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Resistance to antibiotic therapy via production of the enzyme carbapenemase by Klebsiella pneumoniae and other members of Enterobacteriaceae is becoming more common. This resistance is not always detected by conventional antimicrobial susceptibility testing, which may result in inappropriate antimicrobial therapy for the patient.
In Enterobacteriaceae, the gene blaKPC, which encodes KPC (Klebsiella pneumoniae carbapenemase) production, can be detected by real-time PCR. However, molecular methods have not been established for other carbapenemases.
The modified Hodge test, a phenotypic method, is recommended by the Clinical and Laboratory Standards Institute (CLSI) as the method to detect carbapenemases.
Determining carbapenem resistance
A positive result indicates the production of carbapenemase.
A negative result indicates the lack of production of carbapenemase.
This test is not routinely performed on Enterobacteriaceae determined to be fully resistant to carbapenems in the Mayo Microbiology Laboratory.
The 2009 CLSI Standards for Antimicrobial Susceptibility Testing. CLSI Audioconference. Janet Hindler. Original air date: January 21, 2009