AI Article Synopsis
- Colistin is a crucial last-resort antibiotic for treating multidrug-resistant gram-negative bacteria, but traditional susceptibility testing methods may not be reliable due to the antibiotic's large size.
- This study modified Muller-Hinton agar by reducing its concentration and adding protamine, resulting in improved diffusion of colistin for more accurate testing.
- The new method demonstrated high performance, with 94.7% sensitivity and 100% specificity, making it a promising option for clinical microbiology labs, though care is advised in its application.
Article Abstract
Background: Colistin has become a last-resort antibiotic for the management of multidrug-resistant gram-negative bacteria. The disk diffusion test is cheap and easy to perform but may be unreliable for colistin susceptibility testing due to poor diffusion of the large colistin molecule. An improved agar diffusion test would increase the reliability of colistin susceptibility testing. This study aimed to modify Muller-Hinton agar (MHA) to improve colistin diffusion in agar.
Methods: MHA was modified by reducing the agar concentration from 100% to 30% and supplementing with protamine. We tested 60 gram-negative clinical isolates of (N=27) and complex (N=33). Disk diffusion test results were interpreted based on minimum inhibitory concentrations determined by broth microdilution.
Results: The modified MHA yielded the best performance metrics, including 94.7% sensitivity, 100% specificity, and an area under the curve of 0.995 (95% confidence interval, 0.982-1.000), <0.001, at a cut-off point of 13 mm.
Conclusions: A reduction of the agar concentration from 100% to 30% and the addition of protamine improved colistin diffusion in agar and allowed routine colistin susceptibility testing in a clinical microbiology laboratory, but should be handled with caution.
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| http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7054692 | PMC |
| http://dx.doi.org/10.3343/alm.2020.40.4.306 | DOI Listing |
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