Performance of rapid PolymyxinTM NP and Rapid PolymyxinTM acinetobacter for the detection of polymyxin resistance in carbapenem-resistant acinetobacter baumannii and enterobacterales

Abstract

Background: The global spread of carbapenem-resistant Enterobacterales (CRE) and Acinetobacter baumannii (CRAB) has prompted the reintroduction of colistin as a last-resort treatment. Although the recommended method for colistin susceptibility testing is broth microdilution (BMD), methods that are more rapid and easy to use are needed. Objectives: To evaluate the performance of two commercial kits for colistin susceptibility testing: Rapid PolymyxinTM NP (RP-NP) for CRE and Rapid PolymyxinTM Acinetobacter (RP-AB) for CRAB. Methods: A total of 76 CRE and 87 CRAB isolates were collected from hospitalized patients in Europe and Israel. The isolates were subcultured twice on 5%sheep blood in tryptic soy agar. We tested colistin susceptibility using the RP-NP and RP-AB kits and compared the results with those from BMD. Results: Of the CRE isolates, 25% (19/76) were resistant to colistin using BMD. Categorical agreement between RP-NP and BMD was 93.4% (71/76), major errors 1.8% (1/57) and very major errors 21.1% (4/19). Sensitivity was 78.9% and specificity was 98.2%. Of the CRAB isolates, 58.6% (51/87) were resistant to colistin by BMD. Categorical agreement between RP-AB and BMD was 59.8% (52/87), major errors 13.9% (5/36) and very major errors 58.8%(30/51). Sensitivity of RP-AB was 41.2%and specificity was 86.1%. Conclusions: In many of the tested isolates, weak or inconclusive colour changes in the test wells caused difficulty in interpretation, resulting in an unacceptable rate of very major errors.