ArticleAnnals of clinical microbiology and antimicrobials2026
Charcoal agar interference in antibiotic susceptibility testing of Bordetella pertussis: evaluation and alternative methodologies.
Article in Annals of clinical microbiology and antimicrobials, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundErythromycin-resistant Bordetella pertussis (ERBP) has increased sharply in China, posing significant challenges to clinical treatment. The lack of a standardized antimicrobial susceptibility testing (AST) system for B. pertussis makes it difficult to screen out effective antibiotics, which further aggravates the generation of drug-resistant strains and causes a vicious cycle. In this study, we modified a superior charcoal-free medium for antibiotic susceptibility testing, enabling more reliable evaluation of antibiotic efficacy.
methodsThe minimum inhibitory concentrations (MICs) of erythromycin (E), trimethoprim-sulfamethoxazole (TMP-SMX), levofloxacin (LVF), and piperacillin (PIP) were determined using E-test strips on the agar plates with and without charcoal. The performance of these two media for AST was compared to establish a more accurate laboratory detection method. Subsequently, the superior charcoal-free medium was used to assess the antibiotic susceptibility of 98 B. pertussis strains isolated from clinical specimens after the COVID-19 pandemic, analyzing the sensitivity distribution of these first-line and alternative antibiotics.
resultsThe MIC values of TMP-SMX and LVF were significantly higher on charcoal-containing agar plates than on charcoal-free medium. E-test results revealed that the MICs of B. pertussis strains to TMP-SMX and LVF had increased by approximately five gradient levels on the charcoal-containing agar compared to charcoal-free agar. Quality control (QC) testing demonstrated that the MICs of TMP/SMX and LVX fell outside the acceptable QC range due to adsorption by charcoal particles. Antimicrobial susceptibility of 98 B. pertussis clinical isolates showed that all strains were resistant to E with the MIC90 exceeded the maximum value (> 256 μg/mL). The overall MIC90 values for TMP-SMX, LVF and PIP were 1/0.75/<0.016 μg/mL on charcoal-containing agar and 0.023/0.008/<0.016 μg/mL on charcoal-free medium, respectively. Statistical analysis of violin plots confirmed that the MIC values of the second-line antibiotic TMP-SMX and LVF were significantly elevated on charcoal-containing agar.
conclusionAn accurate AST method can provide crucial guidance for optimal antibiotic selection in patients with B. pertussis infections. Our findings demonstrate that charcoal-free agar serves as an effective alternative medium for reliable AST of B. pertussis clinical isolates.
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