Effect of Acetic Acid on Clinical Isolated Pseudomonas aeruginosa Biofilm in Chronic Suppurative Otitis Media: In vitro Study

Background: Forming biofilms on bacteria can inhibit the penetration of antimicrobial agents and avoid the immune defence system. It becomes one of the factors causing therapy failure and chronicity of infection. Pseudomonas aeruginosa is the most common bacteria found in Chronic Suppurative Otitis Media (CSOM), which has the virulence ability to form biofilm structures. Some studies have reported that acetic acid can inhibit and eradicate biofilm complexes and is thought to be an alternative to additional therapy against bacterial infections that form biofilms. Objective: to explain the effect of acetic acid inhibiting and eradicating Pseudomonas aeruginosa biofilm in CSOM. Methods: This study used an experimental in vitro laboratory with a post-test-only control group method. Samples were taken from the secretions of the mastoid cavity of CSOM patients. The inhibitory effect of acetic acid was observed by administering acetic acid to Pseudomonas aeruginosa. In contrast, the effect of eradicating biofilm was observed by administering acetic acid to Pseudomonas aeruginosa which had already formed a biofilm. The observations in this study were using the microtiter plate assay method and were measured with an ELISA reader. Data analysis used the One-Way Anova test and multiple comparisons (Tukey HSD Test). Result: The inhibitory effect of acetic acid on the growth of Pseudomonas aeruginosa biofilm was obtained (p=0.000) with significant results (p <0.05) between the positive control group and the concentration group of 0.16%, 0.31%, 0.63%, 1.25%, 2.5%, and 5%. The Minimum Biofilm Inhibitory Concentration (MIBC) value of acetic acid in forming Pseudomonas aeruginosa biofilms was 0.16%. The effect of acetic acid eradication on Pseudomonas aeruginosa biofilms (p=0.000) with significant results (p<0.05) between the positive control group and the concentration group of 0.08%, 0.16%, 0.31%, 0.63%, 1.25%, 2.5%, and 5%. While the minimum value of acetic acid Biofilm Eradication Concentration (MEBC) for Pseudomonas aeruginosa biofilm eradication was 0.08%. Conclusion: Acetic acid inhibits the formation and eradication of Pseudomonas aeruginosa biofilms in CSOM.