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Antimicrobial susceptibility testing of colistin: Evaluation of standard broth microdilution method for gram-negative bacilli
Naila Begum , Amit Garg , Karvi Agarwal ,
Volume 19, Issue 5 (Sep-Oct 2025)
Abstract
Background: Colistin is regarded as the last resort for managing infections caused by multidrug-resistant (MDR) Gram-negative bacilli (GNB). The World Health Organization (WHO) includes colistin on its list of critically necessary antimicrobials. Minimum inhibitory concentrations (MICs) are used to monitor the development of colistin resistance. This study aimed to assess the performance of the Broth Microdilution Method (BMD) against routine Kirby-Bauer disk diffusion (KBDD) and automated BD Phoenix for the detection of the in vitro activity of colistin against GNB.
Methods: A cross-sectional study was conducted in the Department of Microbiology, LLRM Medical College, Meerut, Uttar Pradesh, from September 2023 to January 2024. The KBDD method, BMD method, and BD Phoenix (Becton Dickinson, USA) automated system were used to detect colistin susceptibility in 320 GNB isolated from various clinical samples. MIC determined by the BMD method was interpreted according to Clinical Laboratory Standards Institute (CLSI) 2023 guidelines.
Results: In our study, 320 isolates of GNB were identified from patients with a mean age of 45.34 years. A total of 320 isolates [145 (45.31%) Escherichia coli, 124 (38.75%) Klebsiella pneumoniae, 32 (10.0%) Pseudomonas aeruginosa, and 19 (5.93%) Acinetobacter baumannii complex] were tested simultaneously with all three methods for colistin susceptibility. The overall resistance to colistin among GNB was found to be 17.18% by the gold standard BMD method, 15.31% by BD Phoenix, and 14.37% by KBDD.
Conclusion: BMD is the most cost-effective, authentic method for routine testing of colistin susceptibility as compared to other methods. The comparative analysis revealed that BMD is superior to other methods in detecting colistin susceptibility, emphasizing its potential role in guiding clinicians in antibiotic therapy decisions.


Outbreak of Burkholderia gladioli septicemia in a neonatal intensive care unit: Investigation and control measures
Karvi Agarwal , Amit Garg, Konpal Agarwal , Naila Begum ,
Volume 20, Issue 2 (Mar-Apr 2026)
Abstract
Background: Burkholderia gladioli (B. gladioli) is a rare but emerging pathogen associated with neonatal sepsis. This case series describes the investigation and control of an outbreak in a tertiary neonatal intensive care unit (NICU) in India.
Methods: In January 2024, seven neonates admitted to the NICU developed bloodstream infections. Clinical manifestations included respiratory distress, feeding refusal, metabolic acidosis, seizures, and shock. Predisposing factors included prematurity, congenital anomalies, and perinatal asphyxia. Blood cultures were processed using the automated BD BactecFX-40 system, and organism identification with antimicrobial susceptibility testing was performed using the BD Phoenix M-50 system. Environmental sampling was conducted to identify the outbreak source.
Results: Of 72 blood culture bottles, 34 (47.2%) flagged positive. B. gladioli were isolated from seven patients, accounting for 20.6% of positive cultures. The overall mortality rate was 57.1% (4/7 Deaths). All clinical isolates showed identical susceptibility patterns, with susceptibility to levofloxacin, cotrimoxazole, ceftazidime, chloramphenicol, minocycline, and meropenem, and intrinsic resistance to colistin. Environmental surveillance identified the same B. gladioli strain from suction apparatus and phototherapy units. Contributory factors included poor hand hygiene compliance (28-33%), limited glove availability, and overcrowding. Following cohorting, deep cleaning with 1% hypochlorite, staff retraining, and reinforcement of infection control protocols, no further isolates were recovered.
Conclusion: This outbreak highlights the high mortality associated with B. gladioli sepsis in neonates and underscores the critical need for stringent infection control practices and automated identification systems in NICUs. To our knowledge, this is the first such report from India.

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