These corresponded to 49 MRSA and 3 MSSA, isolated from single patients and different biological products. All isolates were tested for identification and antibiotic susceptibility by the automated system WalkAway® (Dade Behring™) and selected on the basis of their resistance to ciprofloxacin. Growth conditions Strains were grown in tryptic soy broth (TSB) at 37°C with shaking or in tryptic soy agar (TSA) (Oxoid Ltd., Basingstoke, UK). Strain ATCC25923EtBr was grown in TSB or TSA supplemented with 50 mg/L of EtBr. For determination of minimum inhibitory concentrations (MICs), cultures were grown in Mueller-Hinton

broth (MH, Oxoid) at 37°C. Antibiotics and dyes Antibiotics in powder form were purchased from different sources, as follows: nalidixic acid (Sigma-Aldrich, St. Louis, MO, USA); norfloxacin (ICN Biomedicals Inc., Ohio, USA); ciprofloxacin (Fluka Chemie GmbH, Buchs, see more Switzerland). EtBr was acquired in powder form from Sigma (Madrid, Spain). Efflux inhibitors (EIs) Carbonyl cyanide m-chlorophenylhydrazone (CCCP), thioridazine (TZ), chlorpromazine (CPZ), verapamil (VER) and reserpine (RES) were purchased from Sigma. Solutions of TZ, CPZ and VER find more were prepared in desionized water; RES was prepared in dimethylsulfoxide (DMSO) and CCCP in 50% methanol (v/v). All solutions were

prepared on the day of the experiment and kept protected from light. EtBr-agar Cartwheel (EtBrCW) Method This simple method tests the presence of active efflux systems [11, 12, 23], being an update of the already described, EtBr-agar screening

Celecoxib method [23, 24]. It provides information on the capacity of each isolate to extrude EtBr from the cells by efflux pumps, on the basis of the fluorescence emitted by cultures swabbed in EtBr-containing agar plates. Briefly, each culture was swabbed onto TSA plates containing EtBr concentrations ranging from 0.5 to 2.5 mg/L (0.5 mg/L increments). S. aureus cultures ATCC25923 and ATCC25923EtBr were used as negative and positive controls for efflux activity, respectively [13]. The plates were incubated at 37°C during 16 hours, after which the minimum concentration of EtBr associated with the bacterial mass that produced fluorescence under UV light was recorded in a Gel-Doc XR apparatus (Bio-Rad, Hercules, CA, USA). Isolates showing fluorescence at lower EtBr concentrations have potentially less active efflux systems than isolates for which fluorescence is only detected at higher concentrations of EtBr [11, 12, 23, 24]. Isolates showing emission of fluorescence only at the maximum concentration of EtBr tested (2.5 mg/L) were considered to have potential active efflux systems. Drug susceptibility testing Antibiotics and EtBr MICs for antibiotics were determined by the selleck compound two-fold broth microdilution method [25].