ArticleInfectious diseases & clinical microbiology2026
Modification of CLSI Recommended Colistin Agar Test for Enterobacterales to Handle Large Sample Load in a High-Throughput Laboratory.
Article in Infectious diseases & clinical microbiology, 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
Objective: Accurate colistin susceptibility testing is critical but remains challenging, especially in resource-limited settings with a high workload. Broth microdilution (BMD) is the reference standard; however, it is time- and resource-intensive. The colistin agar test (CAT) offers a viable alternative; however, the additional step of preparing a 1:10 dilution can limit routine workflow. This study aimed to evaluate a simple modification of the CAT for Enterobacterales. Materials and Methods: Enterobacterales isolates were tested using BMD, the standard CAT, and modified CAT (mCAT). The mCAT uses an undiluted 0.5 McFarland inoculum with a reduced inoculum volume (1 µL), instead of the Clinical and Laboratory Standards Institute (CLSI)-recommended 10 µL of a one-tenth-diluted suspension, simplifying the protocol while maintaining an equivalent bacterial inoculum load. Results: A total of 306 Enterobacterales isolates (102 colistin-resistant and 204 intermediate) were evaluated. The mCAT method showed 100% categorical agreement with CAT and 99.3% concordance with BMD (304/306 isolates). Among all isolates, two very major errors were observed only in Conclusion: The mCAT method offers a reliable, simplified, and cost-effective alternative to standard colistin susceptibility testing for Enterobacterales. It holds particular promise for microbiology laboratories in low- and middle-income countries, where routine BMD testing is limited, and sample volumes are high.
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