Published: 2017-07-26

Phenotypic detection of carbapenem resistance in gram negative bacilli from various clinical specimens of a tertiary care hospital in Western Uttar Pradesh

Jyoti Diwakar, Rajesh K. Verma, Dharmendra P. Singh, Amit Singh, Sunita Kumari


Background: Carbapenemase producing multidrug-resistant organisms (i.e., MDROs) is a critical medical and public health issue globally. These bacteria are often resistant to all beta-lactam agents and are also co-resistant to other multiple classes of antimicrobial agents, leaving very few antimicrobial options.

Methods: This study was carried out at UP University of medical sciences Saifai, Etawah, Uttar Pradesh, India, from January 2015 to June 2016. 110 isolates were found resistant by the Kirby Bauer’s disc diffusion method according to the CLSI guidelines. Modified Hodge test and combined disk test were performed for resistant isolates.

Results: A total of 800-gram negative isolate were included in the study. 110 isolates were found resistant to imipenem by disk diffusion method. Out of these 90 (81.81%) were positive for carbapenemase production by modified Hodge test.

Conclusions: We conclude that the modified Hodge test is a useful method for detection of carbapenemase production. Combined disc method is useful to detect metallo beta lactamase production.


Carbapenemases, Gram negative bacteria, Modified Hodge test, Metallo beta lactamase (MBL)

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Behera B, Mathur P, Das A. An evaluation of four different phenotypic techniques for detection of Metallo-beta-lactamase producing Pseudomonas aeruginosa. Indian J Med Microbiol. 2014;26(3):233-7.

Kaur M, Gupte S, Kaur T. Detection of carbapenem resistant gram-negative bacteria in clinical isolates from a tertiary care hospital. J Bacterial mycol. 2016;2(1):130.

Spratt BG, Jobanputra V, Zimmermann W. Binding of thienamycin and clavulanic acid to the penicillin-binding proteins of Escherichia coli K-12. Antimicrob Agents Chemother. 1977;12:406-9.

Yao DJ and Moellering CR. Antibacterial agents. In: Murray RP, editor. Manual of clinical microbiology. 9th ed. ASM Press Washington DC; 2007:1081.

Nordmann P, Naas T, Poirel L. Global Spread of Carbapenems producing Enterobacteriaceae. Emerg Infect Dis. 2011;17:10.

Clinical and Laboratory Standards Institute. Performance standards for antimicrobial susceptibility testing; 25th informational supplement. CLSI document M100-S25. Wayne, PA: CLSI, 2015. Available at

Walsh TR, Bolmstrom A, Qwarnstrom A, Gales A. Evaluation of a new E-test for detecting metallo-β-lactamases in routine clinical testing. J Clin Microbiol. 2002;40:2755-9.

Manoharan A, Premalatha K, Chatterjee S, Mathai D. Correlation of TEM, SHV and CTX-M extended-spectrum beta lactamase among Enterobacteriaceae within their in vitro antimicrobial susceptibility. Indian J Med Microbiol. 2011;29(2):161-4.

Dutta P, Gupta V, Garg S, Chander J. Phenotypic method for differentiation of carbapenems in Enterobacteriaceae: study from north India. Indian J Pathol Microbiol. 2012;55(3):357-60.

Wattal C, Goel N, Oberoi JK, Raveendran R, Dutta S. Surveillance of multidrug resistant organisms in a tertiary care hospital in Delhi. Indian J Assoc Phy India. 2011;58:32-6.

Gupta E, Mohanty S, Sood S, Dhawan B, Das BK. Emerging resistance to carbapenems in a tertiary care hospital in north India. Indian J Med Res. 2006;124(1):95-8.

Prakash D, Saxena RS. Distribution and antimicrobial susceptibility pattern of pathogens causing urinary tract infection in urban community of Meerut city, India. ISRN Microbiol. 2013:2013.

Aswani SM, Chandrashekar U, Shivashankara K, Pruthvi B. Clinical profile of urinary tract infection in diabetics and non-diabetics. Australas Med J. 2014;7(1):29-34.

Manenzhe RI, Zar HJ, Nicol MP, Kaba M. The spread of carbapenems-producing bacteria in Africa: a systemic review. J Antimicrob Chemother. 2014;70(1):23-40.

Mate H, Sulochana D, Mamta D. Prevalence of carbapenem resistance among gram-negative bacteria in a tertiary care hospital in North-East India. J Dent Med Sci. 2014;13(12):56-60.

Mohamudha RP, Harish BN, Parija SC. Emerging carbapenem resistance among nosocomial isolates of Klebsiella pneumoniae in South India. Inter J Pharma Bio Sci. 2010;6(2).

Nagaraj S, Chandran SP, Shamanna P, Macaden R. Carbapenem resistance among Escherichia coli and Klebsiella pneumoniae in a tertiary care hospital in South India. Indian J Med Microbiol. 2012;30(1):93-5.

Sahin K, Tekin A, Ozdas S, Akin D, Yapislar H, Ramazan A, et al. Evaluation of carbapenem resistance using phenotypic and genotypic techniques in Enterobacteriaceae isolates. Ann Clin Microbiol Antimicrob. 2015;14:44.

Girlich D, Poirel L, Nordmann P. Value of the modified Hodge test for detection of emerging carbapenemases in Enterobacteriaceae. Am Soc microbiol. 2012;50(2):477-9.

Kumar S, Mehra SK. Performance of modified Hodge test and combined disc test for detection of carbapenems in clinical isolates of Enterobacteriaceae. Inter J Current Microbiol Applied Sci. 2015;4(5):255-61.

Mate H, Sulochana D, Mamta D. Prevalence of carbapenem resistance among gram-negative bacteria in a tertiary care hospital in North-East India. J Dent Med Sci. 2014;13(12):56-60.