A comparative evaluation of colistin Minimum Inhibitory Concentration determination by reference broth microdilution with other commonly used phenotypic methods in Multidrug-Resistant Gram-negative bacilli

Submitted: 7 July 2023
Accepted: 11 September 2023
Published: 7 December 2023
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Background: over the past decade, the dependency on colistin as a last resort antibiotic has driven the global emergence of colistin resistance among many bacterial species. This study comparatively evaluated the colistin Minimum Inhibitory Concentration (MIC) by various phenotypic methods, including the reference method of Broth Microdilution (BMD), other approved methods of Colistin Broth Disk Elution (CBDE), and Colistin Agar Test (CAT) and widely available method of Epsilometer Test (E-test) among Multidrug Resistant (MDR) Gram-negative bacteria. Methods: ninety Gram-negative bacterial isolates that were resistant to three or more classes of drugs (MDR) were included in the study. All the MDR isolates were subjected to colistin susceptibility determination by BMD, CBDE, CAT, and E-test. Results: amongst 1118 samples, 90 (8.05%) samples yielded MDR Gram-negative bacilli. All the MDR Gram-negative isolates were colistin intermediate by all four methods of phenotypic colistin susceptibility. Three Acinetobacter baumannii and two Klebsiella pneumoniae isolates that had MIC of 2 μg/mL by BMD, displayed MIC of <1 μg/mL by CBDE and CAT. Three isolates (2 Citrobacter koseri and 1 Enterobacter spp.) showed higher MIC by the E-strip method in comparison to BMD. Conclusions: our study holds significance, as there is a paucity of data comparing the four phenotypic methods for colistin MIC determination; BMD is the most reliable, gold standard method, but it is labor-intensive and requires technical expertise. In the present study, CBDE and CAT methods showed good concordance with BMD, and are easy to perform with limited logistics. Thus, they can be used as an alternative to BMD. We found that even though the Etest method was less accurate, it can still be used with caution to exclude the possibility of colistin resistance.

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Alotaibi F. Carbapenem-Resistant Enterobacteriaceae: an update narrative review from Saudi Arabia. J Infect Public Health 2019;12:465-71. DOI: https://doi.org/10.1016/j.jiph.2019.03.024
Bakthavatchalam YD, Shankar A, Thukaram B, et al. Comparative evaluation of susceptibility testing methods for colistin and polymyxin B among clinical isolates of carbapenem- resistant Klebsiella pneumoniae and Acinetobacter baumannii. J Infect Dev Ctries 2018;12:504-7. DOI: https://doi.org/10.3855/jidc.9660
Baron S, Hadjadj L, Rolain J-M, Olaitan AO. Molecular mechanisms of polymyxin resistance: knowns and unknowns. Int J Antimicrob Agents 2016;48:583-91. DOI: https://doi.org/10.1016/j.ijantimicag.2016.06.023
Bernasconi OJ, Principe L, Tinguely R, et al. Evaluation of a New Commercial Microarray Platform for the Simultaneous Detection of β-Lactamase and mcr-1 and mcr-2 Genes in Enterobacteriaceae. J Clin Microbiol 2017;55:3138-41. DOI: https://doi.org/10.1128/JCM.01056-17
Bialvaei AZ, Samadi Kafil H. Colistin, mechanisms and prevalence of resistance. Curr Med Res Opin 2015;31:707-21. DOI: https://doi.org/10.1185/03007995.2015.1018989
Biswas S, Brunel JM, Dubus JC, et al. Colistin: an update on the antibiotic of the 21st century. Expert Rev Anti Infect Ther 2012;10:917-34. DOI: https://doi.org/10.1586/eri.12.78
Chew KL, La MV, Lin RTP, Teo JWP. Colistin and Polymyxin B Susceptibility Testing for Carbapenem-Resistant and mcr-Positive Enterobacteriaceae: Comparison of Sensititre, MicroScan, Vitek 2, and Etest with Broth Microdilution. J Clin Microbiol 2017;55:2609-16. DOI: https://doi.org/10.1128/JCM.00268-17
Clinical and Laboratory Standards Institute (CLSI). M07-A10: methods for dilution antimicrobial susceptibility tests for bacteria that grow aerobically. Approved Standard, Vol. 35. Wayne, PA, USA. 2015.
CLSI. Performance Standards for Antimicrobial Susceptibility Testing. 32nd edition. CLSI document M100-A32 edition. Wayne, PA, USA. 2022.
Dixon RA, Chopra I. Leakage of periplasmic proteins from Escherichia coli mediated by polymyxin B nonapeptide. Antimicrob Agents Chemother 1986;29:781-8. DOI: https://doi.org/10.1128/AAC.29.5.781
European Committee on Antimicrobial Susceptibility Testing (EUCAST). Breakpoint Tables for Interpretation of MICs and Zone Diameters. 2018. Available from: https://www.eucast.org/clinical_breakpoints
Falagas ME, Kasiakou SK, Saravolatz LD. Colistin: the revival of polymyxins for the management of multidrug-resistant gram-negative bacterial infections. Clin Infect Dis 2005;40:1333-41. DOI: https://doi.org/10.1086/429323
Gold HS, Moellering RC Jr. Antimicrobial-drug resistance. N Engl J Med 1996;335:1445-53. DOI: https://doi.org/10.1056/NEJM199611073351907
Hussein K, Raz-Pasteur A, Finkelstein R, et al. Impact of carbapenem resistance on the outcome of patients' hospital-acquired bacteremia caused by Klebsiella pneumoniae. J Hosp Infect 2013;83:307-13. DOI: https://doi.org/10.1016/j.jhin.2012.10.012
Li J, Nation RL, Turnidge JD, et al. Colistin: the re-emerging antibiotic for multidrug-resistant Gram-negative bacterial infections. Lancet Infect Dis 2006;6:589-601. DOI: https://doi.org/10.1016/S1473-3099(06)70580-1
Magiorakos AP, Srinivasan A, Carey RB, et al. Multidrug-resistant, extensively drug-resistant and pan-drug-resistant bacteria: an international expert proposal for interim standard definitions for acquired resistance. Clin Microbiol Infect 2012;18:268-81. DOI: https://doi.org/10.1111/j.1469-0691.2011.03570.x
Peterson E, Kaur P. Antibiotic resistance mechanisms in bacteria: relationships between resistance determinants of antibiotic producers, environmental bacteria, and clinical pathogens. Front Microbiol 2018;9:2928. DOI: https://doi.org/10.3389/fmicb.2018.02928
Poirel L, Jayol A, Nordmann P. Polymyxins: antibacterial activity, susceptibility testing, and resistance mechanisms encoded by plasmids or chromosomes. Clin Microbiol Rev 2017;30:557-96. DOI: https://doi.org/10.1128/CMR.00064-16
Satlin MJ, Lewis JS, Weinstein MP, et al. Clinical and Laboratory Standards Institute and European Committee on Antimicrobial Susceptibility Testing Position Statements on Polymyxin B and Colistin Clinical Breakpoints. Clin Infect Dis 2020;71:e523-9. DOI: https://doi.org/10.1093/cid/ciaa121
Siddiqui MT, Mondal AH, Gogry FA, et al. Plasmid-mediated ampicillin, quinolone, and heavy metal co-resistance among ESBL-producing isolates from the Yamuna River, New Delhi, India. Antibiotics 2020;9:826. DOI: https://doi.org/10.3390/antibiotics9110826
Simner PJ, Bergman Y, Trejo M, et al. Two-Site Evaluation of the Colistin Broth Disk Elution Test To Determine Colistin In Vitro Activity against Gram-Negative Bacilli. J Clin Microbiol 2019;57:e01163-18. DOI: https://doi.org/10.1128/JCM.01163-18
Singhal L, Sharma M, Verma S, et al. Comparative Evaluation of Broth Microdilution with Polystyrene and Glass-Coated Plates, Agar Dilution, E-Test, Vitek, and Disk Diffusion for Susceptibility Testing of Colistin and Polymyxin B on Carbapenem-Resistant Clinical Isolates of Acinetobacter baumannii. Microb Drug Resist 2018;24:1082-8. DOI: https://doi.org/10.1089/mdr.2017.0251
Suay-García B, Pérez-Gracia MT. Present and Future of Carbapenem-resistant Enterobacteriaceae (CRE) Infections. Antibiotics (Basel). 2019;8:122. DOI: https://doi.org/10.3390/antibiotics8030122
Tamma PD, Aitken SL, Bonomo RA, et al. Infectious Diseases Society of America 2022 Guidance on the Treatment of Extended-Spectrum β-lactamase Producing Enterobacterales (ESBL-E), Carbapenem-Resistant Enterobacterales (CRE), and Pseudomonas aeruginosa with Difficult-to-Treat Resistance (DTR-P. aeruginosa). Clin Infect Dis 2022;75:187-212. DOI: https://doi.org/10.1093/cid/ciac268
Thieme E-Journals - Journal of Laboratory Physicians. Available from: https://www.thieme-connect.com/products/ejournals/html/10.1055/s-0041-1731137
Yahav D, Farbman L, Leibovici L, Paul M. Colistin: new lessons on an old antibiotic. Clin Microbiol Infect 2012;18:18-29. DOI: https://doi.org/10.1111/j.1469-0691.2011.03734.x
Seema Gangar, Department of Microbiology, University College of Medical Sciences & Guru Teg Bahadur Hospital, Delhi

