Live/Dead Staining for Quantifying Viable but Not Culturable Cells in Manuka Honey-Treated Wound-Causing Bacteria

Antibiotic resistance and tolerance among bacteria pose a significant threat to global health. Mechanisms contributing to antibiotic resistance and tolerance include genetic mutations and, acquisition of resistance genes, and transition to Viable But Not Culturable (VBNC) and other dormancy states, respectively. Although genetically identical to their non-antibiotic-tolerant counterparts, VBNC cells evade antibiotic effects by remaining metabolically inactive. Antibiotics are effective only when their target processes, such as DNA replication or transcription, are active. Since environmental stressors, particularly antibiotics, can drive bacteria into dormancy, alternative antimicrobials are needed to minimize or prevent this response. The antimicrobial Manuka Honey (MH) is effective against many bacteria, with rare development of resistance. Its multifaceted antimicrobial mechanisms make it a valuable agent for treating bacterial infections. This research investigated MH recalcitrance to antibiotic resistance development by testing the hypothesis that MH induces fewer VBNC cells than conventional antibiotics. To investigate this, a protocol was developed to treat the wound-causing bacteria Staphylococcus aureus and Pseudomonas aeruginosa with minimum inhibitory concentrations of MH or the conventional antibiotics tobramycin or meropenem, that then used the viable plate count to identify metabolically active culturable cells and live/dead staining to identify all viable cells. The number of VBNC cells equaled the viable cell number minus the culturable cell number. In some experiments, the culturable cell number was higher than the viable cell number, giving a negative number of VBNC cells; thus, VBNC cell numbers were not directly compared. Instead, culturable and viable cell numbers were compared for each treatment. Only P. aeruginosa treated with tobramycin had significantly fewer culturable cells than viable cells, indicating a higher number of VBNC cells. This protocol is quick and easy and can be used to evaluate MH induction of VBNC cells in other pathogenic bacteria.