Diagnostic Accuracy of the Simplified Carbapenem Inactivation Method versus the Modified Hodge Test in Carbapenem-Resistant Pseudomonas aeruginosa: A Cross-Sectional Study
DOI:
https://doi.org/10.37275/oaijmr.v6i4.924Keywords:
Carbapenem-resistant Pseudomonas aeruginosa, Carbapenemase, Modified Hodge Test, Sensitivity and specificityAbstract
Background: Carbapenem-resistant Pseudomonas aeruginosa (CRPA) is among the pathogens contributing most to the global burden of antimicrobial resistance, and its pooled prevalence in Indonesia reaches 43%. Carbapenem resistance and carbapenemase production are not equivalent, and only the enzymatic route is transmissible and therapeutically decisive. Molecular confirmation is unavailable in most Indonesian laboratories, so an accurate low-cost phenotypic assay is needed.
Objective: To compare the simplified carbapenem inactivation method (sCIM) with the Modified Hodge Test (MHT) for detecting carbapenemase production in carbapenem-resistant P. aeruginosa.
Methods: This cross-sectional diagnostic-accuracy study evaluated 30 meropenem- and imipenem-resistant clinical isolates archived at Dr. Soetomo General Academic Hospital, Surabaya, using PCR for blaIMP, blaGES, blaOXA, blaNDM, blaKPC and blaVIM as the reference standard.
Result: A carbapenemase gene was detected in 13/30 isolates (43.3%): blaIMP in 9, blaGES in 3 and blaOXA in 1. sCIM achieved 92.31% sensitivity (95% confidence interval 64.0-99.8), 100.00% specificity (80.5-100.0), 96.7% accuracy and near-perfect agreement with PCR (kappa 0.932). MHT achieved 46.15% sensitivity (19.2-74.9), 88.24% specificity (63.6-98.5) and fair agreement (kappa 0.360). The paired exact McNemar test confirmed the sensitivity advantage of sCIM (p = 0.031), and bootstrapping showed a 26.6-percentage-point difference in overall accuracy (95% confidence interval 10.0-43.3). MHT detected no blaGES-positive isolate and only 6/9 blaIMP-positive isolates; sCIM detected all of both, while neither assay detected the single poorly expressed blaOXA isolate.
Conclusion: sCIM is an accurate, rapid and inexpensive assay that should replace MHT in Indonesian laboratories and feed directly into stewardship and infection-control decisions.
Authors
- Fara Nayo Faramarisa1*
- Kristiawan Basuki Rahmat2
- Berliana Nisfa Laily2
- Eddy Bagus Wasito3
- Kuntaman3
- 1Master Program of Clinical Medicine, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia/Faculty of Medicine, University of Darussalam Gontor, Ponorogo, Indonesia
- 2Faculty of Medicine, University of Darussalam Gontor, Ponorogo, Indonesia
- 3Department of Medical Microbiology, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia
Corresponding author Fara Nayo Faramarisa — faranayofaramarisa@fk.unida.gontor.ac.id
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Copyright (c) 2026 Fara Nayo Faramarisa, Kristiawan Basuki Rahmat, Berliana Nisfa Laily, Eddy Bagus Wasito, Kuntaman
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