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Making Antimicrobial Susceptibility Testing More Physiologically Relevant with Bicarbonate?

Mariliis Hinnu1,2, Marta Putrinš1, Karin Kogermann3

  • 1University of Tartugrid.10939.32, Institute of Technology, Tartu, Estonia.

Antimicrobial Agents and Chemotherapy
|April 18, 2022
PubMed
Summary

Bicarbonate addition to lab tests does not improve azithromycin effectiveness against salmonellosis. The observed lower minimum inhibitory concentration (MIC) for azithromycin is due to increased pH, not altered efflux pump activity.

Keywords:
SalmonellaazithromycinbicarbonatepH

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Area of Science:

  • Microbiology
  • Pharmacology
  • Infectious Diseases

Background:

  • Azithromycin is crucial for invasive salmonellosis treatment.
  • Standard laboratory assays show poor azithromycin activity (high MIC).
  • Bicarbonate in blood was proposed to enhance testing relevance.

Purpose of the Study:

  • To investigate the effect of bicarbonate on azithromycin's minimum inhibitory concentration (MIC).
  • To determine if bicarbonate alters efflux pump activity in bacteria.

Main Methods:

  • Bacterial cultures were tested with varying bicarbonate concentrations.
  • pH levels of the media were carefully monitored.
  • Efflux pump activity was assessed under different conditions.

Main Results:

  • Bicarbonate addition lowered azithromycin MIC, but this effect was solely due to media alkalization.
  • The observed MIC reduction was not linked to changes in efflux pump activity.
  • Insufficiently buffered media were responsible for the bicarbonate-triggered effect.

Conclusions:

  • Bicarbonate does not enhance azithromycin's intrinsic activity against salmonellosis.
  • Physiologically relevant testing conditions require careful pH control, not just bicarbonate addition.
  • Current laboratory MIC testing may overestimate azithromycin resistance.