Carbapenamases Facts and Diagnosis
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Number of agents approved
Bars represent number of new antimicrobial agents approved by the FDA during the period listed.
Infectious Diseases Society of America. Bad Bugs, No Drugs. July 2004; Spellberg B et al. Clin Infect Dis. 2004;38:1279-1286;
New antimicrobial agents. Antimicrob Agents Chemother. 2006;50:1912
Most Carbapenemases can Hydrolyze
Beta lactam antibiotics
1. Cephalosporinase : Amp C & CTX- M
+ Porin mutation = low level resistance
2. Carbapenemase: βlactamases that can hydrolyze carbapenems
Amber Class A: 9 families
KPC, SME, NMC-A, IMI, PER, GES, SFO, SFC, IBC
Amber Class B: 6 families
VIM, GIM, SIM, NDM, IMP, SPM
Amber Class D: 2 families
Clinical and Laboratory Standards Institute breakpoints: 2009 & 2010
Revised Break Points 2010
1) Some isolates demonstrate low-level carbapenem resistance
2) Some automated systems fail to detect low-level resistance
The Modified Hodge Test is a phenotypic confirmatory test for “Carapnemase” activity and is indicated when there is a positive screening test and resistance to one or more agents in cephalosporin subclass III (i.e., cefoperazone, cefotaxime, ceftazidime, ceftizoxime, and ceftriaxone) Be aware that imipenem disk tests perform poorly as a screen for carbapenemases.
Procedure described by Lee et al. CMI, 7, 88-102. 2001.
Modified Hodge Test (MHT)
Carbapenem Inactivation Assay
Lawn of E. coli ATCC 25922
1:10 dilution of a
0.5 McFarland suspension
Described by Lee et al. CMI, 7, 88-102. 2001.
Three Enterobacteriaceae isolates carrying a newly described resistance mechanism, the New Delhi metallo-beta-lactamase (NDM-1) , were identified from three U.S. states at the CDC antimicrobial susceptibility laboratory. This is the first report of NDM-1 in the United States, and the first report of metallo-beta-lactamase carriage among Enterobacteriaceae in the United States
An international organization dedicated to curbing antibiotic resistance
Chapters exist currently in several Asian countries: Australia, China, India, Nepal, Pakistan, Philippines, South Korea, Taiwan, Vietnam