Senior Resident, Department of Microbiology, University College of Medical Sciences & Guru Teg Bahadur Hospital, Delhi.

Malika Grover , Department of Microbiology, Institute of Liver and Biliary Sciences, Delhi

PDCC Resident, Department of Microbiology, Institute of Liver and Biliary Sciences, Delhi.

Narendra Pal Singh , Department of Microbiology, University College of Medical Sciences & Guru Teg Bahadur Hospital, Delhi

Director Professor and Head, Department of Microbiology, University College of Medical Sciences & Guru Teg Bahadur Hospital, Delhi.

Aditya Nath Dwivedi, Department of Microbiology, University College of Medical Sciences & Guru Teg Bahadur Hospital, Delhi

Senior Technical Assistant, Department of Microbiology, University College of Medical Sciences & Guru Teg Bahadur Hospital, Delhi

Ananya Varshney, Department of Microbiology, University College of Medical Sciences & Guru Teg Bahadur Hospital, Delhi

Postgraduate Student, Department of Microbiology, University College of Medical Sciences & Guru Teg Bahadur Hospital, Delhi

Deeksha Chaudhary, Department of Microbiology, University College of Medical Sciences & Guru Teg Bahadur Hospital, Delhi

Postgraduate Student, Department of Microbiology, University College of Medical Sciences & Guru Teg Bahadur Hospital, Delhi

Neelam Arya, Department of Microbiology, University College of Medical Sciences & Guru Teg Bahadur Hospital, Delhi

Postgraduate Student, Department of Microbiology, University College of Medical Sciences & Guru Teg Bahadur Hospital, Delhi.

How to Cite

Goyal, N., Gangar, S., Grover , M., Singh , N. P., Dwivedi, A. N., Varshney, A., Chaudhary, D., & Arya, N. (2023). A comparative evaluation of colistin Minimum Inhibitory Concentration determination by reference broth microdilution with other commonly used phenotypic methods in Multidrug-Resistant Gram-negative bacilli. Microbiologia Medica, 38(2). https://doi.org/10.4081/mm.2023.11573