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Antibiotic Susceptibility Testing of Bacterial Strains

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Escherichia coli ATCC 25922, Enterobacter cloacae ATCC 13047, Klebsiella pneumoniae ATCC 13883, Pseudomonas aeruginosa ATCC 27853, and Acinetobacter baumannii 17978 were obtained from the American Type Culture Collection (Manassas, VA). Strains were stored at −80°C in tryptic soy broth (BD Diagnostics, Franklin Lakes, NJ) containing 50% glycerol (Sigma-Aldrich, St. Louis, MO).
Meropenem was from Ark Pharm (Arlington Heights, IL), cefepime was from Chem Impex (Wood Dale, IL), gentamicin was from Alfa Aesar (Haverhill, MA), and ciprofloxacin was from US Biological (Salem, MA). Antibiotic stock solutions were prepared in water for manual dilution-based testing or in water containing 0.3% polysorbate-20 as required for liquid handling by the HP D300 digital dispenser (HP Inc., Palo Alto, CA).9 We previously determined through extensive analysis that polysorbate-20 at the concentrations used in assay wells has no effect on MIC determinations for all antibiotics examined.5 (link), 10 (link)
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2

Carbapenem-resistant Enterobacterales Permeability

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One carbapenem-resistant clinical isolate each of K. pneumoniae (KP3800) and E. cloacae (EC3800) were used for all OM permeability studies. Two additional K. pneumoniae isolates (KP6478 and KP6484) were used for additional OM permeability studies to further support the developed assay and obtain insights on strain-to-strain variability. Imipenem and meropenem were purchased from AK Scientific (Union City, CA). Ceftazidime, cefepime, aztreonam, and PAβN were obtained from Chem-Impex International (Wood Dale, IL). Water and methanol (both LC/MS grade) were purchased from Fisher Scientific (Fair Lawn, NJ). Formic acid was acquired from Sigma-Aldrich (St. Louis, MO). Bacteria were grown in cation-adjusted Mueller-Hinton broth (MHII; BD BBL, Sparks, MD), and agar MICs (14 (link)) were determined according to CLSI guidelines (14 (link), 36 ).
To predict the clinically relevant range of β-lactam concentrations, we performed Monte Carlo simulations to calculate the average unbound concentration at steady state in critically ill patients at the highest clinical dose (5 (link)). These simulations were performed for a continuous infusion and based on a literature review for the pharmacokinetics of each compound (Imipenem [37 (link)– (link)40 (link)], meropenem [41 (link)– (link)45 (link)], cefepime [46 (link)], Ceftazidime [47 (link), 48 (link)], and aztreonam [38 (link), 49 (link)]).
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