Annals of Laboratory Medicine

Korean Society for Laboratory Medicine (대한진단검사의학회)
권호 표지
DOI QR코드

DOI QR Code

Comparative Evaluation of Three Chromogenic Media Combined with Broth Enrichment and the Real-Time PCR-Based Xpert MRSA Assay for Screening of Methicillin-Resistant Staphylococcus aureus in Nasal Swabs

  • Lee, Seungok (Department of Laboratory Medicine, College of Medicine, The Catholic University of Korea) ;
  • Park, Yeon-Joon (Department of Laboratory Medicine, College of Medicine, The Catholic University of Korea) ;
  • Park, Kang-Gyun (Department of Laboratory Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea) ;
  • Jekarl, Dong Wook (Department of Laboratory Medicine, College of Medicine, The Catholic University of Korea) ;
  • Chae, Hyojin (Department of Laboratory Medicine, College of Medicine, The Catholic University of Korea) ;
  • Yoo, Jin-Kyung (Department of Intensive Care Unit, Seoul St. Mary's Hospital, The Catholic University of Korea) ;
  • Seo, Sin Won (Department of Intensive Care Unit, Seoul St. Mary's Hospital, The Catholic University of Korea) ;
  • Choi, Jung Eun (Department of Intensive Care Unit, Seoul St. Mary's Hospital, The Catholic University of Korea) ;
  • Lim, Jung Hye (Department of Intensive Care Unit, Seoul St. Mary's Hospital, The Catholic University of Korea) ;
  • Heo, Seon Mi (Department of Intensive Care Unit, Seoul St. Mary's Hospital, The Catholic University of Korea) ;
  • Seo, Ju Hee (Department of Intensive Care Unit, Seoul St. Mary's Hospital, The Catholic University of Korea)
  • Published : 2013.07.01
⟨ Previous Next ⟩

Abstract

Background: We evaluated the performance of three chromogenic media (Brilliance agar I [Oxoid, UK], Brilliance agar II [Oxoid], and ChromID MRSA [Biom$\acute{e}$rieux, France]) combined with broth enrichment and the Xpert MRSA assay for screening of methicillin-resistant Staphylococcus aureus (MRSA). Methods: We obtained 401 pairs of duplicate nasal swabs from 321 patients. One swab was suspended overnight in tryptic soy broth; $50-{\mu}L$ aliquots of suspension were inoculated on the three chromogenic media. Brilliance agar I and II were examined after 24 hr, and ChromID MRSA, after 24 and 48 hr. The paired swab was processed directly using realtime PCR-based Xpert MRSA assay. Results: True positives, designated as MRSA growth in any of the culture media, were detected with the prevalence of 17% in our institution. We report the sensitivity, specificity, positive predictive value, and negative predictive value of MRSA growth as follows: 92.3%, 94.0%, 75.9%, and 98.4% in Brilliance agar I (24 hr); 92.7%, 97.9%, 90.0%, and 98.5% in Brilliance agar II (24 hr); 95.6%, 95.8%, 82.3%, and 99.1% in ChromID MRSA (24 hr); 100%, 92.5%, 73.1%, and 100% in ChromID MRSA (48 hr); 92.6%, 96.7%, 85.1%, and 98.5% in Xpert MRSA assay. The agreement between the enriched culture and Xpert MRSA assay was 96.0%. Conclusions: Three chromogenic culture media combined with enrichment and Xpert MRSA assay demonstrated similar capabilities in MRSA detection. The Xpert MRSA assay yielded results comparable to those of culture methods, saving 48-72 hr, thus facilitating earlier detection of MRSA in healthcare settings.

