{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,10]],"date-time":"2025-11-10T12:17:38Z","timestamp":1762777058163,"version":"build-2065373602"},"reference-count":28,"publisher":"MDPI AG","issue":"11","license":[{"start":{"date-parts":[[2025,11,10]],"date-time":"2025-11-10T00:00:00Z","timestamp":1762732800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Ministry of Health to Ricerca corrente IRCCS MultiMedica"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diseases"],"abstract":"<jats:p>Background: Gynecological infections, including bacterial vaginosis, vulvovaginal candidiasis, and recurrent urinary tract infections, represent a major clinical burden and are often complicated by biofilm formation and antimicrobial resistance. Novel non-antibiotic strategies are urgently needed. We previously demonstrated the antimicrobial activity of silver-bound titanium dioxide (TiAB) against multidrug-resistant bacteria isolated from dermatological infections. Objectives: We evaluated whether TiAB, at concentrations used in marketed medical devices, exerts antibacterial and antifungal effects against clinically relevant vaginal isolates by determining Minimum Inhibitory Concentration\/ Minimum Bactericidal and Fungicidal Concentration (MIC, MBC\/MFC), and time\u2013kill kinetics. Methods: A total of 73 clinical isolates were collected from vaginal swabs, including Staphylococcus aureus (MSSA, MRSA), Escherichia coli (ESBL+ and non-ESBL), Klebsiella pneumoniae, Enterococcus spp., Streptococcus agalactiae, and Candida albicans. Minimum inhibitory concentrations (MICs) and minimum bactericidal\/fungicidal concentrations (MBCs\/MFCs) were determined by broth microdilution, and bactericidal activity was confirmed by time-kill assays. Results: TiAB exhibited potent activity against Gram-negative bacteria, with median MIC values of 1\u20132% (w\/v) for E. coli and K. pneumoniae. Gram-positive isolates, including S. agalactiae and Enterococcus spp., showed higher MIC values (2\u20134%). Candida albicans displayed fungistatic inhibition at 4%. Time-kill assays confirmed rapid bactericidal effects for Gram-negative isolates within 8 h at 2\u00d7 MIC, while Gram-positive bacteria required prolonged exposure. Conclusions: These findings extend previous evidence of TiAB\u2019s antimicrobial properties to gynecological pathogens, supporting its potential as a topical, non-antibiotic option for managing vaginal infections in an era of rising antimicrobial resistance. Further in vivo validation is warranted.<\/jats:p>","DOI":"10.3390\/diseases13110366","type":"journal-article","created":{"date-parts":[[2025,11,10]],"date-time":"2025-11-10T11:47:27Z","timestamp":1762775247000},"page":"366","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["In Vitro Activity of Silver-Bound Titanium Dioxide (TiAB) Against Multidrug-Resistant Vaginal Pathogens"],"prefix":"10.3390","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5206-540X","authenticated-orcid":false,"given":"Lorenzo","family":"Drago","sequence":"first","affiliation":[{"name":"UOC Laboratory of Clinical Medicine with Specialized Areas, IRCCS MultiMedica, 20138 Milan, Italy"},{"name":"Clinical Microbiology and Microbiome Laboratory, Department of Biomedical Sciences for Health, University of Milan, 20133 Milan, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8760-1292","authenticated-orcid":false,"given":"Luigi Regenburgh","family":"De La Motte","sequence":"additional","affiliation":[{"name":"UOC Laboratory of Clinical Medicine with Specialized Areas, IRCCS MultiMedica, 20138 Milan, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Erika","family":"Stef\u00e0no","sequence":"additional","affiliation":[{"name":"UOC Laboratory of Clinical Medicine with Specialized Areas, IRCCS MultiMedica, 20138 Milan, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Vincenzo","family":"Minasi","sequence":"additional","affiliation":[{"name":"UOC Laboratory of Clinical Medicine with Specialized Areas, IRCCS MultiMedica, 20138 Milan, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Loredana","family":"Deflorio","sequence":"additional","affiliation":[{"name":"UOC Laboratory of Clinical Medicine with Specialized Areas, IRCCS MultiMedica, 20138 Milan, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-1762-7567","authenticated-orcid":false,"given":"Sofia","family":"Benedetti","sequence":"additional","affiliation":[{"name":"UOC Laboratory of Clinical Medicine with Specialized Areas, IRCCS MultiMedica, 20138 Milan, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-1574-8229","authenticated-orcid":false,"given":"Fabiana","family":"Giarritiello","sequence":"additional","affiliation":[{"name":"UOC Laboratory of Clinical Medicine with Specialized Areas, IRCCS MultiMedica, 20138 Milan, Italy"},{"name":"Department of Medicine and Health Sciences \u201cV. Tiberio\u201d, University of Molise, 86100 Campobasso, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,11,10]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1478","DOI":"10.1086\/503780","article-title":"High recurrence rates of bacterial vaginosis over the course of 12 months after oral metronidazole therapy and factors associated with recurrence","volume":"193","author":"Bradshaw","year":"2006","journal-title":"J. Infect. Dis."},{"key":"ref_2","first-page":"41","article-title":"Gardnerella vaginalis and anaerobic bacteria in the etiology of bacterial (nonspecific) vaginosis","volume":"40","author":"Spiegel","year":"1983","journal-title":"Scand. J. Infect. Dis. Suppl."},{"key":"ref_3","first-page":"23","article-title":"Bacteriology of the vagina","volume":"86","author":"Hill","year":"1984","journal-title":"Scand. J. Urol. Nephrol. 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