Colistin, the last resort antibiotic: challenges in the implementation of its routine susceptibility testing
https://doi.org/10.4081/mm.2024.12388
Accepted: 12 April 2024
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Background: colistin has become a critical antibiotic for lifethreatening multidrug resistance Gram-negative infections, particularly carbapenemase-producing bacteria. Detecting colistin resistance in routine microbiology laboratories is crucial for combating these fatal infections poses a challenge. Especially in developing countries, there is a need for a cost-effective, rapid, and user-friendly diagnostic method. Objective: implementing the various available methods for colistin testing is a significant challenge in resource-limited settings due to logistic difficulties and the need for technical expertise. Materials and Methods: this study shares experiences and insights gained while implementing in-vitro colistin susceptibility testing in a high-load bacteriology laboratory of a tertiary care center in Delhi, India. The following test methods for colistin susceptibility testing were incorporated in the routine antimicrobial susceptibility testing of our laboratory: Colistin Agar Test, Colistin Broth Disk Elution Test, Broth Microdilution susceptibility testing. Results: inconsistent growth patterns were observed in the colistin agar dilution Minimum Inhibitory Concentration (MIC) method, which could be resolved only after the preparation of fresh plates containing that specific concentration of colistin. The contamination issue of plates on use over a few days was addressed by pouring agar containing various concentrations of colistin in cottonplugged glass tubes. In the colistin broth disk elution test, due to the non-availability of screw-capped 10 mL glass tubes, MacCornety bottles (30 mL) were used. Subcultures were performed from the turbid wells to rule out the growth of contaminants when encountering discordant MIC values or skipped wells on the colistin broth microdilution test. Conclusions: despite several technical issues in in-vitro colistin susceptibility testing, we have successfully implemented it in our laboratory. Our experiences can offer guidance to laboratories that are still in the process of implementing it.
Bakthavatchalam YD, Veeraraghavan B. Challenges, issues and warnings from CLSI and EUCAST working group on polymyxin susceptibility testing. Journal of Clinical and Diagnostic Research: JCDR. 2017;11:DL03. DOI: https://doi.org/10.7860/JCDR/2017/27182.10375
Bergen PJ, Li J, Rayner CR, Nation RL. Colistin methanesulfonate is an inactive prodrug of colistin against Pseudomonas aeruginosa. Antimicrob Agents Chemother. 2006;50:1953-8. DOI: https://doi.org/10.1128/AAC.00035-06
Chew KL, La MV, Lin RT, Teo JW. Colistin and polymyxin B susceptibility testing for carbapenem-resistant and MCR-positive Enterobacteriaceae: comparison of Sensititre, MicroScan, Vitek 2, and Etest with broth microdilution. Journal of Clinical Microbiology. 2017;55:2609-16. DOI: https://doi.org/10.1128/JCM.00268-17
CLSI. Performance Standards for Antimicrobial Susceptibility Testing; Thirty Second edition. CLSI document M100-A32 edition. Wayne, PA: Clinical and Laboratory Standards Institute; 2022.
Dortet L, Bonnin RA, Pennisi I, et al. Rapid detection and discrimination of chromosome- and MCR-plasmid-mediated resistance to polymyxins by MALDI-TOF MS in Escherichia coli: the MALDIxin test. J Antimicrob Chemother. 2018;73:3359-67. DOI: https://doi.org/10.1093/jac/dky330
Elias R, Melo-Cristino J, Lito L, et al. Klebsiella pneumoniae and colistin susceptibility testing: performance evaluation for broth microdilution, agar dilution and Minimum Inhibitory Concentration test strips and impact of the “skipped well” phenomenon. Diagnostics. 2021;11:2352. DOI: https://doi.org/10.3390/diagnostics11122352
Falagas ME, Kasiakou SK, Saravolatz LD. Colistin: the revival of polymyxins for the management of multidrug-resistant gram-negative bacterial infections. Clinical Infectious Diseases. 2005;40:1333-41. DOI: https://doi.org/10.1086/429323
