Further Modification of the Modified Hodge Test for Detecting Metallo-β-Lactamase-Producing Carbapenem-Resistant Enterobacteriaceae
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Background: The modified Hodge test (MHT) was designed to detect carbapenemase-producing Enterobacteriaceae (CPE). This study evaluated variables to improve the performance of MHT. Methods: Carbapenem-resistant Enterobacteriaceae isolated from November 2010 to March 2013 at the Asan Medical Center, were evaluated, including 33 metallo-β-lactamase (MBL) producers and 103 non-CPEs. MHT was performed by using two carbapenem disks (ertapenem and meropenem; Becton Dickinson, USA), three media (Mueller-Hinton agar (MHA), MacConkey agar (MAC), and zinc-enriched MHA), and two inoculums (0.5-McFarland [McF] suspension and a 10-fold dilution of it.) PCR was performed to detect β-lactamase genes of the MBL, AmpC, and CTX-M types. Results: The sensitivity of MHT for detecting New Delhi metallo-β-lactamase (NDM) producers was highest using ertapenem and 0.5-McF, 52.0% on MHA and 68.0% on MAC, respectively. NDM-producing Klebsiella pneumoniae (NDMKP) were detected with higher sensitivity on MAC (78.6%) vs. MHA (28.6%) (P=0.016), but VIM-producing Enterobacter, Citrobacter, and Serratia were detected with higher sensitivity on MHA (78.5%) vs. MAC (14.3%) (P=0.004). MBL producers were consistently identified with lower sensitivity using meropenem vs. ertapenem, 39.4% vs. 60.6% (P=0.0156), respectively. The effects of zinc and inoculum size were insignificant. Enterobacter aerogenes producing unspecified AmpC frequently demonstrated false positives, 66.7% with ertapenem and 22.2% with meropenem. Conclusions: The MHT should be adjusted for the local distribution of species and the carbapenemase type of MBL producers. MAC and ertapenem are preferable for assessing NDMKP, but MHA is better for VIM. Laboratory physicians should be aware of the limited sensitivity of MHT and its relatively high false-positive rate.
Abstract
Background: The modified Hodge test (MHT) was designed to detect carbapenemase-producing Enterobacteriaceae (CPE). This study evaluated variables to improve the performance of MHT. Methods: Carbapenem-resistant Enterobacteriaceae isolated from November 2010 to March 2013 at the Asan Medical Center, were evaluated, including 33 metallo-β-lactamase (MBL) producers and 103 non-CPEs. MHT was performed by using two carbapenem disks (ertapenem and meropenem; Becton Dickinson, USA), three media (Mueller-Hinton agar (MHA), MacConkey agar (MAC), and zinc-enriched MHA), and two inoculums (0.5-McFarland [McF] suspension and a 10-fold dilution of it.) PCR was performed to detect β-lactamase genes of the MBL, AmpC, and CTX-M types. Results: The sensitivity of MHT for detecting New Delhi metallo-β-lactamase (NDM) producers was highest using ertapenem and 0.5-McF, 52.0% on MHA and 68.0% on MAC, respectively. NDM-producing Klebsiella pneumoniae (NDMKP) were detected with higher sensitivity on MAC (78.6%) vs. MHA (28.6%) (P=0.016), but VIM-producing Enterobacter, Citrobacter, and Serratia were detected with higher sensitivity on MHA (78.5%) vs. MAC (14.3%) (P=0.004). MBL producers were consistently identified with lower sensitivity using meropenem vs. ertapenem, 39.4% vs. 60.6% (P=0.0156), respectively. The effects of zinc and inoculum size were insignificant. Enterobacter aerogenes producing unspecified AmpC frequently demonstrated false positives, 66.7% with ertapenem and 22.2% with meropenem. Conclusions: The MHT should be adjusted for the local distribution of species and the carbapenemase type of MBL producers. MAC and ertapenem are preferable for assessing NDMKP, but MHA is better for VIM. Laboratory physicians should be aware of the limited sensitivity of MHT and its relatively high false-positive rate.
