Oxi/Ferm Pluri Test® (Liofilchem, Italy) was used. Next, the automatic characterization was carried out with the VITEK® 2 equipment and with the VITEK®2 GN identification cards (bioMérieux, Marcy-l’Étoile, France). The motility of the bacterium was tested in Motility Test Agar, (Liofilchem, Italy). Antimicrobial sensitivity was determined using E-test in Müller Hinton agar (Pronadisa®, Madrid, Spain) using the following antibiotics: piperacillin and piperacillin with tazobactam, cefepime (bioMérieux, Marcy-l’Étoile, France); ceftazidime, imipenem, imipenem with EDTA, amikacin, gentamicin, and ciprofloxacin (Liofilchem, Italy).
Piperacillin
Manufactured by bioMérieux
Sourced in Spain, Sweden
Piperacillin is a broad-spectrum antibiotic that belongs to the class of penicillins. It is a synthetic derivative of penicillin and is used to treat a wide range of bacterial infections. Piperacillin is an injectable medication that is typically administered intravenously or intramuscularly.
Automatically generated - may contain errors
Lab products found in correlation
Cefepime, by bioMérieux (5 mentions)
Ciprofloxacin, by bioMérieux (3 mentions)
Imipenem, by bioMérieux (3 mentions)
Piperacillin tazobactam, by bioMérieux (2 mentions)
Amoxicillin, by bioMérieux (2 mentions)
Cefotaxime, by bioMérieux (2 mentions)
Tobramycin, by bioMérieux (2 mentions)
Amikacin, by bioMérieux (2 mentions)
Levofloxacin, by bioMérieux (2 mentions)
Gentamicin, by Liofilchem (1 mentions)
Amikacin, by Liofilchem (1 mentions)
Ceftazidime, by Liofilchem (1 mentions)
Vitek 2 equipment, by bioMérieux (1 mentions)
Oxi ferm pluri test, by Liofilchem (1 mentions)
Vitek 2 gn identification cards, by bioMérieux (1 mentions)
Motility test agar, by Liofilchem (1 mentions)
Ciprofloxacin, by Liofilchem (1 mentions)
Imipenem, by Liofilchem (1 mentions)
Amoxicillin clavulanic acid, by bioMérieux (1 mentions)
Etest strips, by bioMérieux (1 mentions)
6 protocols using piperacillin
1
Automated Characterization of Bacterial Isolates
2
Antimicrobial Susceptibility Testing of Strains
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Antimicrobial susceptibility testing of strains was performed using the disc diffusion method as previously described [20 (link)] and according to the EUCAST recommendations [38 (link)]. Antibiotics (bioMérieux) tested were as follows: amoxicillin, amoxicillin-clavulanic acid, piperacillin, piperacillin-tazobactam, ertapenem, imipenem, cefoxitin, tetracycline, tigecycline, chloramphenicol, moxifloxacin, metronidazole, linezolid and vancomycin. Minimum inhibitory concentrations (MICs) for tetracycline, clindamycin and cefotaxime were determined using the E-test strips as specified by the manufacturer (bioMérieux). Antimicrobial susceptibility testing was performed twice.
3
Antibiotic Susceptibility Testing of BAL Samples
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The BAL fluid from each subject was divided into 2 samples. The first sample was sent to the routine diagnostic laboratory. Antibiotic susceptibilities results were classified as susceptible, intermediate, and resistant by the Phoenix automated microbiology system (BD Diagnostics, le Pont de Claix, France) according to The European Committee on Antimicrobial Susceptibility Testing recommendations. The second BAL sample (10 mL) was sent to our laboratory, where it was subjected to centrifugation (4,000g for 4 min). Once the supernatant was carefully removed, a 1.5-mL aliquot was used to inoculate 2 Mu ¨ller-Hinton and 1 blood agar plates. A set of 9 different E-test strips, including amoxicillin, amoxicillin plus clavulanate, cefotaxime, cefepime, piperacillin, piperacillin-tazobactam, ertapenem, doripenem, and colimycin (BioMe ´rieux, Marcy-L'e ´toile, France), was directly applied to the Mu ¨ller-Hinton agar plates. Vancomycin and cefoxitin E-test strips were applied onto the blood agar plate (Fig. 1). The Mu ¨ller-Hinton agar plates were incubated at 37°C, whereas the blood agar plates were in a 5% CO 2 incubator at 37°C.
4
Antibiotic Resistance Profiling of P. aeruginosa
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Following the recommendations of the European Committee on Antimicrobial Susceptibility Testing (EUCAST) (EUCAST 2019 ), both P. aeruginosa isolates were tested against the following antibiotic discs using the disc diffusion method. The multidrug discs contained ciprofloxacin (5 µg), piperacillin (100 µg), imipenem (10 µg), cefepime (30 µg), fosfomycin (200 µg), colistin (10 µg), and tobramycin (10 µg) (AB Biodisk, UK). The zones of inhibition (ZoI) were measured in millimetres following 12–18 h incubation at 37 °C, and interpreted in accordance with the manufacturer’s recommendations. Bacterial isolates were designated as antibiotic resistant (AMR) if they were resistant to multiple antimicrobial agents, classes, or subclasses of antibiotics as defined by EUCAST (Magiorakos et al. 2012 (link)).
5
Antibiotic Susceptibility of E. coli
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The E coli isolates were subjected to antibiotic susceptibility testing by modified Kirby-Bauer disk diffusion method on Mueller-Hinton agar plates as per the Clinical and Laboratory Standards Institute (CLSI) guidelines.46 The commercially available minimum inhibitory concentration (MIC) strips containing the following antimicrobials were tested for the DEC isolates: ampicillin, piperacillin, levofloxacin, ciprofloxacin, ampicillin-sulbactam, piperacillin-tazobactam, amikacin, cefoxitin, gentamicin, ceftazidime, cefotaxime, ceftriaxone, cefepime, aztreonam, imipenem, and meropenem (AB Biodisk, Solna, Sweden). The strips were aseptically placed on the surfaces of the sensitivity agar plates and these were incubated for 18 to 24 hours at 37°C. The MIC values (mg/L) were determined (MIC50 and MIC90 were calculated as the MIC point at which 50% and 90% of the isolates were inhibited) and interpreted according to CLSI guidelines as modified in 2013.
6
Antimicrobial Susceptibility of Pseudomonas aeruginosa
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The isolated JNQH-PA57 was grown in Mueller-Hinton agar (MHA) (Oxoid, Hampshire, United Kingdom) at 37 °C for 24 h. The species identification was determined with Microflex LT/SH MALDI-TOF mass spectrometer (Bruker, Germany). The antimicrobial susceptibility of this stain was performed using MIC evaluation via the E-test method for the following antimicrobial agents: piperacillin, piperacillin/tazobactam, ticarcillin/clavulanic acid, ceftazidime, cefepime, aztreonam, imipenem, meropenem, amikacin, tobramycin, levofloxacin, ciprofloxacin, according to the manufacturer’s guidelines (AB Biodisk, Sweden). For colistin, the MIC was determined via a broth microdilution method, according to the Clinical and Laboratory Standards Institute (CLSI) guideline. P. aeruginosa ATCC 27853 served as a quality control strain for susceptibility testing. The interpretation of the results was based on the CLSI 2020 guideline [55 ].
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