Colistin is being increasingly used for treating patients with MultiDrug Resistant (MDR) Gram-negative infections. Rapid and reliable colistin Susceptibility Testing (ST) is necessary for routine testing and appropriate therapeutic decision making. In vitro ST of colistin is challenging and is influenced by: i) multicomponent composition of colistin; ii) cationic property of colistin attributes for adherence to the microtiter plate; iii) heteroresistance to colistin [1] Adherence of colistin or polymyxin B to microtiter plates is reported as the major technical issues by many investigators across the world [3]. The addition of Polysorbate-80 (P-80), a surfactant, prevents to some extent the binding of polymyxin to microtiter plate [4]. However, CLSI or EUCAST guidelines never approved the use of P-80 for colistin or polymyxin B ST. It has been demonstrated that P-80 might exhibit synergistic effect with colistin [5]. In addition, P-80 acts as a surfactant and has mild antibacterial activity of its own [6]. This antimicrobial activity was further explored with the combined effect of polymyxin B and P-80 in P. aeruginosa [5,6]. Initially, polymyxin B binds to lipid A and leads to destabilization of the outer membrane of bacteria. This membrane destabilization allows P-80 to get into the cell and promoting the rupturing of inner membrane leading to cell lysis [7]. Moreover, isolates that are resistant to polymyxin compromise the entry of P-80 into cells. As a result, cell membrane remains intact and yields higher MIC values, while performing ST (colistin or polymyxin B) in the presence of P-80. However, further studies are essential to warrant the precise interaction between P-80 and polymyxin antibiotics.Among the commercially available methods, colistin gradient Epsilometer test (E-test) is convenient for routine day-to-day testing, but the validity of MICs is not well established. Several studies have reported underestimated MIC values by one or more two fold dilutions, especially for concentrations of ≥2 μg/mL, leading to false susceptible results {Very Major Error (VME)} up to 32% [8][9][10]. Recently in 2016, EUCAST has given "warning'' for testing colistin susceptibility with E-test [11]. However, marginally better result For colistin ST, the recommended Quality Control (QC) strains were Escherichia coli ATCC ® 25922™ (0.25-2 μg/mL) and Pseudomonas aeruginosa ATCC ® 27853™ (0.5-4 μg/mL). Most of the discordant results between BMD and E-test were reported with MIC of ≥2 μg/ mL, but the suggested MICs of QC strains were lower. Currently, EUCAST has advised to include colistin resistant E. coli NCTC 13846 (mcr-1 positive) as resistant QC strain. For E. coli NCTC 13846, the colistin MIC target value is between 4 μg/mL and 8 μg/mL [11].Currently, there is no US Food and Drug Administration (FDA) approved breakpoint for colistin. Colistin ST using semi-automated systems has been evaluated in limited studies. It tests mainly the performance of VITEK 2 system (bioMérieux). However, the findings were conflict, impl...