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5 protocols using aztreonam

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Antibiotic Susceptibility Testing by MIC

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Mueller-Hinton (MH) agar-dilution minimum inhibitory concentration (MIC) measurements were performed according to Clinical and Laboratory Standards Institute (CLSI) guidelines 2014, Performance Standards for Antimicrobial Susceptibility Testing; Twenty-Fourth Informational Supplement80 (link),81 (link). The MICs are reported as the concentrations at which bacterial growth was no longer observed. Avibactam was tested at a constant 4 μg/mL in combination with its respective antibiotic partners. All MIC measurements were performed at least three times.
Ampicillin, piperacillin, ceftriaxone, cephalothin, potassium clavulanate, cefotaxime, and chloramphenicol were purchased from Sigma-Aldrich. Ceftazidime was procured from Sigma and Research Products International and used interchangeably throughout the experimentation. Imipenem was obtained from USP and from the commercial source. Sulbactam was bought from Astatech. Tazobactam and aztreonam were purchased from Chem-Impex Int’l. Ceftolozane-Tazobactam, cefepime, meropenem, ertapenem, and doripenem were obtained from their commercial sources. Avibactam was purchased from Advanced ChemBlocks.
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Antibiotic Susceptibility Testing Protocols

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Ceftazidime was procured from Sigma-Aldrich (catalog no. C3809) and Research Products International (catalog no. 33527) and used interchangeably throughout the experimentation. Merck & Co., Inc. (Kenilworth, NJ, USA) provided ceftolozane powder. Avibactam was purchased from Advanced ChemBlocks (catalog no. R16073). Piperacillin (catalog no. P8396), cefotaxime (catalog no. C7912), and chloramphenicol (catalog no. R4405) were purchased from Sigma-Aldrich. Imipenem was obtained from USP (catalog no. 1337809) and from the commercial source. Tazobactam (catalog no. 15141) and aztreonam (catalog no. 15151) were purchased from Chem-Impex International. ceftolozane-Tazobactam, cefepime, and meropenem were obtained from their commercial sources. Nitrocefin (catalog no. BR0063G) was purchased from Oxoid. The LP-06 and S02030 BATSIs were synthesized as previously described (43 (link), 44 ). See Drawz et al. (20 (link)) for a discussion on the P. aeruginosa control strains (18SH AmpC for PDC-3 and PAO1 for PDC-1).
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Microbial Susceptibility Testing Agents

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Ampicillin (catalog no. A9518), piperacillin (catalog no. P8396), ceftriaxone (catalog no. C5793), cephalothin (catalog no. C4520), potassium clavulanate (catalog no. 33454), cefotaxime (catalog no. C7912), and chloramphenicol (catalog no. R4405) were purchased from Sigma-Aldrich. Ceftazidime was procured from Sigma (catalog no. C3809) and Research Products International (catalog no. 33527), and the products from the two sources were used interchangeably throughout the experimentation. Imipenem was obtained from USP (catalog no. 1337809) and from the commercial source (pharmacy). Sulbactam was bought from Astatech. Tazobactam (catalog no. 15141) and aztreonam (catalog no. 15151) were purchased from Chem-Impex International. Ceftolozane-Tazobactam, cefepime, meropenem, ertapenem, and doripenem were obtained from their commercial sources. Ceftaroline was provided by Allergan. Nitrocefin (catalog no. BR0063G) was purchased from Oxoid. Avibactam was purchased from Advanced ChemBlocks (catalog no. R16073).
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Synthesis and Procurement of Antibiotics

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Cefiderocol, ceftolozane, and avibactam were synthesized at the research laboratories of Shionogi & Co., Ltd. (Osaka, Japan). Commercial-grade antibiotics were obtained as follows: ceftazidime, tazobactam, amikacin, and aztreonam from Chem-Impex International, Inc. (Wood Dale, IL); cefepime and metronidazole from U.S. Pharmacopeia (Rockville, MD); meropenem, colistin, and gentamicin from Wako Pure Chemical Industries, Ltd. (Osaka, Japan); and ciprofloxacin and piperacillin from LKT Laboratories, Inc. (St. Paul, MN).
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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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