Evaluation of rapid polymyxin Nordmann Poirel test for detection of polymyxin resistance in clinical isolates of Enterob
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BRIEF REPORT
Evaluation of rapid polymyxin Nordmann Poirel test for detection of polymyxin resistance in clinical isolates of Enterobacteriaceae Muhammad Shoaib 1 & Ashfaq Hussain 1 & Luqman Satti 1 & Wajid Hussain 1 & Gohar Zaman 1 & Faisal Hanif 2 Received: 6 May 2020 / Accepted: 3 June 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Polymyxins play a significant role against carbapenem-resistant Enterobacteriaceae (CRE). A total of 121 clinical samples yielded growth of CRE that were included in the study. Rapid Polymyxin NP test was performed on all the isolates as described by Nordmann P et al. and results were compared with broth microdilution method. Majority of the isolates were Klebsiella pneumoniae (70.2%) followed by Escherichia coli (17.4%). A total of 71 isolates were found resistant and 50 as susceptible by broth microdilution. Sensitivity and specificity of rapid polymyxin NP test were found to be 97.2% and 100%, respectively. Our study concluded that rapid polymyxin NP test is reliable and can be used as an alternative to broth microdilution in resource limited settings.
Introduction Emergence of carbapenem-resistant gram-negative microorganisms has become a global dilemma as there are limited therapeutic options [1–3]. Polymyxins have regained their importance because they have retained their spectrum of activity against CRE. Unfortunately, injudicious use of polymyxins has led to emergence of polymyxin resistance. [2–5]. There are various obstacles in polymyxin susceptibility testing including problem of hetero-resistance [4, 6, 7]. Poor penetration of polymyxins into agar limits use of routinely used disk diffusion method and E-test [4, 8]. Broth microdilution has been recommended by the European Committee on Antimicrobial Susceptibility Testing (EUCAST) and the Clinical Laboratory Standard Institute (CLSI) as standard reference method [4, 7, 9]. Colistin agar test (CAT) and colistin disk broth elution (CBDE) are two novel susceptibility methods for colistin only which have been recommended recently by CLSI. All three methods require 16–20 h of incubation time [7, 9].
* Ashfaq Hussain [email protected] 1
2
Department of Microbiology, Armed Forces Institute of Pathology (AFIP), National University of Medical Sciences, Rawalpindi, Pakistan Department of Microbiology, Pakistan Navy Ship Shifa Hospital, Bahria University Medical and Dental College Karachi, Karachi, Pakistan
A rapid and practical method “rapid polymyxin NP test” was developed by Nordmann P et al. It was based on the principle of acid production from carbohydrate metabolism that was subsequently identified by pH indicator phenol red [10]. Subsequently, various studies were conducted on the test, which showed variable specificity and sensitivity [11–15]. In our study, we evaluated the performance of the rapid polymyxin NP test in our setup comparing it with the reference broth microdilution.
Methodology This study was conducted from 22 May 2018 through 21 May 2019 at the Department of Microbiolog
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