Chlorhexidine-impregnated PEM/THFM polymer exhibits superior activity to fluconazole-impregnated polymer against Candida albicans biofilm formation

Biofilm-associated infections represent a major challenge for biomaterials. Methods to alter the chemical characteristics of biomaterials offer an attractive solution for enhanced microbial control. The aim of this study was to investigate the efficacy of a poly(ethyl methacrylate)/tetrahydrofurfuryl methacrylate (PEM/THFM) acrylic model impregnated with fluconazole (FLU) or chlorhexidine (CHX) in preventing Candida biofilm formation in vitro. PEM/THFM disks impregnated with CHX (n = 50) or FLU (n = 50) and drug-free control disks (n = 50) were infected with Candida albicans ATCC 90028. Disks were incubated for 2, 7, 14, 21 or 28 days at 37 °C and the biofilm biomass and metabolic activity was quantified at each time point using crystal violet staining and XTT [2,3-bis(2-methoxy-4-nitro-5-sulfo-phenyl)-2H-tetrazolium-5-carboxanilide] reduction assay. FLU disks exhibited poor overall biofilm inhibitory characteristics, with mean metabolic and biomass inhibition of 12.6% and 8.8%, respectively. Conversely, CHX disks were highly effective, significantly inhibiting biofilm development by 75% (P ≤ 0.001) and its metabolism by 84% (P ≤ 0.001) for all time points tested. The notable efficacy of CHX against C. albicans biofilms is a promising outcome to overcome the side effects and poor relative activity of conventional antifungal agents against Candida biofilms. These findings indicate that impregnation of PEM/THFM with antimicrobials has potential as a treatment modality for denture stomatitis.