Background. The escalation of colistin resistance, due to transferable mcr-genes, threatens public and animal health as there are limited therapeutic options. Given that colistin is a last-line antibiotic, there is a need to contain the spread of its resistance to conserve its efficacy. Herein, current and emerging colistin resistance diagnostics are described to inform faster clinical diagnostic choices.
Methods. A literature search in Pubmed, between 2016 and 2020, was performed. English articles evaluating colistin resistance methods/diagnostics were included.
Results. Screening resulted in the inclusion of 89 journal articles. Current colistin resistance diagnostics are either phenotypic or molecular. Broth microdilution (BMD) is currently the only golden standard for determining colistin MIC values. However, other methods have been developed to overcome the challenges associated with the BMD.
Phenotypic methods comprise agar-based methods i.e. ChromAgar Col-APSE, SuperPolymyxin, ChromID Colistin R etc., MIC-determiners i.e. Microscan, BD Phoenix, Sensitest colistin, Sensititre, Micronaut etc., MCR-detectors i.e. lateral flow immunoassay (LFI), chelator based assays i.e. EDTA- and DPA-based tests as well as biochemical colorimetric tests i.e. Rapid Polymyxin NP test, Rapid ResaPolymyxin NP test etc. Molecular methods only characterize mobile colistin resistance; they include PCR, LAMP, whole-genome sequencing (WGS) etc.
Conclusion. Considering the efficiency (sensitivity, specificity, turnaround time) of the Rapid ResaPolymyxin NP test, it is recommended for the initial screening of colistin-resistant isolates. This can be followed by chelator-based tests or the LFI for the rapid screening of mcr-genes. However molecular assays such as LAMP, PCR may be considered for use in well-equipped clinical laboratories.