Articles

Modified Hodge test: A simple and effective test for detection of carbapenemase production

Abstract

Background and Objectives: Resistance among bacterial isolates is the leading cause of increased mortality and morbidity worldwide. Carbapenems once thought to be effective are becoming ineffective mostly due to the emergence of carbapenemase. This study was designed to determine in vitro efficacy of Modified Hodge test for detection of carbapenemase production in Gram negative rods.
Material and Methods: The study was done in the Department of Microbiology, Armed Forces Institute of Pathology Rawalpindi Pakistan from January 2010 to December 2010. A total of 200 Gram negative rods from different clinical samples were taken. Those isolates which showed intermediate or susceptible zones i.e 16mm-21mm on disc diffusion were included in the study. These isolates were then subjected to Modified Hodge test.
Result: Out of 200 isolates, 138 (69%) were positive for carbapenemase production by Modified Hodge test. Out of 138 MHT positive organisms, the frequency of E. coli was 38%, followed by Pseudomonas aeruginosa (30%), Klebsiella pneumoniae (17%), Acinetobacter baumannii (12%), Citrobacter diversus (2%) and Enterobacter agglomerans (1.4%).
Conclusion: Modified Hodge test is a simple test which can be performed in the routine lab for detection of carbapenemases in isolates showing intermediate or sensitive zone diameter on disc diffusion.

Centers for Disease Control and Prevention; Guidance for control of infections with carbapenem-resistant or carbapenemase-producing enterobacteriacae in acute care facilities. MMWR 2009; 58: 256-259.

CLSI Guidance for control of infections with carbapenem-resistant or carbapenemase producing Enterobacteriaceae in acute care facilities CLSI home. [Online] cited on March 30, 2010.

Schwaber M, Carmeli Y. Antimicrobial resistance and patient outcomes: The hazards of adjustment. Crit care 2006; 10: 164.

Gary D O, Margret FC. Carbapenemases: A brief review for pediatric infectious disease specialists. Pediatr Infect Dis J 2010; 29: 68-70.

Swenson M J, Hindler J F, Jorgensen H J (2007). Special Phenotypic Methods for Detecting Antibacterial Resistance In: Baron E J, Jorgensen J H, Landry M L, Pfaller M A, eds, Manual of Clinical Microbiology, 9th ed; vol.1 Washington DC: ASM Press, pp.1180-1182.

Carbapenemases. Beta-lactamase-Wikipedia, the free encyclopedia. Viewed on 9 March 2010 http;// en.wikipedia.org/wiki/Beta-lactamase.

Tenover C F. Mechanisms of Antimicrobial Resistance in Bacteria. AM J Med 2006; 119 (6A).

Clinical and Laboratory Standards Institute CLSI.2010. Screening and Confirmatory Tests for Suspected Carbapenemases Production. vol: 20 supplemental table 2A-S2.

Centers for disease control and prevention. Modified Hodge test for carbapenemase detection in enterobacteriaceae. Available at http://www.ndhealth. gov/microlab/Uploads/HodgeTest.pdf.

Chu Y W, Afzal-Shah M, Houang E T S, Palepou M F I, Lyon D J, Woodford N, et al. IMP-4, a novel metallo-β-lactamase from nosocomial Acinetobacter spp. collected in Hong Kong between 1994 and 1998. Antimicrob Agents Chemother 2001; 45: 710-714.

Iyobe S, Kusadokoro H, Ozaki J, Matsumura N, Minami S, Haruta S, et al. Amino acid substitution in a variant of IMP-1 metallo-β-lactamase. Antimicrob Agents Chemother 2000; 44: 2023-2027.

Lee K, Lim JB, Yum JH, Yong D, Chong Y, Kim JM ,et al. bla VIM-2 cassette-containing novel integrons in metallo-β-lactamase-producing Pseudomonas aeruginosa and Pseudomonas putida isolates disseminated in a Korean hospital. Antimicrob Agents Chemother 2002; 46: 1053-1058.

Migliavacca R, Docquier JD, Mugnaioli C, Amicosante G, Daturi R, Lee K, et al. Simple microdilution test for detection of metallo-β-lactamase production in Pseudomonas aeruginosa. J Clin Microbiol 2002; 40:4388-4390.

Tolman MA, Rolston K, Jones RN, Walsh TR.Molecular characterization of VIM-4, a novel metallo- beta-lactamase isolated from Texas: report from the cancer surveillance program (2001). Proceedings of the 42nd Interscience Conference on Antimicrobial Agents and Chemotherapy. Abstract C1-1851. San Diego, California; 2002.

