Be lieve in Inno vat ion

ANTIMICROBIAL SUSCEPTIBILITY TESTING

Providing rapid susceptibility test results can reduce hospitalization costs, antibiotic use and drug-resistance

In cases of serious bacterial infections the timely administration of an effective antibiotic therapy is associated with an increase in disease resolution and subsequent patient survival.

For this reason, the microbiology laboratory has to provide "clinically useful results" in order to guide the clinician to choose the most appropriate antibiotic therapy as soon as possible. Rapid Antimicrobial Susceptibility Test (AST) results facilitate effective treatment, reduce the number of laboratory tests ordered, days of hospitalization and Public Health costs. In addition, they are useful in monitoring the evolution of resistant bacteria.

LIGHT SCATTERING TECHNOLOGY APPLIED TO SUSCEPTIBILITY TESTING

EACH ANTIBIOTIC IS INDIVIDUALLY MARKED* Alfred 60 and HB&L are conceived in Lyophilized Antibiotics Code EUCAST Lyophilized Antibioticsi Codice CLSI order to properly monitor the turbidity 1. AMPICILLIN ENTEROBACTERIACEAE SI 954-AMP 1. AMIKACIN SI 912-AMK levels of the samples simultaneously to 2. CEFUROXIME SI 960-FUR 2. AMOXICILLIN-CLAVULANATE 3. AMIKACIN ENTEROBACTERIACEAE SI 956-AMK STAPHYLOCOCCUS SI 938-AMC the culture test. 4. AMIKACIN PSEUDOMONAS SI 978-AMK 3. AMPICILLIN SI 939-AME 5. AMIKACIN STAPHYLOCOCCI SI 981-AMK 4. AMPICILLIN G + ENTEROC. SI 922-AMP Positive culture samples can be fl agged 6. AMPICILLIN ENTEROCOCCI SI 955-AMP 5. AZTREONAM SI 926-ATM by the instruments when the turbidity 7. AZTREONAM ENTEROBACTERIACEAE SI 957-ATM 6. CEFOTAXIME SI 937-CTX reaches the 0.5 Mc Farland (by the 8. CEFOTAXIME SI 959-CTX 7. CEFOXITIN SCN SI 941-FXC 9. CEFTAZIDIME ENTEROBACTERIACEAE SI 949-CAZ 8. CEFOXITIN STAPH. AUREUS SI 940-CFX Mc Farland Monitor). Monomicrobial 10. CEFTRIAXONE SI 951-CRO 9. CEFTAZIDIME FOR samples can then be tested with a 11. CEFOXITIN STAPH. AUREUS SI 961-FOX ENTEROBACTERIACEAE SI 947-CAE customized antibiotic panel providing 12. CEFOXITIN SCN SI 962-FOX 10. CEFTAZIDIME SI 919-CAZ 13. CIPROFLOXACIN SI 963-CIP 11. CEFTRIAXONE SI 933-CRO results within few hours. 14. CLINDAMYCIN STAPHYLOCOCCI SI 964-CLI 12. CEFUROXIME SI 931-FUR 15. COLISTIN PSEUDOMONAS SI 983-CST 13. CIPROFLOXACIN SI 916-CIP The results are expressed in 16. COTRIMOXAZOLE ENTEROBACTERIACEAE SI 965-SXT 14. CLINDAMYCIN FOR percentage of resistance to the 17. COTRIMOXAZOLE ENTEROCOCCI SI 977-SXT STAPHYLOCOCCUS SI 943-CLI antibiotic and classifi ed as Resistant, 18. COTRIMOXAZOLE STAPHYLOCOCCI SI 982-SXT 15. COTRIMOXAZOLE SI 911-SXT 19. GENTAMICIN SI 967-GEN 16. FOSFOMYCIN SI 910-FOS Intermediate or Sensitive. 20. GENTAMICIN STAPHYLOCOCCI SI 968-GEN 17. GENTAMICIN SI 913-GEN 21. LEVOFLOXACIN SI 969-LEV 18. LEVOFLOXACIN SI 927-LEV Alifax Antimicrobial Susceptibility Testing 22. LINEZOLID SI 970-LZD 19. LINEZOLID SI 934-LZD is applicable on positive monomicrobial 23. MEROPENEM ENTEROBACTERIACEAE SI 971-MEM 20. MEROPENEM SI 942-MEM cultures obtained using the Uro-Quick 24. MEROPENEM PSEUDOMONAS SI 979-MEM 21. NORFLOXACIN SI 932-NOR 25. PIPERACILLIN-TAZOBACTAM 22. OXACILLIN STAPH. AUREUS SI 915-OXA Screening Kit (Code SI 390.900), ENTEROBACTERIACEAE SI 953-TZP 23. PIPERACILLIN-TAZOBACTAM SI 925-TZP HB&L™ Culture Kit (Code SI 405.901) 26. TEICOPLANINA SCN SI 976-TEI 24. TEICOPLANIN SI 945-TEI and on bacterial suspensions obtained 27. TEICOPLANIN S. AUREUS AND 25. VANCOMYCIN SI 930-VAN ENTEROCOCCI SI 975-TEI * MARKED on Urine and isolated colonies from isolated colonies. 28. VANCOMYCIN STAPHYLOCOCCI SI 973-VAN 29. VANCOMYCIN ENTEROCOCCI SI 974-VAN Now available the new application of Alifax direct AST on positive hemoculture. Results are available within 3 hours after the start of analysis. Comparative studies vs the Kirby Bauer reference system(1,2) and other automated systems(3,4,5) show high correlations. ALIFAX ANTIMICROBIAL SUSCEPTIBILITY TESTING The Alifax systems determine if a bacteria is sensitive or resistant to selected antibiotics by comparing growth curves of the same bacterial suspension inoculated in vials with and without (reference vial) drugs.

