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Fosfomycin-based combination therapy has emerged as an attractive option in our armamentarium due to its synergistic activity against carbapenem-resistant Gram-negative bacteria (CRGNB). The ability to simultaneously measure fosfomycin and other antibiotic drug levels will support in vitro and clinical investigations to develop rational antibiotic combination dosing regimens against CRGNB infections. We developed an analytical assay to measure fosfomycin with nine important antibiotics in human plasma and cation-adjusted Mueller-Hinton II broth (CAMHB). We employed a liquid-chromatography tandem mass spectrometry method and validated the method based on accuracy, precision, matrix effect, limit-of-detection, limit-of-quantification, specificity, carryover, and short-term and long-term stability on U.S. Food & Drug Administration (FDA) guidelines. Assay feasibility was assessed in a pilot clinical study in four patients on antibiotic combination therapy. Simultaneous quantification of fosfomycin, levofloxacin, meropenem, doripenem, aztreonam, piperacillin/tazobactam, ceftolozane/tazobactam, ceftazidime/avibactam, cefepime, and tigecycline in plasma and CAMHB were achieved within 4.5 min. Precision, accuracy, specificity, and carryover were within FDA guidelines. Fosfomycin combined with any of the nine antibiotics were stable in plasma and CAMHB up to 4 weeks at -80 °C. The assay identified and quantified the respective antibiotics administered in the four subjects. Our assay can be a valuable tool for in vitro and clinical applications.

A novel solvent-loaded dispersive solid-phase extraction (SL-DSPE) method integrated with liquid-phase microextraction (LPME) has been developed by the direct loading of solvent into the pores of a metal-organic framework (MOF), MIL-101(Cr)-NH 2 . Despite numerous advantages of MOFs, they are usually highly hydrophobic which limits their dispersibility and therefore effective contact with the analytes in aqueous samples. To overcome this and promote its interactions with polar compounds, MIL-101(Cr) was functionalized with -NH 2 and loaded with a comparatively polar organic solvent, dichloromethane. The purpose of dichloromethane was to condition the MIL-101(Cr)-NH 2 , promote LPME of the analytes and facilitate the re-collection of the materials after the extraction. Five chlorophenoxy acid herbicides, including 2,4-dichlorophenoxyacetic acid, 2,4,5-trichlorophenoxyacetic acid, 4-chlorophenoxyacetic acid, 2-(2,4-dichlorophenoxy)propionic acid, and 2-(2,4,5-trichlorophenoxy)propionic acid, were studied and determined by ultra-high-performance liquid chromatography-tandem mass spectrometry (UHPLC-MS/MS). MIL-101(Cr)-NH 2 was characterized by X-ray diffraction, Fourier-transform infrared spectroscopy, scanning electron microscopy, and surface area measurement. Several extraction parameters were optimized, and under the most favorable conditions, the SL-DSPE-UHPLC-MS/MS method achieved enrichment factors between 25 and 66. Low limits of detection (2.66-19.7 ng·L -1 ) and wide dynamic working ranges with good linearity (r 2  ≥ 0.991) were attained for all analytes. The method was repeatable, with intra- and inter-day relative standard deviations (RSDs) below 4.5 and 7.6%, respectively, for three replicate determinations. The application of SL-DSPE-UHPLC-MS/MS to paddy field waters gave satisfactory relative recoveries ranging between 80.2 and 108%, with RSDs better 8.4%. Several of the CPAs were detected in these samples. Graphical abstract Schematic of the solvent-loaded dispersive solid-phase extraction procedure. By directly loading dichloromethane into the pores of MIL-101(Cr)-NH 2 , this method improves the extraction capability of the sorbent through the combination of solvent- and sorbent-based microextraction.