READERS OPINION
Modified Hodge test as screening test for spreading Carbapenemase resistance has become more important
Mustafa HatipogluI,
, Sevket BaltaII, Mustafa CakarIII, Sait DemirkolII, Omer KurtIII, Mustafa DincIV
Corresponding author
I Gulhane Military Medicine Academy Haydarpasa Training Hospital, Infectious Diseases and Clinical Microbiology, Üsküdar/İstanbul, Turkey
II Gulhane Medical Academy, Cardiology, Ankara, Turkey
III Gulhane Medical Academy, Internal Medicine, Ankara, Turkey
IV Beytepe Military Hospital, Internal Medicine, Ankara, Turkey
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] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">I</span>" "identificador" => "aff1" ] 1 => array:2 [ "etiqueta" => "*" "identificador" => "cor1" ] ] ] 1 => array:3 [ "nombre" => "Sevket" "apellidos" => "Balta" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">II</span>" "identificador" => "aff2" ] ] ] 2 => array:3 [ "nombre" => "Mustafa" "apellidos" => "Cakar" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">III</span>" "identificador" => "aff3" ] ] ] 3 => array:3 [ "nombre" => "Sait" "apellidos" => "Demirkol" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">II</span>" "identificador" => "aff2" ] ] ] 4 => array:3 [ "nombre" => "Omer" "apellidos" => "Kurt" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">III</span>" "identificador" => "aff3" ] ] ] 5 => array:3 [ "nombre" => "Mustafa" "apellidos" => "Dinc" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">IV</span>" "identificador" => "aff4" ] ] ] ] "afiliaciones" => array:4 [ 0 => array:3 [ "entidad" => "Gulhane Military Medicine Academy Haydarpasa Training Hospital, Infectious Diseases and Clinical Microbiology, Üsküdar/İstanbul, Turkey" "etiqueta" => "I" "identificador" => "aff1" ] 1 => array:3 [ "entidad" => "Gulhane Medical Academy, Cardiology, Ankara, Turkey" "etiqueta" => "II" "identificador" => "aff2" ] 2 => array:3 [ "entidad" => "Gulhane Medical Academy, Internal Medicine, Ankara, Turkey" "etiqueta" => "III" "identificador" => "aff3" ] 3 => array:3 [ "entidad" => "Beytepe Military Hospital, Internal Medicine, Ankara, Turkey" "etiqueta" => "IV" "identificador" => "aff4" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor1" "etiqueta" => "*" "correspondencia" => "Tel.: 90 506 7888063" ] ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="para10" class="elsevierStylePara elsevierViewall">Dear Editor,</p><p id="para20" class="elsevierStylePara elsevierViewall">We read the article by Cury et al. titled ‘‘The modified Hodge test is a useful tool for ruling out <span class="elsevierStyleItalic">Klebsiella pneumoniae</span> carbapenemase” with interest (<a class="elsevierStyleCrossRef" href="#bib1">1</a>). The authors aimed to evaluate the modified Hodge test (MHT) as a phenotypic screening test for <span class="elsevierStyleItalic">Klebsiella pneumoniae</span> carbapenemase (KPC). They concluded that standardizing MHT interpretation may improve the specificity of KPC detection. Additionally, negative test results ruled out 100% of the isolates harboring <span class="elsevierStyleItalic">Klebsiella pneumoniae</span> carbapenemase-2. The test may therefore be regarded as a good epidemiological tool.</p><p id="para30" class="elsevierStylePara elsevierViewall">Carbapenemase resistance has become a major problem around the world. However, the prevalence of carbapenemase resistance genes may have epidemiological differences between different regions, such as BlaKPC in the American and European zones, NDM in India, and OXA-48 in Turkey (<a class="elsevierStyleCrossRef" href="#bib2">2</a>). BlaKPC examination in these trials was used to identify the genotype. Other resistance genes have been neglected. Thus, we believe that if BlaKPC-negative isolates, as determined by PCR, were to be tested in the presence of BlaIMP, BlaNDM, and BlaOXA-48, the significance of the study would increase.