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8 protocols using daptomycin

1

Antibiotic Resistance Profiling

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Resistance to a set of other agents was assessed with the use of the disc diffusion (DD) method and the E-test method. The former (by Oxoid) was applied for penicillin (P); amikacin (AK); gentamycin (CN); ciprofloxacin (CIP); levofloxacin (LEV); mupirocin (MUP); fusidic acid (FUS); tetracycline (TET), and the latter (by BioMerieux) for ceftaroline (CPT); vancomycin (VA); teicoplanin (TP); linezolid (LZD); daptomycin (DPC); tigecycline (TGC); and spectinomycin (SC), according to the EUCAST guidelines [28 ,51 ].
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2

Temporal Trends in MRSA Antibiotic Susceptibility

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A total of 200 isolates of MRSA obtained from clinical specimens (pus – 119; blood – 12; tissue bit – 9; pleural fluid – 2; tracheal aspirate – 4; wound swab – 40, and 14 from other specimens) submitted to Department of Microbiology, JIPMER, Puducherry from January 2012 to December 2014. The isolates were almost equally distributed over the three-year period – 2012 (62), 2013 (63), and 2014 (75). Only one isolate per patient was included in the analysis. In case of multiple isolates, the first isolate was included. Minimum inhibitory concentration (MIC) was determined by E-test for anti-MRSA antibiotics vancomycin, linezolid, daptomycin, and tigecycline, according to manufacturer's instructions (bioMérieux,) and the results were interpreted as per CLSI guidelines6 and EUCAST guidelines7 for tigecycline. For quality control, Staphylococcus aureus ATCC 29213 was employed. Methicillin resistance was confirmed by PCR for mecA gene.
The percentage of isolates with a median MIC value less than or equal to that of the index year (2012) was calculated for each antibiotic in the three years under study, to observe changes in the proportion of isolates with lower MIC values, which would suggest an “MIC creep”. In addition, MIC50 and MIC90 values of vancomycin, linezolid, daptomycin, and tigecycline were also calculated.
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Antimicrobial Susceptibility of SAR Bari Strain

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Antimicrobial susceptibility of the SAR Bari strain was determined by a BD PHOENIX 100 instrument (Becton Dickinson, Franklyn Lake, NJ). Data were elaborated by the BD Epicenter Expert System according to EUCAST rules (http://www.eucast.org). The PMIC/ID-88 (BD) panel was used to test susceptibility to ampicillin, cefoxitin, ceftaroline, ciprofloxacin, clindamycin, daptomycin, erythro-mycin, fosfomycin, fusidic acid, gentamicin, imipenem, linezolid, moxifloxacin, mupirocin, nitro-furantoin, oxacillin, penicillin, rifampin, teicoplanin, tetracyclin, tigecycline, trimethoprim/ sulfamethoxazole, and vancomycin. The Epsilometer Test (ETest) was used for testing resistance to ciprofloxacin, daptomycin, erythromycin, gentamicin, moxifloxacin, tetracyclin, tigecycline, trimethoprim/sulfamethoxazole, and vancomycin (bioMérieux, Marcy-L’Étolie, France and Liofilchem, Roseto degli Abruzzi, Italy). All tests were repeated on four independent technical replicates. MIC interpretative breakpoints were defined according to EUCAST recommendations. Staphylococcus aureus ATCC 29213 was used as a control strain.
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Antibiotic Susceptibility of srtA Mutant

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Overnight cultures of the srtA conditional mutant grown in HIB supplemented with AHT (1.0 ng/ml) were harvested by centrifugation, and cells were washed in fresh medium and diluted 100 fold. 100-μl aliquots of cell suspensions were spread on HIB agar plates containing various concentrations of AHT (0, 10, and 100 ng/ml). Each E-test strip containing benzylpenicillin, vancomycin or daptomycin (bioMerieux) was laid on bacterial plates. After 3 days of incubation at 37°C, elliptical zones of inhibition were observed on plates and the minimum inhibitory concentration (MIC) of each antibiotic was recorded. Mean values and standard deviations of MICs were calculated from three independent experiments. Statistical significance was determined by Student’s t test.
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5

Antibiotic Susceptibility of Marseille-P3237

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The antibiotic susceptibility of strain Marseille-P3237 was assessed using the E-test method for the following molecules: benzylpenicillin, amoxicillin, cefotaxime, ceftriaxone, imipenem, amikacin, erythromycin, daptomycin, rifampicin, minocycline, teicoplanin, vancomycin, colistin and metronidazole (bioMérieux).
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6

Antibiotic Resistance Profile Evaluation

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The antibiotic resistance profile of the strain was evaluated using the E‐test method and the following molecules: benzylpenecilin, amoxicillin, cefotaxime, ceftriaxone, imipenem, rifampicin, minocycline, tigecycline, amikacin, teicoplanin, vancomycin, colistin, daptomycin, and metronidazole (Biomerieux, France).
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7

Investigation of VanB Enterococcus Isolates

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Altogether, 278 non-repetitive isolates with the VanB phenotype received by the NRCARS during 1999–2010 from 36 centers in 22 cities were investigated. Fifty-eight VanB isolates from 1999 to 2005 were partly characterized previously [16 (link)]; of these, 56 were available and 222 isolates were received in 2006–2010. Twenty-seven and 48 isolates were obtained from invasive and non-invasive infections, respectively, and 201 from carriage; for two remaining isolates, the source was not reported. Antimicrobial susceptibility was tested using the broth microdilution method [17 ] and the Etest method for vancomycin, teicoplanin, and daptomycin (bioMerieux, Marcy l’Etoile, France). Results were interpreted following the European Committee on Antimicrobial Susceptibility Testing (EUCAST)-approved breakpoints [18 ] and the Epidemiological Cut-Offs (ECOFFs) (http://mic.eucast.org/Eucast2/, 6th November 2017, date last accessed).
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8

Cell Wall and Membrane Sensitivity Analysis

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To investigate further the effects of csp gene removal on cell wall and cell membrane systems, we next compared the sensitivity of the WT strain and the csp deletion mutants to cell wall- and cell membrane-targeting antibiotics. Bacteria were grown overnight on blood agar plates at 37°C, after which 0.5 McFarland standard density bacteria solutions were prepared and spread onto Muller Hinton plus blood agar plates to cover the whole surface. Ampicillin, daptomycin, polymyxin B, and vancomycin E tests strips were then placed on the center of each plate, and sensitivity to each antibiotic was determined in accordance with the recommendations of the manufacturer (Biomerieux, Lyon, France). To simulate conditions under which nisin stress sensitivity was tested, daptomycin and vancomycin sensitivity was also determined using BHI agar plates. The results were assessed after 48 h of incubation at 37°C.
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