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CORRESPONDENCE
Year : 2019  |  Volume : 150  |  Issue : 4  |  Page : 417

Challenges & issues of colistin susceptibility testing in diagnostic microbiology laboratories


Department of Microbiology, All India Institute of Medical Sciences, Bhubaneswar, Bhubaneswar 751 019, Odisha, India

Date of Submission27-Jun-2019
Date of Web Publication29-Nov-2019

Correspondence Address:
Bijayini Behera
Department of Microbiology, All India Institute of Medical Sciences, Bhubaneswar, Bhubaneswar 751 019, Odisha
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijmr.IJMR_1132_19

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How to cite this article:
Behera B. Challenges & issues of colistin susceptibility testing in diagnostic microbiology laboratories. Indian J Med Res 2019;150:417

How to cite this URL:
Behera B. Challenges & issues of colistin susceptibility testing in diagnostic microbiology laboratories. Indian J Med Res [serial online] 2019 [cited 2019 Dec 13];150:417. Available from: http://www.ijmr.org.in/text.asp?2019/150/4/417/272084

Sir,

I read with interest the article by Sinha et al[1] on colistin-resistant bacteria. The authors have highlighted the pertinent issue of drug-resistant Gram-negative bacilli in intensive care unit (ICU) settings of a tertiary care centre in India, which is now a global phenomenon. I would like to highlight some of the points in the above-mentioned article:

  1. A joint initiative of the European Centre for Disease Prevention and Control and the US Centers for Disease Control and Prevention had published expert consensus definition of multidrug resistant (MDR), extensively drug resistant (XDR) and pandrug-resistant (PDR) bacterial agents[2]. According to that definition, an isolate can be levied as PDR if it is non-susceptible to all agents in all the antimicrobial categories in current clinical use. The authors have not mentioned whether all the classes of drugs were tested.
  2. The authors have determined colistin minimum inhibitory concentration (MIC) by E-test using Colistin Ezy MIC Strip (HiMedia Laboratories Pvt. Ltd., Mumbai). It is a known fact that colistin and polymyxin B E-test is associated with high major errors[3]. The implementation of the Clinical and Laboratory Standards Institute (CLSI)-approved broth microdilution method in routine microbiology laboratories remains a challenge till date.


In conclusion, there is no second thought that the judicious use of colistin is the need of the hour, but every microbiology laboratory which is catering to ICU patients receiving polymyxin B/colistin should adopt the standardized CLSI/EUCAST (European Committee on Antimicrobial Susceptibility Testing) method of colistin susceptibility testing at least in MDR/XDR isolates[3].

Conflicts of Interest: None.



 
   References Top

1.
Sinha S, Sahu S, Pati J, Ray B, Pattnaik SK. Retrospective analysis of colistin-resistant bacteria in a tertiary care centre in India. Indian J Med Res 2019; 149 : 418-22.  Back to cited text no. 1
    
2.
Magiorakos AP, Srinivasan A, Carey RB, Carmeli Y, Falagas ME, Giske CG, et al. Multidrug-resistant, extensively drug-resistant and pandrug-resistant bacteria: An international expert proposal for interim standard definitions for acquired resistance. Clin Microbiol Infect 2012; 18 : 268-81.  Back to cited text no. 2
    
3.
Bakthavatchalam YD, Pragasam AK, Biswas I, Veeraraghavan B. Polymyxin susceptibility testing, interpretative breakpoints and resistance mechanisms: An update. J Glob Antimicrob Resist 2018; 12 : 124-36.  Back to cited text no. 3
    



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1 Authorsę response
Sharmili Sinha,Suneeta Sahu,Jyotirmaya Pati,Banambar Ray,SarojKumar Pattnaik
Indian Journal of Medical Research. 2019; 150(4): 417
[Pubmed] | [DOI]



 

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