https://doi.org/10.4081/mm.2024.12388

Colistin, the last resort antibiotic: challenges in the implementation of its routine susceptibility testing

Vol. 39 No. 1 (2024)
Submitted: 14 February 2024
Accepted: 12 April 2024
Published: 28 May 2024
Colistin testing, Colistin Agar Test, Colistin Broth Disk Elution test, Broth Microdilution susceptibility testing
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Authors

Nisha Goyal
drnishagoyalucms@gmail.com
https://orcid.org/0000-0002-8828-1139
Department of Microbiology, University College of Medical Sciences & Guru Teg Bahadur Hospital, Delhi, India.
Seema Gangar
https://orcid.org/0000-0002-4846-2074
Department of Microbiology, University College of Medical Sciences & Guru Teg Bahadur Hospital, Delhi, India.
Krishna Sarkar
Department of Microbiology, University College of Medical Sciences & Guru Teg Bahadur Hospital, Delhi, India.
Narendra Pal Singh
Department of Microbiology, Post Graduate Institute of Child Health, Noida, India.
Shukla Das
Department of Microbiology, University College of Medical Sciences & Guru Teg Bahadur Hospital, Delhi, India.
Aditya Nath Dwivedi
Department of Microbiology, University College of Medical Sciences & Guru Teg Bahadur Hospital, Delhi, India.

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.

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How to Cite

Goyal, N., Gangar, S., Sarkar, K., Singh, N. P., Das, S., & Dwivedi, A. N. (2024). Colistin, the last resort antibiotic: challenges in the implementation of its routine susceptibility testing. Microbiologia Medica, 39(1). https://doi.org/10.4081/mm.2024.12388
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