ArticleCureus2026
Checkerboard Insights: Diagnostic Integration of Synergy Testing for Multidrug-Resistant Klebsiella Isolates in Critical Care.
Article in Cureus, 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
introductionThe rise of multidrug-resistant
methodsThis cross-sectional, laboratory-based study was conducted over one year (April 2024 to March 2025) at a tertiary care center in Ghaziabad, India. Initial antimicrobial susceptibility testing of 196 ICU isolates was performed using the VITEK® 2 Compact system (bioMérieux India Private Limited, New Delhi, India). A subset of 100 isolates nonsusceptible to colistin and resistant to companion agents was selected for checkerboard synergy testing using the HiMIC™ (HiMedia Laboratories Pvt. Ltd., Mumbai, India) microdilution method to evaluate combinations of colistin with meropenem, amikacin, and amoxicillin-clavulanate. This study aimed to evaluate the demographic and clinical specimen profiles of ICU patients with MDR/PDRKlebsiella infections and to determine the in vitro synergistic potential of colistin-based combinations using the checkerboard assay.
resultsAmong the 196 MDR isolates, the largest demographic group comprised patients aged ≥60 years (38.3%), and male patients represented 59.7% of cases. Respiratory specimens were the primary source of isolates (40.3%), followed by blood (19.9%) and pus (14.8%). High resistance rates were observed for amoxicillin-clavulanate (88.3%), meropenem (81.6%), and amikacin (75.5%). In checkerboard testing of 100 selected isolates, the colistin-meropenem combination achieved the highest synergistic activity (12.0%) with zero antagonism. Colistin-amikacin demonstrated 10.0% synergy and 6.0% antagonism, while colistin-amoxicillin/clavulanate showed the lowest synergy (5.0%) and highest antagonism (12.0%).
conclusionThe colistin-meropenem combination exhibited the highest in vitro synergistic activity against MDR Klebsiella isolates, with no antagonistic behavior, highlighting its potential clinical utility in critical care settings.
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