A total of 19 (29.7%) isolates presented the mucoid phenotype, but no statistical significant differences in the susceptibility profile of mucoid and non-mucoid isolates were found for the antibiotics tested in the different conditions performed in this study (MIC, BIC and MCA). The repeatability of the assays demonstrated a coefficient of variation (CV) of MIC and BIC for CAZ, CIP, IPM, MEM, and TOB of 10.21 and 9.45, 7.09 and 8.46, 14.74 and 2.13, 7.70 and 3.94, 10.01 and 8.51, respectively. When macrolides

were associated, the highest CV was 20.12% for CAZ with 8 mg/L of CLR and the lowest was 0% for TOB with 2 and 8 mg/L of CLR. Discussion Bacteria in biofilm are more prone to resist treatment with antibiotics and to evade the action of immune system cells. The present study observed Fedratinib cost a significant difference between MIC in planktonic Sirolimus and in biofilm growth conditions. BIC values were considerably higher than the conventional MIC values for all anti-pseudomonal antibiotics tested in our study as also found by Moskowitz and collaborators [19]. MEM proved to be the most active antibiotic regardless the growth condition, CAZ proved to be the second most active antibiotic in planktonic conditions of growth, whereas CIP was the

second most active antibiotic in biofilm conditions. In vitro studies have indicated that CIP is one of the most active agents against bacterial biofilm of S. aureus and P. aeruginosa. This is possibly related to the fluoroquinolones ability to penetrate into biofilms killing non-growing bacteria [20–22]. As expected, all isolates were resistant to AZM and CLR. The principal finding of our study was that non-susceptible second P. aeruginosa exposed to macrolides at sub-inhibitory concentrations became susceptible to a variety of anti-pseudomonal agents (CAZ, CIP, IPM, MEM, and TOB) in biofilm conditions. It is of note that in many associations we found a strong

IQ between anti-pseudomonal agents and macrolides. The impact of tobramycin/clarithromycin and ceftazidime/clarithromycin Selleck FRAX597 co-administration on P. aeruginosa biofilms was also observed in studies of Tré-Hardy and collaborators [23, 24]. Other study showed that the biofilm was strongly affected by the presence of clarithromycin, and, in its presence, amikacin MIC lower than those obtained in the absence of clarithromycin [25]. In our study, co-administration of AZM at 8 mg/L presented considerable impact when associated with all anti-pseudomonal agents tested (CAZ, CIP, IPM, MEM, and TOB) on P. aeruginosa biofilms from CF patients. Although AZM has no bactericidal effect on P.