REFERENCE RESISTANT SENSITIVE ALIFAX SUSCEPTIBILITY TESTING ON POSITIVE HEMOCULTURE SAMPLES Ref. 6

NEW 1. POSITIVE SAMPLE SELECTION AND MICROSCOPE EVALUATION

Thanks to the new revolutionary 1:10 2. DILUTION 1:10 OF POSITIVE BLOOD CULTURE BROTH application on HB&L and Alfred IN SALINE SOLUTION 60, positive blood cultures can be tested with Alifax AST kits dramatically reducing the analytical turnaround time and 3. 500 µl SUSPENSION DILUTION IN A HB<M giving results in few hours(4,5,6). CULTURE VIAL + DEB SUPPLEMENT UNTIL THE 0.5 MCFARLAND Alifax AST gives results about antibiotics effectiveness 24-48 hours sooner than traditional methods. 4. ALIFAX AST with a customized antibiotic panel following: - Gram indication - Administered drug information - Therapeutic protocols data and guide line 0.5 Mc Farland Antibiotic 4 Reference Antibiotic 1 Antibiotic 2 Antibiotic 3 Antibiotic 5

5. RESULTS IN 3 HOURS

Each Alifax AST antibiotic kit contains: SHELF LIFE • 10 vials of lyophilized antibiotic From production: 8 months at +2÷8 °C. • Regenerative Solution From reconstitution: 7 days at +4 °C STORAGE CONDITIONS • 60 blue cap disposable vials with coloured glass Refrigerated temperature (+2÷8 °C) RELATED KIT AST Mc Farland Kit Code SI 912 SVR

Bibliography 1- S. Roveta et al. (Microbiology Institute, Genoa University, Italy) "Antibiotic susceptibility tests directly on urine samples by Uro-Quick, a rapid automated system", J Chemother. 2006 Feb;18(1): 12-9 2- E. Pezzati et al. (Microbiology Institute, Genoa University, Italy) " Evaluation of the Uro-Quick system for antibiotic susceptibility tests of strains collected from intensive care units" Annals of Microbiology 2006, 56(2):179-183 3- A. Tessari et al. (Mic. Dep., Padova University Hospital ,Padova, Italy) Evaluation of a new rapid method for microbial growth analysis and antimicrobial susceptibility test in human biological fl uids” Abstract, 17th ECCMID, München, 31 March-3 April 2007. 4- V. Kroumova et al. (Microbiology and Virology laboratory from university mayor hospital of charity of Novara, Italy) “Preliminary indications for antibiotic susceptibility tests in less than six hour in positive blood cultures” Microbiologia Medica, Anno 2010, Vol. 25, N° 1, 24-26 5- S. Barocci et al. (Microbiology Unit, Clinical Pathology Laboratories ASUR 4 Senigallia (AN), Italy) “HB&L System: rapid determination of antibiotic sensitivity of bacteria isolated from blood cultures” Microbiologia Medica, Anno 2010, Vol. 25, N° 1, 60-63 Rev. 07.10.11 Rev. 6- V. Rondinelli et al.“ New method for rapid Susceptibility Testing on blood culture with HB&L system: preliminary data” (Mic. e Vir. Lab Azienda Ospedaliera Pugliese-Ciaccio, Catanzaro) Microbiologia Medica, 2010, Vol. 25, N°4, 238-243

ALIFAX S.p.A. Via F. Petrarca, 2/1 35020 Polverara - Padova, ITALY Tel. +39 049 0992000 Fax +39 049 5855434 [email protected] www.alifax.com Entered in Padova companies register at the n. 04337640280. Company stock € 6.000.000 entirely deposited Company with single partner