참고문헌 (33)
- 노경호, "Isolation of a Klebsiella pneumoniae Isolate of Sequence Type 258 Producing KPC-2 Carbapenemase in Korea", Annals of Laboratory Medicine, 31(4), pp.298~301 (2011), 대한진단검사의학회
- Lee Y, "Molecular mechanisms of carbapenem resistance in Enterobacter cloacae clinical isolates from Korea and clinical outcome", Ann Clin Lab Sci, 42, pp.281~286 (2012)
- Cohen Stuart J, "Guideline for phenotypic screening and confirmation of carbapenemases in Enterobacteriaceae", Int J Antimicrob Agents, 36, pp.205~210 (2010)
- Birgy A, "Phenotypic screening of carbapenemases and associated β-lactamases in carbape nem-resistant Enterobacteriaceae", J Clin Microbiol, 50, pp.1295~1302 (2012)
- Kumarasamy KK, "Emergence of a new antibiotic resistance mechanism in India, Pakistan, and the UK: a molecular, biological, and epidemiological study", Lancet Infect Dis, 10, pp.597~602 (2010)
- Nordmann P, "Identification and screening of carbapenemase-producing Enterobacteriaceae", Clin Microbiol Infect, 18, pp.432~438 (2012)
- National Committe for Clinical Laboratory Standards, "Performance standards for antimicrobial susceptibility testing. Twenty-third Informational supplement, M100-S23", Clinical and Laboratory Standards Institue, ~ (2013)
- Girlich D, "Value of the modified Hodge test for detection of emerging carbapenemases in Enterobacteriaceae", J Clin Microbiol, 50, pp.477~479 (2012)
- Castanheira M, "Early dissemination of NDM-1- and OXA-181-producing Enterobacteriaceae in Indian hospitals: report from the SENTRY Antimicrobial Surveillance Program, 2006-2007", Antimicrob Agents Chemother, 55, pp.1274~1278 (2011)
- Doyle D, "Laboratory detection of Enterobacteriaceae that produce carbapenemases", J Clin Microbiol, 50, pp.3877~3880 (2012)
- Jacoby GA, "Role of beta-lactamases and porins in resistance to ertapenem and other beta-lactams in Klebsiella pneumoniae", Antimicrob Agents Chemother, 48, pp.3203~3206 (2004)
- Mammeri H, "Phenotypic and biochemical comparison of the carbapenem-hydrolyzing activities of five plasmid-borne AmpC β-lactamases", Antimicrob Agents Chemother, 54, pp.4556~4560 (2010)
- Woodford N, "Ertapenem resistance among Klebsiella and Enterobacter submitted in the UK to a reference laboratory", Int J Antimicrob Agents, 29, pp.456~459 (2007)
- Shin SY, "Resistance to carbapenems in sequence type 11 Klebsiella pneumoniae is related to DHA-1 and loss of OmpK35 and", or OmpK36, 2012, pp.61, 239~245
- Kim MN, "Nosocomial clustering of NDM-1-producing Klebsiella pneumoniae sequence type 340 strains in four patients at a South Korean tertiary care hospital", J Clin Microbiol, 50, pp.1433~1436 (2012)
- Kim SY, "Characteristics of carbapenem-resistant Enterobacteriaceae isolates from Korea", Diagn Microbiol Infect, 76, pp.486~490 (2013)
- Lee K, "Improved performance of the modified Hodge test with MacConkey agar for screening carbapenemase-producing Gram-negative bacilli", J Microbiol Methods, 83, pp.149~152 (2010)
- National Committe for Clinical Laboratory Standards, "Performance standards for antimicrobial susceptibility testing. Twentieth Informational supplement, M100-S20", Clinical and Laboratory Standards Institute, ~ (2010)
- National Committe for Clinical Laboratory Standards, "Performance standards for antimicrobial disk susceptibility tests; approved standard-Eleventh edition, M02-A11", Clinical and Laboratory Standards Institue, ~ (2012)
- Livermore DM, "Antibiotics in laboratory medicine", pp.543~546 (1996), Williams & Willkins
- Ellington MJ, "Multiplex PCR for rapid detection of genes encoding acquired metallo-beta-lactamases", J Antimicrob Chemother, 59, pp.321~322 (2007)
- Zarfel G, "Emergence of New Delhi metallo-β-lactamase, Austria", Emerg Infect Dis, 17, pp.129~130 (2011)
- Song W, "Increasing trend in the prevalence of plasmid-mediated AmpC beta-lactamases in Enterobacteriaceae lacking chromosomal ampC gene at a Korean university hospital from 2002 to 2004", Diagn Microbiol Infect Dis, 55, pp.219~224 (2006)
- Woodford N, "Multiplex PCR for rapid detection of genes encoding CTX-M extended-spectrum β-lactamases", J Antimicrob Chemother, 57, pp.154~155 (2006)
- Nordmann P, "Global spread of Carbapenemase-producing Enterobacteriaceae", Emerg Infect Dis, 17, pp.1791~1798 (2011)
- Lee K, "Modified Hodge and EDTA-disk synergy tests to screen metallo-beta-lactamase-producing strains of Pseudomonas and Acinetobacter species", Clin Microbiol Infect, 7, pp.88~91 (2001)
- Nordmann P, "Rapid detection of carbapenemase-producing Enterobacteriaceae", Emerg Infect Dis, 18, pp.1503~1507 (2012)
- Tijet N, "Evaluation of the Carba NP test for rapid detection of carbapenemase-producing Enterobacteriaceae and Pseudomonas aeruginosa", Antimicrob Agents Chemother, 57, pp.4578~4580 (2013)
- Nordmann P, "Strategies for identification of carbapenemase-producing Enterobacteriaceae", J Antimicrob Chemother, 68, pp.487~489 (2013)
- Mathers AJ, "Modified Hodge test versus indirect carbapenemase test: prospective evaluation of a phenotypic assay for detection of Klebsiella pneumoniae carbapenemase (KPC) in Enterobacteriaceae", J Clin Microbiol, 51, pp.1291~1293 (2013)
- Rottman M, "Chromosomal ampC genes in Enterobacter species other than Enterobacter cloacae, and ancestral association of the ACT-1 plasmid-encoded cephalosporinase to Enterobacter asburiae", FEMS Microbiol Lett, 210, pp.87~92 (2002)
- Carvalhaes CG, "Cloverleaf test (modified Hodge test) for detecting carbapenemase production in Klebsiella pneumoniae: be aware of false positive results", J Antimicrob Chemother, 65, pp.249~251 (2010)
- Wang P, "Occurrence of false positive results for the detection of carbapenemases in carbapenemase-negative Escherichia coli and Klebsiella pneumoniae isolates", PLoS One, 6, pp.e26356~ (2011)