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4 protocols using ceftriaxone

1

Antibiotic Susceptibility Testing with E-Test

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Because the disk diffusion method allows to analysis of the impact of a single concentration of an antibiotic/disk, in this experiment E-test strips with exponentially decreasing antibiotic gradient were applied. In this investigation line, the antibiotics were selected whose application, coupled with exposure to RMF, caused the largest and the smallest differences in the zones of growth inhibition in the disc diffusion method (compared to unexposed controls). The E-tests containing cefoxitin, amoxicillin, imipenem, ceftriaxone, cefuroxime, ceftazidime and cefepime were obtained from Liofilchem (Roseto degli Abruzzi, Italy), whereas the E-test containing meropenem was purchased from BioMérieux (Craponne, France).
Similarly, as in the case of the disc diffusion method, the optimal RMF frequency and exposure time, as well as unexposed controls were used. The analyses were performed on M-H agar in accordance with the E-test manufacturer’s recommendations.
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2

Detecting Neisseria gonorrhoeae via PCR

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A direct PCR was performed in the KEMRI-NUITM laboratory to confirm the presence of Neisseria gonorrhoeae. The direct PCR was done using the mighty amp reagents and the simpliprep machine. Specifically designed primers, forward-CGGCAGCATTCAATTTGTTAAAGC and reverse-CGCCATTTTTGTA, which were to yield a PCR product of 162 base pairs each, were used [14 ]. The thermal cycle conditions for the simpliprep machine were: 94°C, 60 sec (denaturation), 59°C, 60 secs (annealing), 72°C, 26 sec/max 429bp (1 min. kbp), (elongation), 72°C, 10 minutes (extended elongation). When the reaction was over, the samples were loaded on gel electrophoresis, stained, and viewed under ultraviolet light (UV).
The antimicrobial susceptibility testing was done by disk diffusion using 13 antimicrobials from Liofilchem Company (Ciprofloxacin (CIP,30μg), Ceftriaxone (CRO,30μg), Cefepime (FEP,25μg), Cefotaxime (CTX,30μg), Cefuroxime (CXM,30μg), Cefazolin (KZ,30μg), Ceftazidime (CAZ,30μg), Cefoxitin (FOX,30μg), Tetracycline (TE,30μg), Ampicillin (AMP,10μg), Amikacin (AK,30μg), Gentamycin (CN,30μg) and Amoxillin (AUG,30μg).The antimicrobial discs were inoculated onto a culture of Neisseria gonorrhoeae and incubated for 24–48 hours. The zone of inhibition was measured and interpreted using the CLSI 2016 guidelines.
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3

Pneumococcal Susceptibility Testing

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All isolates were identified according to the defined protocol of the Swiss National Center for Pneumococci [12 (link)]. Isolates were tested for penicillin and ceftriaxone susceptibility by using two different methods: the BMD method with cation-adjusted Mueller-Hinton broth supplemented with 5% lysed horse blood and the Etest method (penicillin from bioMérieux SA, Marcy-l’Étoile, France; ceftriaxone from Liofilchem, Roseto degli Abruzzi, TE, Italy) on MHA with 5% mechanically defibrinated horse blood and 20 μg/mL nicotinamide adenine dinucleotide [11 ]. The following CLSI categorization from 2022 was used for S. pneumoniae and meningitis [11 ]: penicillin ≤ 0.06 mg/L = susceptible, ≥0.12 mg/L = resistant; ceftriaxone ≤ 0.5 mg/L = susceptible, ≥2 mg/L = resistant.
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Antimicrobial Susceptibility Testing of Salmonella Choleraesuis

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S. Choleraesuis isolates were tested for susceptibility to antimicrobial agents using the agar disk diffusion method (Kirby Bauer test) following the guidelines and criteria of the Clinical and Laboratory Standards Institute (CLSI) [26 ]. The antibiotics tested (Oxoid, England) were ampicillin (10 µg), amoxicillin–calvulanic acid (20/10 µg), aztreonam (30 µg), cefepime (30 µg), ceftazidime (30 µg), cefoxitin (30 µg), cefotaxime (30 µg), cefpodoxime (10 µg), cephalothin (30 µg), cefuroxime (30 µg), ceftriaxone (30 µg), ceftiofur (30 µg), ciprofloxacin (5 µg), chloramphenicol (30 µg), nalidixic acid (30 µg), norfloxacin (10 µg), streptomycin (10 µg), tetracycline (30 µg), and trimethoprim/sulfamethoxazole (25 µg). Furthermore, cefotaxime-resistant S. Choleraesuis isolates were screened for ESBL producers by the combination disk method (CLSI, 2008) [12 (link)]. The MICs for ciprofloxacin (32–0.002 µg/mL), cefotaxime (256-0.016 µg/mL), ceftazidime (256-0.016 µg/mL), ceftriaxone (256-0.016 µg/mL) and cefpodoxime (256-0.016 µg/mL) were determined using the Liofilchem MIC test strip (Liofilchem, Roseto degli Abruzzi, Italy), according to the manufacturer’s instructions. Escherichia coli ATCC 25922 was used as the quality control strain for antimicrobial susceptibility testing.
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