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Chapter 5.13 : The Modified Hodge Confirmatory Test (or the Carbapenem Inactivation Test) for Carbapenemase Production in

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The Modified Hodge Confirmatory Test (or the Carbapenem Inactivation Test) for Carbapenemase Production in , Page 1 of 2

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Abstract:

Carbapenemases, or carbapenem-hydrolyzing enzymes, are produced by a variety of organisms, including , and spp. They are classified into three molecular groups (Ambler Classes A, B, and D) and vary in prevalence by geographic location. The carbapenemase (KPC) enzymes encoded by the genes belong to Ambler Class A and are produced by , and , among others. Other carbapenemases include metallo-beta-lactamases (MBLs) of Ambler Class B, enzymes (SMEs), imipenem-hydrolyzing beta-lactamases (IMIs), and “not metalloenzyme carbapenemases” (NMCs). These carbapenemases result in varying degrees of resistance to carbapenems as well as varying resistance to extended-spectrum cephalosporins and aztreonam.

Citation: Leber A. 2016. The Modified Hodge Confirmatory Test (or the Carbapenem Inactivation Test) for Carbapenemase Production in , p 5.13.1-5.13.6. In Clinical Microbiology Procedures Handbook, Fourth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555818814.ch5.13
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Figures

Image of Figure 5.13–1
Figure 5.13–1

Modified Hodge test on small (100 mm) Mueller-Hinton agar plate with meropenem disk in center. 1 = negative QC strain, ATCC BAA-1706. 2 = patient isolate negative for carbapenemase. 3 = positive QC strain, ATCC BAA-1705. 4 = patient isolate positive for carbapenemase.

Citation: Leber A. 2016. The Modified Hodge Confirmatory Test (or the Carbapenem Inactivation Test) for Carbapenemase Production in , p 5.13.1-5.13.6. In Clinical Microbiology Procedures Handbook, Fourth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555818814.ch5.13
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Image of Figure 5.13–2
Figure 5.13–2

Modified Hodge test on large (150 mm) Mueller-Hinton agar plate with ertapenem (E) and meropenem (M) disks. 1 = positive QC strain, ATCC BAA-1705. 2 = patient isolate positive for carbapenemase. 3 = patient isolate negative for carbapenemase. 4 = negative QC strain, ATCC BAA-1706.

Citation: Leber A. 2016. The Modified Hodge Confirmatory Test (or the Carbapenem Inactivation Test) for Carbapenemase Production in , p 5.13.1-5.13.6. In Clinical Microbiology Procedures Handbook, Fourth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555818814.ch5.13
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Image of Figure 5.13–3
Figure 5.13–3

Modified Hodge test on small (100 mm) Mueller-Hinton agar plate with meropenem disk in center. 1 = positive QC strain, ATCC BAA-1705. 2 = clinical isolate with AmpC plus porin mutation demonstrating a slight indentation of growth by the , leading to a positive result due to mechanisms other than carbapenemase production. 3 = clinical isolate negative for carbapenemase. 4 = negative QC strain, ATCC BAA-1706. Photo courtesy of Dr. Paul Schreckenberger.

Citation: Leber A. 2016. The Modified Hodge Confirmatory Test (or the Carbapenem Inactivation Test) for Carbapenemase Production in , p 5.13.1-5.13.6. In Clinical Microbiology Procedures Handbook, Fourth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555818814.ch5.13
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References

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1. CLSI. 2015. Performance Standards for Antimicrobial Susceptibility Testing: Twenty-fifth Informational Supplement. CLSI document M100-S25, CLSI, Wayne, PA.
2. CLSI. 2010. Performance Standards for Antimicrobial Susceptibility Testing: Twentieth Informational Supplement. CLSI document M100-S20. CLSI, Wayne, PA.
3. Endimiani A, Perez F, Bajaksouzian S, Windau AR, Good CE, Choudhary Y, Hujer AM, Bethel CR, Bonomo RA, Jacobs MR. 2010. Evaluation of updated interpretative criteria for categorizing Klebsiella pneumoniae with reduced carbapenem susceptibility. J Clin Microbiol 48:44174425.
4. Doyle D, Peirano G, Lascols C, Lloyd T, Church D, Pitout J. 2012. Laboratory detection of Enterobacteriaceae that produce carbapenemases. J Clin Microbiol 50:38773880.
5. Carvalhaes CG, Picõo RC, Nicoletti AG, Xavier DE, Gales AC. 2010. Cloverleaf test (modified Hodge test) for detecting carbapenemase production in Klebsiella pneumoniae: be aware of false positive results. J Antimicrob Chemother 65:249251.
6. Mochon AB, Garner OB, Hindler JA, Krogstad P, Ward KW, Lewinski MA, Rasheed JK, Anderson KF, Limbago BM, Humphries RM. 2011. New Delhi metallo-β-lactamase (NDM-1)-producing Klebsiella pneumoniae: case report and laboratory detection strategies. J Clin Microbiol 49:16671670.

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Citation: Leber A. 2016. The Modified Hodge Confirmatory Test (or the Carbapenem Inactivation Test) for Carbapenemase Production in , p 5.13.1-5.13.6. In Clinical Microbiology Procedures Handbook, Fourth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555818814.ch5.13
Generic image for table
Untitled

Citation: Leber A. 2016. The Modified Hodge Confirmatory Test (or the Carbapenem Inactivation Test) for Carbapenemase Production in , p 5.13.1-5.13.6. In Clinical Microbiology Procedures Handbook, Fourth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555818814.ch5.13

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