Comparison of Carbapenem Inactivation Test and Modified Hodge Test in Carbapenemase-Producing Klebsiella pneumoniae Strains/Karbapenemaz Ureten Klebsiella pneumoniae Suslarinda Karbapenem Inaktivasyon Testi ve Modifiye Hodge Testinin Karsilastirilmasi

• Published in: KLIMIK dergisi Vol. 31; no. 3; p. 223
• Main Authors: Davarci, Ismail, Kocoglu, Mucahide Esra, Zengin, Ferhat
• Format: Journal Article
• Language: English
• Published: AVES 01.12.2018
• Subjects: Anopheles; Antibacterial agents; Beta lactamases; Care and treatment; Comparative analysis; Diagnosis; Enterobacteriaceae infections; Genes; Health aspects; Imipenem; Infection; Infrastructure (Economics); Medical research; Meropenem; Pneumonia; Polymerase chain reaction
• ISSN: 1301-143X; 1309-1484
• DOI: 10.5152/kd.2018.54

Objective: Carbapenem-resistant Enterobacteriaceae are reported increasingly everywhere throughout the world. Rapid and simple detection of carbapenemase-producing strains has become imperative because of the use of carbapenems in the treatment of extended spectrum [beta]-lactamase (ESBL)producing Enterobacteriaceae infections. In this study, we aimed to compare the diagnostic value of modified Hodge test and carbapenem inactivation test for Klebsiella pneumoniae isolates producing carbapenemase, verified by molecular method, and to evaluate their use in routine laboratory practice. Methods: 64 K. pneumoniae strains which have shown resistance gene causing carbapenem resistance by the polymerase chain reaction, and 40 ESBL-negative and carbapenem-susceptible K. pneumoniae strains have been included in this study. Meropenem, imipenem and ertapenem were studied separately in modified Hodge test and carbapenem inactivation test was performed for all strains. Carbapenem inactivation test was evaluated at the 6th hour for preliminary decision and at the 24th hour for the final decision. Cite this article as: Davarci I, Kocoglu ME, Zengin F [Comparison of carbapenem inactivation test and modified Hodge test in carbapenemase-producing Klebsiella pneumoniae strains]. Klimik Derg. 2018; 31(3): 223-6. Turkish. Yazisma Adresi / Address for Correspondence: Ismail Davarci, Erzincan Binali Yildirim Universitesi, Mengucek Gazi Egitim ve Arastirma Hastanesi, Tibbi Mikrobiyoloji Laboratuvari, Erzincan, Turkiye E-posta/E-mail: ismaildavarci@hotmail.com (Gelis/Received: 12 Subat/February 2018; Kabul/Accepted: 5 Haziran/June 2018) DOI: 10.5152/kd.2018.54 Results: The sensitivity of the modified Hodge test using meropenem, imipenem and ertapenem for detecting presence of carbapenemase was 60.9%, 62.5% and 68.8%, respectively. In the carbapenem inactivation test with meropenem, imipenem and ertapenem, sensitivity to determine carbapenemase production was 32.8%, 75% and 96.9% after 6 hours, and 64.1%, 84.4% and 96.9% after 24 hours, respectively. There were no positive results in modified Hodge and carbapenem inactivation tests with K. pneumoniae strains that were ESBL-negative and carbapenem-susceptible. Conclusions: As a result, molecular tests are essential to detect carbapenem encoding genes. However, we believe that the carbapenemase inactivation test is a better alternative to the modified Hodge test to detect carbapenemase production in laboratories without adequate infrastructure.Klimik Dergisi 2018; 31(3): 223-6. Key Words: Carbapenem-resistant Enterobacteriaceae, carbapenem inactivation test, modified Hodge test. Amac: Karbapeneme direncli Enterobacteriaceae turleri dunyanin her yerinden giderek artan siklikta bildirilmektedir. Genislemis spektrumlu [beta]-laktamaz (GSBL) ureten Enterobacteriaceae infeksiyonlarinin tedavisinde karbapenemlerin kullanilmasi, karbapenemaz ureten suslarin hizli ve basit bir yontemle saptanmasini zorunlu hale getirmistir. Bu calismada, molekuler olarak karbapenemaz urettigi dogrulanmis Klebsiella pneumoniae izolatlarinda modifiye Hodge testinin ve karbapenem inaktivasyon testinin tanisal degerinin kiyaslanmasi ve rutin laboratuvar pratiginde kullaniminin degerlendirilmesi amaclanmistir. Yontemler: Calismamiza deney grubunu olusturmak uzere karbapenem direncine sebep olan direnc geni polimeraz zincir reaksiyonuyla gosterilmis 64 K. pneumoniae ve kontrol grubunu olusturmak uzere GSBL-negatif ve karbapeneme duyarli 40 K. pneumoniae susu dahil edilmistir. Meropenem, imipenem ve ertapenem ayri ayri tum suslara karsi modifiye Hodge testi ve karbapenem inaktivasyon testiyle denenmistir. Karbapenem inaktivasyon testinde altinci saatte on degerlendirme, 24. saatte son degerlendirme yapilmistir. Bulgular: Modifiye Hodge testinin karbapenemaz varliginin belirlenmesindeki duyarliligi, meropenem, imipenem ve ertapenem icin sirasiyla %60.9, %62.5 ve %68.8 olarak bulunmustur. Karbapenem inaktivasyon testinin karbapenemaz varliginin belirlenmesindeki duyarliligi, meropenem, imipenem ve ertapenem icin altinci saatte sirasiyla %32.8, %75 ve %96.9 iken, 24. saatte %64.1, %84.4 ve %96.9 olarak saptanmistir. GSBL uretmeyen ve karbapenemlere duyarli bulunan K. pneumoniae suslariyla yapilan modifiye Hodge ve karbapenem inaktivasyon testlerinde pozitiflik gorulmemistir. Sonuclar: Sonuc olarak karbapenemaz kodlayan genleri tespit etmek icin molekuler testler gereklidir. Ancak yeterli altyapisi olmayan laboratuvarlarda karbapenemaz varliginin belirlenmesi icin karbapenem inaktivasyon testi, modifiye Hodge testinden daha iyi bir alternatif olabilir. Klimik Dergisi 2018; 31(3): 223-6. Anahtar Sozcukler: Karbapeneme direncli Enterobacteriaceae, karbapenem inaktivasyon testi, modifiye Hodge testi.