Bratu S, Brooks S, Burney S, Kochar S, Gupta J, Landman D, et al. Detection and spread of Escherichia coli possessing the plasmid-borne carbapenemase KPC-2 in Brooklyn, New York. Clin Infect Dis 2007;44: 972-975.

Lomaestro BM, Tobin EH, Shang W, Gootz T. The spread of Klebsiella pneumoniae carbapenemase- producing K. pneumoniae to upstate New York. Clin Infect Dis 2006; 43: 26-28.

Bratu S, Mooty M, Nichani S, Landman D, Gullans C, Pettinato B, et al. Emergence of KPC-possessing Klebsiella pneumoniae in Brooklyn, New York: epidemiology and recommendations for detection. Antimicrob Agents Chemother 2005; 49: 3018-3020.

Yigit H, Queenan A M, Rasheed J K, Biddle J W, Domenech-Sanchez A, Alberti S, et al. Carbapenem- resistant strain of Klebsiella oxytoca harboring carbapenem- hydrolyzing β-lactamase KPC-2. Antimicrob Agents Chemother 2003; 47: 3881-3889.

Navon-Venezia S, Chmelnitsky I, Leavitt A, Schwaber M J, Schwartz D, Carmeli Y. Plasmid-mediated imipenem- hydrolyzing enzyme KPC-2 among multiple carbapenem- resistant Escherichia coli clone in Israel. Antimicrob Agents Chemother 2006; 50: 3098-3101.

Deshpande L M, Rhomberg P R, Sader H S, Jones R N.Emergence of serine carbapenemases (KPC and SME) among clinical strains of Enterobacteriaceae isolated in the United States medical centers: report from the MYSTIC program (1999-2005). Diagn Microbiol Infect Dis 2006; 56: 367-372.

Villegas MV, Lolans K, Correa A, Kattan JN, Lopez JA, Quinn JP, et al. First identification of Pseudomonas aeruginosa isolates producing a KPC type carbapenem- hydrolyzing β-lactamase. Antimicrob Agents Chemother 2007; 51: 1553-1555.

Miriagou V, Tzouvelekis LS, Rossiter S, Tzelepi E, Angulo FJ, Whichard JM. Imipenem resistance in a Salmonella clinical strain due to plasmid-mediated class A carbapenemase KPC-2. Antimicrob Agents Chemother 2003; 47: 1297-1300.

Tibbetts R, Frye JG, Marschall J, Warren D, Dunne W. Detection of KPC-2 in a clinical isolate of Proteus mirabilis and first reported description of carbapenemase resistance caused by a KPC β-lactamase in P. mirabilis.

J Clin Microbiol 2008; 46: 3080-3083.

Lee K, Lim YS, Yong D, Yum JH, Chong Y.

Evaluation of the Hodge test and the imipenem-EDTA double disk synergy test for differentiating metallo-β- lactamase-producing isolates of Pseudomonas spp and Acinetobacter spp. J Clin Microbiol 2003; 41: 4623-4629.

Anderson KF, Lonsway RD, Rasheed KJ, Biddle J, Jensen B, McDougal LK, et al. Evaluation of methods to identify the Klebsiella pneumoniae carbapenemase in

Enterobacteriaceae. J Clin Microbiol 2007; 45: 2723 -2725.

Galani I, Rekatsina DP, Hatzaki D, Plachouras D, Souli M, Giamarellou H. Evaluation of different laboratory tests for the detection of metallo-β-lactamase production in Enterobacteriaceae. J Antimicrob Chemother 2008;61: 548-553.

McGettigan SE, Andreacchio K, Edelstein PH. Specificity of Ertapenem Susceptibility Screening for Detection of Klebsiella pneumoniae Carbapenemases. J Clin Microbiol 2009; 47: 785-786.

Kumarasamy KK, Toleman AM, Walsh RT, Bagaria J, Butt F, Balakrishnan R, et al. Emergence of a new antibiotic resistance mechanism in India, Pakistan, and the UK: a molecular, biological, and epidemiological study. Lancet Infect Dis 2010; 10: 597-602.

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Keywords
Modified Hodge test disc diffusion carbapenemases

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How to Cite
1.
Amjad A, Mirza I, Abbasi S, Farwa U, Malik N, Zia F. Modified Hodge test: A simple and effective test for detection of carbapenemase production. Iran J Microbiol. 1;3(4):189-193.