Effects of combination of alcohol and Cinnamomum burmannii essential oil against Klebsiella pneumoniae resistance


Jennifer Anggraini Sasangka(1*), Handi Suyono(2), Gladdy Lysias Waworuntu(3)

(1) Undergraduate Program of Medical Doctor, the Faculty of Medicine, Widya Mandala Surabaya Catholic University, Surabaya
(2) Department of Physiology and Biochemistry, Faculty of Medicine, Widya Mandala Surabaya Catholic University, Surabaya,
(3) Department of Microbiology and Parasitology, Faculty of Medicine, Widya Mandala Surabaya Catholic University, Surabaya, East Java, Indonesia
(*) Corresponding Author


Alcohol-based antiseptics are widely used in the COVID-19 pandemic to prevent the transmission of infections, including bacterial infections. However, bacterial resistance to the alcohol-based antiseptics is begun reported. Klebsiella pneumonia resistance is one of the bacterial resistances that is prioritized by the WHO to be overcome. Cinnamomum burmannii essential oil, containing cinnamaldehyde and eugenol, was investigated for antimicrobial activity. This study aimed to evaluate the synergistic effect of the combination of alcohol and C. burmannii essential oil in inhibiting bacterial growth. Ethanol 80% in a combination with C. burmannii essential oil at concentrations of 1, 2, and 3% v/v were evaluated against K. pneumoniae using the Kirby-Bauer disc diffusion method. Test was repeated three times in independent experimental. Inhibition zone diameter (IZD, mm) and antimicrobial index (AI, %) were determined and analyzed using Kruskal-Wallis test continued the Mann-Whitney test. The combination of ethanol and C. burmannii essential oil was sensitive to K. pneumoniae, meanwhile, ethanol 80% was not more sensitive. The IZD of the combination solution at 1, 2, and 3% concentration were 6.7±0.19, 9.0±0.58, and 11.0±1.15mm, respectively (p<0.05). The AI of the combination solution at concentrations of 1, 2, and 3% v/v were 7.04±2.04, 30.53±6.79, and 51.64±12.91%, respectively (p<0.05). In conclusion, the combination of ethanol 80% and C. burmannii essential oil active against K. pneumoniae which resistant to the ethanol.


alcohol; Cinnamomum burmannii; Klebsiella pneumonia; resistance; antiseptics

Full Text:



