MTS™ Synergy Application System

Patent granted in Europe, USA and Canada.

MTS-SAS combines the reliability of MIC Test Strip with patented tools to facilitate and standardize a critical assay such as the in-vitro combination of antibiotics. Antimicrobial resistance is a major challenge for clinicians and clinical microbiologists, the use of synergy testing is nowadays increasingly requested. MTS-SAS procedure is significantly faster than any other methods in antibiotic synergy tests (i.e. timekill, checkerboard), does not require any additional trainings to those who are skilled in the usage of MIC Test Strip, reduces or eliminates the risks of procedure errors when compared to laborious and complicated traditional methods.

• standardised

• easy to use

• save time, materials, workload, resources




  1. Perform standard M.I.C. of drugs A andB prior to synergy set-up.
  2. Use the "MTS Synergy Applicator System"* for the synergy testing.
  3. Take a MTS (MIC Test Strip) of the first antibiotic (A) with the tweezers and place it on the MTS Synergy Applicator Platform according to position
  4. Adjust the MTS (antibiotic A) such that the the MIC value of the first antibiotic (MICA) is positioned at the base intersection.

  1. Take a MTS of the second antibiotic (B) with tweezers and place it on the base according to position 2.

  1. Adjust the second MTS (antibiotic B) such that the MIC value of the second antibiotic (MICB) is positioned at the base intersection and intersects MTS- antibiotic A at its MIC value.

  1. Use the MTS Synergy Delivery Tool, press hard onto the two carefully positioned MTS (A and B) and move them to the agar plate.

  1. Carefully place the MTS Synergy Delivery Tool (with MTSA and MTSB) on the agar.
  2. Wait until the strips are completely moistened by surface of the agar.

  1. Remove the MTS Synergy Delivery Tool from the agar plate leaving MTSA and MTSB positioned at 90°. If necessary, use the tweezers to push the strips onto the agar surface.
  2. Finally incubate according to the standard MTS procedure for the specific microorganism.

  1. Interpret the results visually or by FIC calculation:

Synergy FIC ? 0.5
Additive FIC > 0.5 and ? 1.0
Indifference FIC > 1 and ? 4 Antagonism FIC > 4


MTS Synergy Application System
Description packaging ref.
MTS Synergy Applicator Platform 1 base 96860
MTS Synergy Delivery Tool 10 disposable applicators 96870



Learn more about MTS™ (MIC Test Strip)



Evaluation of in vitro activity of fosfomycin, and synergy in combination, in Gram-negative bloodstream infection isolates in a UK teaching hospital
J. Suich, D. Mawer, M. van der Woude, D. Wearmouth, P. Burns, T. Smeets, G. Barlow
Journal of Medical Microbiology 2022;71:001524

In-vitro activity of Isavuconazole and Amphotericin B in association against Mucorales.
G. Ortalli, E. Oliva, G. Lo Cascio, C. Farina
Pathogens 2023, 12, 948

In Vitro Synergistic Activity of Antimicrobial Combinations against Carbapenem- and Colistin-Resistant Acinetobacter baumannii and Klebsiella pneumoniae
P. Mantzana, E. Protonotariou, A. Kassomenaki, G. Meletis, A. Tychala, E. Keskilidou, M. Arhonti, C. Katsanou, A. Daviti, O. Vasilaki et al
MDPI Antibiotics 2023, 12, 93

Evaluation of in-vitro activity of double beta-lactam therapy and relationship with penicillin binding proteins activity in E. coli isolates.
J. Suich, M. Van der Woude, D. Wearmouth, P. Burns, G. Barlow
ECCMID 2022, Poster 0789

Khan A, Erickson SG, Pettaway C, Arias CA, Miller WR, Bhatti MM. 2021
Evaluation of susceptibility testing methods for aztreonam and ceftazidime-avibactam combination therapy on extensively drug-resistant Gram-negative organisms.
ASM Antimicrob Agents Chemother 65:e00846-21

Evaluation of synergistic activity of plazomicin-based combinations against KPC-producing Klebsiella pneumoniae with complex multidrug resistance phenotypes
M. Iannaccone, M. Boattini, G. Bianco, R. Cavallo & C. Costa
Journal of Chemotherapy, July 2021

Meropenem/vaborbactam-based combinations against KPC-producing Klebsiella pneumoniae and multidrug-resistant Pseudomonas aeruginosa
Marco Iannaccone, Matteo Boattini, Gabriele Bianco, Rossana Cavallo, Cristina Costa
International Journal of Antimicrobial Agents, July 2020

Evaluation of the in vitro activity of WCK 5222 (cefepime/zidebactam) and currently available combination therapies against single- and double-carbapenemase producing Enterobacteriaceae: Expanding the zone of hope
L. M. Avery , E. M. Mullane , D. P. Nicolau
International Journal of Antimicrobial Agents, Volume 55, Issue 2, February 2020, 105863

Importance of "in vitro" synergism examinations on infections caused by multidrug-resistant pathogens
M. Knausz, A. Becker, R. Nikolova, E. Urbaán, A. Laázaár

Multicentric evaluation of the reliability and the reproducibility of synergy testing using the MIC test strip - synergy application system (MTS-SAS™)
E. Carretto, F. Brovarone, P. Gaibani, G. Russello, C. Farina

Evaluation of in vitro synergy testing of South African invasive Salmonella Typhi isolates using the Liofilchem® MTS application system
Arvinda Sooka, Karen H. Keddy

Efficacy of Fosmidomycin alone and in combination with colistin, tigecycline and rifampicin against multi-drug resistant and extensively drug resistant Enterobacteriaceae
J. Tyrrell, T. R. Walsh
ECCMID 2014, Poster no. 235

In vitro activity of colistin as single agent and in combination with antifungals against filamentous fungi occurring in patients with cystic fibrosis.
H. Schemuth, S. Dittmer, M. Lackner, L. Sedlacek, A. Hamprecht, E. Steinmann, J. Buer, P.-M. Rath and J. Steinmann
Mycoses, 2013, 56, 297–303

Evaluation of gradient concentration strips for in vitro combination testing of antifungal combinations against Candida spp.
M. Siopi, A. Elefanti, N. Siafakas, L. Zerva, J. Meletiadis
ECCMID 2013, poster no. 976

Synergistic effects of rifampicin, nitrofurantoin, fosfomycin and colistin against NDM-1 positive Klebsiella pneumoniae and Escherichia coli using the new MTS synergy method
J. Weeks, T. R. Walsh
ECCMID 2013, poster no. 1553