Fenwick AJ, Bergman Y, Lewis S, et al. Evaluation of the NG-Test MCR-1 lateral flow assay and EDTA-colistin broth disk elution methods to detect plasmid-mediated colistin resistance among Gram-negative bacterial isolates. Journal of Clinical Microbiology. 2020;58:10-128. DOI: https://doi.org/10.1128/JCM.01823-19
Fonseca e Silva D, Silva-Dias A, Gomes R, et al. Evaluation of rapid colistin susceptibility directly from positive blood cultures using a flow cytometry assay. Int. J. Antimicrob. Agents 2019;54:820-3. DOI: https://doi.org/10.1016/j.ijantimicag.2019.08.016
Guérin F, Isnard C, Sinel C, et al. Cluster-dependent colistin hetero-resistance in Enterobacter cloacae complex. Journal of Antimicrobial Chemotherapy. 2016;71:3058-61. DOI: https://doi.org/10.1093/jac/dkw260
Gupta S, Govil D, Kakar PN, et al. Colistin and polymyxin B: a re-emergence. Indian J Critical Care Med. 2009;13:49. DOI: https://doi.org/10.4103/0972-5229.56048
Humphries RM. Susceptibility testing of the polymyxins: where are we now? Pharmacotherapy: The Journal of Human Pharmacology and Drug Therapy. 2015;35:22-7. DOI: https://doi.org/10.1002/phar.1505
Humphries RM, Green DA, Schuetz AN, et al. Multicenter evaluation of colistin broth disk elution and colistin agar test: a report from the Clinical and Laboratory Standards Institute. Journal of Clinical Microbiology. 2019;57:10-128. DOI: https://doi.org/10.1128/JCM.01269-19
India National Centre for Disease Control. Standard operating procedures for Colistin Agar Test for Enterobacteriaceae and Pseudomonas aeruginosa. 2020. Available from: https://ncdc.mohfw.gov.in/wp-content/uploads/2024/03/58495493521681880873.pdf
Jayol A, Nordmann P, Brink A et al. Heteroresistance to colistin in Klebsiella pneumoniae associated with alterations in the PhoPQ regulatory system. Antimicrob Agents Chemother 2015;59:2780-4. DOI: https://doi.org/10.1128/AAC.05055-14
Jeannot K, Bolard A, Plesiat P. Resistance to polymyxins in Gram-negative organisms. J Antimicrob Agents. 2017;49:526-35. DOI: https://doi.org/10.1016/j.ijantimicag.2016.11.029
Karvanen M, Malmberg C, LagerbäckP, et al. Colistin is extensively lost during standard in vitro experimental conditions. Antimicrob Agents Chemother 2017;61:e00857-17. DOI: https://doi.org/10.1128/AAC.00857-17
Landman D, Salamera J, Quale J. Irreproducible and uninterpretable polymyxin B MICs for Enterobacter cloacae and Enterobacter aerogenes. J Clin Microbiol. 2013;51:4106-11. DOI: https://doi.org/10.1128/JCM.02129-13
Larrouy-Maumus G, Clements A, Filloux A, et al. Direct detection of lipid A on intact Gram-negative bacteria by MALDI-TOF mass spectrometry. J Microbiol Methods. 2016;120:68-71. DOI: https://doi.org/10.1016/j.mimet.2015.12.004
Meletis G, Tzampaz E, Sianou E et al. Colistin heteroresistance in carbapenemase-producing Klebsiella pneumoniae. J Antimicrob Chemother 2011;66:946-7. DOI: https://doi.org/10.1093/jac/dkr007
Napier BA, Band V, Burd EM, Weiss DS. Colistin heteroresistance in Enterobacter cloacae is associated with cross-resistance to the host antimicrobial lysozyme. Antimicrobial Agents and Chemotherapy. 2014;58:5594-7. DOI: https://doi.org/10.1128/AAC.02432-14
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
Schurek KN, Sampaio JL, Kiffer Cret al. Involvement of pmrAB and phoPQ in polymyxin B adaptation and inducible resistance in non-cystic fibrosis clinical isolates of Pseudomonas aeruginosa. Antimicrob Agents Chemother. 2009;53:4345-51. DOI: https://doi.org/10.1128/AAC.01267-08
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
Stojanoski V, Sankaran B, Prasad BV, et al. Structure of the catalytic domain of the colistin resistance enzyme MCR-1. BMC Biology. 2016;14:81. DOI: https://doi.org/10.1186/s12915-016-0303-0
Uwizeyimana JD, Kim D, Lee H, et al. Determination of colistin resistance by simple disk diffusion test using modified Mueller-Hinton Agar. Ann Lab Med. 2020;40:306-11- DOI: https://doi.org/10.3343/alm.2020.40.4.306
Van Belkum A, Burnham CA, Rossen JW, et al. Innovative and rapid antimicrobial susceptibility testing systems. Nature Reviews Microbiology. 2020;18:299-311. DOI: https://doi.org/10.1038/s41579-020-0327-x
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