Sikora A and Zahra F. Nosocomial infections. [Updated 2022 Sep 23]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-.
2.Saharman YR, Karuniawati A, Sedono R, Aditianingsih D, Goessens WHF, Klaassen CHW, et al. Clinical impact of endemic NDM-producing Klebsiella pneumoniae in intensive care units of the national referral hospital in Jakarta, Indonesia. Antimicrob Resist Infect Control 2020; 9(1):61.
3.Durdu B, Hakyemez IN, Bolukcu S, Okay G, Gultepe B, Aslan T. Mortality markers in nosocomial Klebsiella pneumoniae bloodstream infection. Springerplus 2016; 5(1):1892.
4.Hawley L, Ziegler RJ, Clarke Bl. Microbiology & immunology, 6th eds. Philadelphia: Lippincott Williams & Wilkins, 2014.
5.CDC. Antibiotic resistance threats in the United States. Centers Dis Control Prev. 2019; 65-77.
6.Eichenberger EM, Thaden JT. Epidemiology and mechanisms of resistance of extensively drug resistant Gram-negative bacteria. Antibiotics 2019; 8(2):37.
7.World Health Organization (WHO). Global priority list of antibiotic-resistant bacteria to guide research, discovery, and development of new antibiotics. WHO Press 2017: 1–7.
8.Ferreira RL, da Silva BCM, Rezende GS, Nakamura-Silva R, Pitondo-Silva A, Campanini EB, et al. High prevalence of multidrug-resistant Klebsiella pneumoniae harboring several virulence and β-lactamase encoding genes in a Brazilian intensive care unit. Front Microbiol 2019; 9:3198.
9.Exner M, Bhattacharya S, Christiansen B, Gebel J, Goroncy-Bermes P, Hartemann P, et al. Antibiotic resistance: What is so special about multidrug-resistant Gram-negative bacteria? GMS Hyg Infect Control 2017; 12:doc05.
10.Al-Talib H, Alkhateeb A, Ruzuki ASA, Zulkifli NF, Hamizi S, Muhamad NS, et al. Effectiveness of commonly used antiseptics on bacteria causing nosocomial infections in tertiary hospital in Malaysia. Afr J Microbiol Res 2019; 13(10):188-94.
https://doi.org/10.5897/AJMR 2019.9058
11.Matthew EW, Lucy JB, Laura CB, Sutton JM. Mechanisms of increased resistance to chlorhexidine and cross-resistance to colistin following exposure of Klebsiella pneumoniae clinical isolates to chlorhexidine. Antimicrob Agents Chemother 2017; 61(1):1-12.
12.Mbajiuka C, Onuoha S, Ugah U. Comparative studies of the efficacy of some disinfectants on human pathogens. Researcher 2015; 7(1):39-45.
13.Centers for Disease Control and Prevention (CDC). Chemical disinfectants disinfection: Sterilization guidelines Guidelines Library Infection Control CDC [Internet]. Guideline for Disinfection and Sterilization in Healthcare Facilities. 2008. Available from: https://www.cdc.gov/infectioncontrol/guidelines/disinfection/disinfection-methods/chemical.html
14.Mohsin T, Sarfaraz H, Gohar MUF. Antimicrobial applications of differnet plant essential oils. Eur J Pharm Med Res 2017; 4(3):58.
15.Winska K, Mączka W, Łyczko J, Grabarczyk M, Czubaszek A, Szumny A. Essential oils as antimicrobial agents—myth or real alternative? Molecules 2019; 24(11):2130.
16.Vangalapati M, Sree Satya N, Surya Prakash DV, Avanigadda S. A review on pharmacological activities and clinical effects of Cinnamon species. Res J Pharm Biol Chem Sci 2012; 31(1):653-63.
17.Ács K, Balázs VL, Kocsis B, Bencsik T, Böszörményi A, Horváth G. Antibacterial activity evaluation of selected essential oils in liquid and vapor phase on respiratory tract pathogens. BMC Complement Altern Med 2018; 18(1):227.
18.Julianti E, Rajah KK, Fidrianny I. Antibacterial activity of ethanolic extract of cinnamon bark, honey, and their combination effects against acne-causing bacteria. Sci Pharm 2017; 85(2):19.
19.Hudzicki J. Kirby-Bauer disk diffusion susceptibility test protocol. American Sociaty for Microbiology, 2012.
20.CSLI. Performance standards for antimicrobial susceptibility testing, 32nd ed. CSLI supplement M100. Wayne PA: Clinical and Laboratory Standard Institute, 2020.
21.Zhang Y, Liu X, Wang Y, Jiang P, Quek SY. Antibacterial activity and mechanism of cinnamon essential oil against Escherichia coli and Staphylococcus aureus. Food Control 2016; 59:282-9.
22.Gold NA, Mirza TM, Avva U. Alcohol sanitizer. In: StatPearls [Internet]. Treasue Island (FL): StatPearls Publishing, 2022.
23.Aboualizadeh E, Bumah VV, Masson-Meyers DS, Eells JT, Hirschmugl CJ, Enwemeka CS. Understanding the antimicrobial activity of selected disinfectants against methicillin-resistant Staphylococcus aureus (MRSA). PLoS ONe 2017; 12(10):e0186375.
24.Nirwati H, Sinanjung K, Fahrunissa F, Wijaya F, Napitupulu S, Hati VP, et al. Biofilm formation and antibiotic resistance of Klebsiella pneumoniae isolated from clinical samples in a tertiary care hospital, Klaten, Indonesia. 2019;13(Suppl 11):20.
25.Sauerbrei A. Bactericidal and virucidal activity of ethanol and povidone-iodine. Microbiologyopen 2020; 9(9):e1097.
26.Akthar MS, Degaga B, Azam T. Antimicrobial activity of essential oils extracted from medicinal plants against the pathogenic microorganisms : a review. Issues Biol Sci Pharm Res 2014; 2(1):001-7.
27.Seukep JA, Fankam AG, Djeussi DE, Voukeng IK, Tankeo SB, Noumdem JA, et al. Antibacterial activities of the methanol extracts of seven Cameroonian dietary plants against bacteria expressing MDR phenotypes. Springerplus 2013; 2:236.
28.El-Shouny W, Abd El-Zaher E, Shabana S, Mohammed O. Antimicrobial activity of different essential oils against Aspergillus flavus and Klebsiella pneumoniae isolated from respiratory tract. Egypt J Bot 2017; 57:161-72.
29.Elcocks ER, Spencer-Phillips PTN, Adukwu EC. Rapid bactericidal effect of cinnamon bark essential oil against Pseudomonas aeruginosa. J Appl Microbiol 2020; 128(4):1025-37.
30.Fajara A, Ammara GA, Hamzaha M, Manurunga R, Abduh MY. Effect of tree age on the yield, productivity, and chemical composition of essential oil from Cinnamomum burmannii. Curr Res Biosci Biotechnol 2019; 1(1):17-22.
31.Farias APP, Monteiro OS, da Silva JKR, Figueiredo PLB, Rodrigues AAC, Monteiro IN, et al. Chemical composition and biological activities of two chemotype-oils from Cinnamomum verum J. Presl growing in North Brazil. J Food Sci Technol 2020; 57(9):3176-83.
32.EL-Farmawi D, Olama Z, Holail H. The Antibacterial effect of some natural bioactive materials against Klebsiella pneumoniae and MRSA. Int J Curr Microbiol App Scie 2014; 3(3):576-88.
33.Cui HY, Zhou H, Lin L, Zhao CT, Zhang XJ, Xiao ZH, et al. Antibacterial activity and mechanism of cinnamon essential oil and its application in milk. J Anim Plant Sci. 2016; 26:532-41.
34.Vasconcelos NG, Croda J, Simionatto S. Antibacterial mechanisms of cinnamon and its constituents: a review. Microb Pathog 2018; 120:198-203.
35.Yang SK, Yusoff K, Ajat M, Thomas W, Abushelaibi A, Akseer R, et al. Disruption of KPC-producing Klebsiella pneumoniae membrane via induction of oxidative stress by cinnamon bark (Cinnamomum verum J. Presl) essential oil. PLoS One 2019; 14(4):e0214326

DOI: https://doi.org/10.19106/JMedSci005501202302

Article Metrics

Abstract views : 383 | views : 396

Copyright (c) 2023 Jennifer Anggraini Sasangka, Handi Suyono, Gladdy Lysias Waworuntu

Creative Commons License
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

View My Stats


Creative Commons License
Journal of the Medical Sciences (Berkala Ilmu Kedokteran) by  Universitas Gadjah Mada is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
Based on a work at http://jurnal.ugm.ac.id/bik/.