaluated the adjuvant antimicrobial activity and resensitization efficacy of adjuvant geraniol. Geraniol-antibiotic combinations significantly reduced the MIC of all four antibiotics (P < 0.0001), and the fold change in MIC decreased by 4 to >256-fold for tigecycline, >16 to >4,096-fold for ceftazidime, 1 to >4,096-fold for cefepime, and >2 to >4096-fold for ciprofloxacin. Importantly, geraniol showed adjuvant antimicrobial activity and resensitization efficacy when used in combination with antibiotics in 21 A. baumannii clinical isolates. However, there was no statistically significant difference between the HE and LE groups. Low concentrations (0.125% and 0.0625%) of geraniol showed no cytotoxic or hemolytic activity. Our study shows that geraniol, acting as an antibiotic adjuvant, is a good candidate for in vivo studies of combination therapy for the treatment of MDR/XDR A. baumannii infections.