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Antibiotic Susceptibility Profiling of A. hydrophila

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Antibiotic susceptibility profile for A. hydrophila Ah17 was determined by the Kirby‐Bauer disk diffusion method (Bauer, Kirby, Sherris, & Turck, 1966). The following antibiotics were tested: Amikacin (AK: 30 μg), Amoxicillin (AMC: 30 μg), Ampicillin (AMP: 10 μg), Azithromycin (AZM: 15 μg), Cefixime (CFM: 5 μg), Cefoperazone (CPZ: 75 μg), Cefpodoxime (CPD: 10 μg), Ciprofloxacin (CIP: 5 μg), Chlorompenicol (C: 30 μg), Clarithromycin (CLR: 15 μg), Co‐Trimoxazole (COT: 25 μg), Doxycycline hydrochloride (DO: 30 μg), Fosfomycin (FO: 200 μg), Fusidic acid (FC: 10 μg), Gentamicin (GEN: 10 μg), Imipenem (IPM: 10 μg), Kanamycin (K: 30 μg), Linezolid (LZ: 30 μg), Methicillin (MET: 5 μg), Minocycline (MI: 30 μg), Nalidixic acid (NA: 30 μg), Nitrofurantoin (NIT: 300 μg), Norfloxacin (NX: 10 μg), Penicillin G (P: 10 μg), Pristinomycin (RP: 15 μg), Rifampicin (RIF: 5 μg), Streptomycin (S: 10 μg), Teicoplanin (TEI: 30 μg), Tetracycline (TE: 30 μg), Trimethoprim (TR: 5 μg), Tobramycin (TOB: 10 μg), and Vancomycin (VA: 30 μg) (HiMedia). 200 μl of A. hydrophila Ah17 suspension was swabbed on Mueller‐Hinton agar (MHA) medium (HiMedia) and kept for drying. Antibiotic discs were placed on the MHA medium and incubated at 37°C for 24–48 hr. The diameter of the zone of inhibition was measured, and susceptibility was categorized according to the manufacturer's protocol.
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Antimicrobial Susceptibility of MRSA Isolates

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The in vitro antimicrobial susceptibility test for all the MRSA isolates were performed using ampicillin (A), ampicillin/sulfbactam (A/S), chloramphenicol (CL), ciprofloxacin (CP), clindamycin (CD), co-trimoxazole (COT), levofloxacin (LE), linezolid (LZ), fusidic acid (FC), minocycline (MIN), mupirocin (MU), ofloxacin (OF), oxacillin (OX), gentamicin (G), tetracycline (TET), rifampicin (RIF), teicoplanin (TEI), and vancomycin (V) (HiMedia Laboratories, India). Minimal inhibitory concentration (MIC) of daptomycin and vancomycin were determined by E-test method (Biomerieux, New Delhi; Ezy MIC strips, HiMedia Laboratories, India). The MRSA isolate that exhibited a vancomycin MIC of 4-8 mg/L was considered a VISA isolate. All assays were performed in accordance with Clinical and Laboratory Standards Institute guidelines.[18 ]
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Antibiotic Susceptibility of Bacterial Isolates

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The susceptibility to the commercial antibiotics of the bacterial isolates was evaluated using the disc diffusion method. Antibiotics used against Gram-positive bacteria included cefoxitin, benzyl-penicillin, oxacillin, imipenem, gentamicin, ciprofloxacin, moxifloxacin, inducible clindamycin resistance, erythromycin, clindamycin, vancomycin, tetracycline, fusidic acid, and trimethoprim/sulfamethoxazole. On the other hand, antibiotics used against Gram-negative bacteria included temocillin, ampicillin, amoxicillin/clavulanic acid, ticarcillin, ticarcillin/clavulanic acid, piperacillin, piperacillin/tazobactam, cephalothin, cefuroxime, cefotaxime, ceftazidime, ceftriaxone, cefepime, ertapenem, imipenem, meropenem, amikacin, gentamicin, tobramycin, ciprofloxacin, tigecycline, fosfomycin, nitrofurantoin, pefloxacin, minocycline, colistin, and trimethoprim/sulfamethoxazole (Himedia Labs, Mumbai, India) [19 ].
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Antimicrobial Resistance Profiling of Clinical Isolates

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Antimicrobial susceptibility tests of the clinical isolates against different antimicrobials were performed in Müller–Hinton agar (MHA) using the standard disk diffusion technique (modified Kirby–Bauer method) and interpreted as per Clinical and Laboratory Standards Institute guidelines.16 The following antimicrobial agents were tested: ampicillin (10 μg), cefoxitin (30 μg), ciprofloxacin (5 μg), chloramphenicol (30 μg), clindamycin (2 μg), cotrimoxazole (25 μg), doxycycline (30 μg), erythromycin (15 μg), gentamicin (10 μg), minocycline (30 μg), rifampicin (5 μg), teicoplanin (30 μg), tetracycline (30 μg) and vancomycin (30 μg) (HiMedia Laboratories, Mumbai, Maharashtra, India). S. aureus ATCC 25923 was used as the control organism.
Isolates were considered multidrug resistant (MDR) based on the guidelines recommended by the joint initiative of the European Centre for Disease Prevention and Control (ECDC) and the Centers for Disease Control and Prevention (CDC).17 (link) According to those guidelines, the isolates showing non-susceptibility to at least one agent in three or more antimicrobial categories were identified as MDR.
S. aureus isolates showing positive D zone test were considered as resistant to clindamycin.
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