</p><p id="para40" class="elsevierStylePara elsevierViewall">Molecular detection of the presence of carbapenemases is the gold standard for diagnosis, but testing performed on a routine basis is expensive and impractical (<a class="elsevierStyleCrossRef" href="#bib2">2</a>). All carbapenemase resistance caused by the resistance genes is detectable using the MHT, for which the sensitivity and specificity of the screening is known to be very good (<a class="elsevierStyleCrossRef" href="#bib1">1</a>,<a class="elsevierStyleCrossRef" href="#bib2">2</a>). However, the weakest aspect of the MHT is specificity. In a recent study using <span class="elsevierStyleItalic">K. pneumoniae</span> ATCC 700603 as the indicator strain instead of <span class="elsevierStyleItalic">E. coli</span> ATCC 25922 in a test procedure, the MHT had 97% sensitivity and 100% specificity (<a class="elsevierStyleCrossRef" href="#bib3">3</a>). Another study reported a problem with sensitivity in expressing NDM-1 strains and found that specificity increased with the addition of ZnSO<span class="elsevierStyleInf">4</span> (<a class="elsevierStyleCrossRef" href="#bib4">4</a>). Therefore, different resistance genes in different bacteria must be considered when designing a methodology to increase sensitivity and specificity. We believe that more studies are needed on this subject.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:1 [ "nota" => "<p class="elsevierStyleNotepara" id="cenpara10">No potential conflict of interest was reported.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "REFERENCES" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "cebibsec10" "bibliografiaReferencia" => array:4 [ 0 => array:3 [ "identificador" => "bib1" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The modified Hodge test is a useful tool for ruling out klebsiella pneumoniae carbapenemase" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => """ A Cury \n \t\t\t\t\t\t\t\t """ 1 => """ D Andreazzi \n \t\t\t\t\t\t\t\t """ 2 => """ M Maffucci \n \t\t\t\t\t\t\t\t """ 3 => """ H Caiaffa-Junior \n \t\t\t\t\t\t\t\t """ 4 => """ F Rossi \n \t\t\t\t\t\t\t\t """ ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Clinics" "fecha" => "2012" "volumen" => "67" "numero" => "12" "paginaInicial" => "1427" "paginaFinal" => "1431" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib2" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "[Comparison of ertapenem-EMB Agar with traditional methods for screening carbapenem-resistant Klebsiella pneumoniae from rectal swabs]" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => """ D Perçin \n \t\t\t\t\t\t\t\t """ 1 => """ S Colakoğlu \n \t\t\t\t\t\t\t\t """ 2 => """ S Durmaz \n \t\t\t\t\t\t\t\t """ 3 => """ P Ekincioğlu \n \t\t\t\t\t\t\t\t """ ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:7 [ "tituloSerie" => "Mikrobiyol Bul" "fecha" => "2012" "volumen" => "46" "numero" => "4" "paginaInicial" => "546" "paginaFinal" => "552" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23188568" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib3" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Sensitive and specific modified Hodge test for KPC and metallo-beta- lactamase detection in Pseudomonas aeruginosa by use of a novel indicator strain, Klebsiella pneumoniae ATCC 700603" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => """ F Pasteran \n \t\t\t\t\t\t\t\t """ 1 => """ O Veliz \n \t\t\t\t\t\t\t\t """ 2 => """ M Rapoport \n \t\t\t\t\t\t\t\t """ 3 => """ L Guerriero \n \t\t\t\t\t\t\t\t """ 4 => """ A Corso \n \t\t\t\t\t\t\t\t """ ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1128/JCM.05602-11" "Revista" => array:7 [ "tituloSerie" => "J Clin Microbiol" "fecha" => "2011" "volumen" => "49" "numero" => "12" "paginaInicial" => "4301" "paginaFinal" => "4303" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22012019" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib4" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Value of the modified Hodge test for detection of emerging carbapenemases in Enterobacteriaceae" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => """ D Girlich \n \t\t\t\t\t\t\t\t """ 1 => """ L Poirel \n \t\t\t\t\t\t\t\t """ 2 => """ P Nordmann \n \t\t\t\t\t\t\t\t """ ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1128/JCM.05247-11" "Revista" => array:7 [ "tituloSerie" => "J Clin Microbiol" "fecha" => "2012" "volumen" => "50" "numero" => "2" "paginaInicial" => "477" "paginaFinal" => "479" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22116154" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/18075932/0000006800000008/v1_202212010718/S1807593222016544/v1_202212010718/en/main.assets" "Apartado" => null "PDF" => "https://static.elsevier.es/multimedia/18075932/0000006800000008/v1_202212010718/S1807593222016544/v1_202212010718/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1807593222016544?idApp=UINPBA00004N" ]
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