Keywords

References

  1. Yi J and Kim EC. Microbiological characteristics of methicillin-resistant Staphylococcus aureus. Korean J Clin Microbiol 2010;13:1-6. https://doi.org/10.5145/KJCM.2010.13.1.1
  2. Honda H, Krauss MJ, Coopersmith CM, Kollef MH, Richmond AM, Fraser VJ, et al. Staphylococcus aureus nasal colonization and subsequent infection in intensive care unit patients: does methicillin resistance matter? Infect Control Hosp Epidemiol 2010;31:584-91. https://doi.org/10.1086/652530
  3. Weber SG, Huang SS, Oriola S, Huskins WC, Noskin GA, Harriman K, et al. Legislative mandates for use of active surveillance cultures to screen for methicillin-resistant Staphylococcus aureus and vancomycin-resistant enterococci: position statement from the Joint SHEA and APIC Task Force. Infect Control Hosp Epidemiol 2007;28:249-60. https://doi.org/10.1086/512261
  4. Lee K, Kim MN, Kim JS, Hong HL, Kang JO, Shin JH, et al. Further increases in carbapenem-, amikacin-, and fluoroquinolone-resistant isolates of Acinetobacter spp. and P. aeruginosa in Korea: KONSAR study 2009. Yonsei Med J 2011;52:793-802. https://doi.org/10.3349/ymj.2011.52.5.793
  5. Arbefeville SS, Zhang K, Kroeger JS, Howard WJ, Diekema DJ, Richter SS. Prevalence and genetic relatedness of methicillin-susceptible Staphylococcus aureus isolates detected by the Xpert MRSA nasal assay. J Clin Microbiol 2011;49:2996-9. https://doi.org/10.1128/JCM.00046-11
  6. Wolk DM, Picton E, Johnson D, Davis T, Pancholi P, Ginocchio CC, et al. Multicenter evaluation of the Cepheid Xpert methicillin-resistant Staphylococcus aureus (MRSA) test as a rapid screening method for detection of MRSA in nares. J Clin Microbiol 2009;47:758-64. https://doi.org/10.1128/JCM.01714-08
  7. Makgotlho PE, Kock MM, Hoosen A, Lekalakala R, Omar S, Dove M, et al. Molecular identification and genotyping of MRSA isolates. FEMS Immunol Med Microbiol 2009;57:104-15. https://doi.org/10.1111/j.1574-695X.2009.00585.x
  8. Rossney AS, Herra CM, Brennan GI, Morgan PM, O'Connell B. Evaluation of the Xpert methicillin-resistant Staphylococcus aureus (MRSA) assay using the GeneXpert real-time PCR platform for rapid detection of MRSA from screening specimens. J Clin Microbiol 2008;46:3285-90. https://doi.org/10.1128/JCM.02487-07
  9. Wolk DM, Marx JL, Dominguez L, Driscoll D, Schifman RB. Comparison of MRSASelect Agar, CHROMagar Methicillin-Resistant Staphylococcus aureus (MRSA) Medium, and Xpert MRSA PCR for detection of MRSA in Nares: diagnostic accuracy for surveillance samples with various bacterial densities. J Clin Microbiol 2009;47:3933-6. https://doi.org/10.1128/JCM.00601-09
  10. Malhotra-Kumar S, Abrahantes JC, Sabiiti W, Lammens C, Vercauteren G, Ieven M, et al. Evaluation of chromogenic media for detection of methicillin-resistant Staphylococcus aureus. J Clin Microbiol 2010;48:1040-6. https://doi.org/10.1128/JCM.01745-09
  11. Clinical and Laboratory Standards Institute. Performance standards for antimicrobial susceptibility testing, M100-S20. Wayne, PA: CLSI, 2010.
  12. Zhang K, McClure JA, Elsayed S, Louie T, Conly JM. Novel multiplex PCR assay for characterization and concomitant subtyping of staphylococcal cassette chromosome mec types I to V in methicillin-resistant Staphylococcus aureus. J Clin Microbiol 2005;43:5026-33. https://doi.org/10.1128/JCM.43.10.5026-5033.2005
  13. Milheirico C, Oliveira DC, de Lencastre H. Update to the multiplex PCR strategy for assignment of mec element types in Staphylococcus aureus. Antimicrob Agents Chemother 2007;51:3374-7. https://doi.org/10.1128/AAC.00275-07
  14. Stenehjem E, Rimland D, Crispell EK, Stafford C, Gaynes R, Satola SW. Cepheid Xpert MRSA cycle threshold in discordant colonization results and a quantitative measure of nasal colonization burden. J Clin Microbiol 2012;50:2079-81. https://doi.org/10.1128/JCM.06690-11
  15. Qian Q, Eichelberger K, Kirby JE. Rapid identification of Staphylococcus aureus in blood cultures by use of the direct tube coagulase test. J Clin Microbiol 2007;45;2267-9. https://doi.org/10.1128/JCM.00369-07
  16. Song JH, Hsueh PR, Chung DR, Ko KS, Kang CI, Peck KR, et al. Spread of methicillin-resistant Staphylococcus aureus between the community and the hospitals in Asian countries: an ANSORP study. J Antimicrob Chemother 2011;66:1061-9. https://doi.org/10.1093/jac/dkr024
  17. Kim JS, Park JS, Song W, Kim HS, Cho HC, Lee KM et al. Panton-Valentine leukocidin positive Staphylococcus aureus isolated from blood in Korea. Korean J Lab Med 2007;27:286-91. https://doi.org/10.3343/kjlm.2007.27.4.286

Cited by

  1. Screening agars for MRSA: evaluation of a stepwise diagnostic approach with two different selective agars for the screening for methicillin-resistant Staphylococcus aureus (MRSA) vol.2, pp.1, 2013, https://doi.org/10.1186/s40779-015-0046-1
  2. Active Surveillance of Multidrug-Resistant Organisms with Rapid Detection Methods for Infection Control vol.18, pp.4, 2013, https://doi.org/10.5145/acm.2015.18.4.103
  3. Multicenter Evaluation of MRSA Select II Chromogenic Agar for Identification of Methicillin-Resistant Staphylococcus aureus from Wound and Nasal Specimens vol.54, pp.2, 2013, https://doi.org/10.1128/jcm.02410-15
  4. Evaluation of the novel artus C. difficile QS-RGQ, VanR QS-RGQ and MRSA/SA QS-RGQ assays for the laboratory diagnosis of Clostridium difficile infection (CDI), and for vancomycin-resistant enterococci vol.36, pp.5, 2017, https://doi.org/10.1007/s10096-016-2867-6
  5. Evaluation of Xpert MRSA Gen 3 and BD MAX MRSA XT for meticillin-resistant Staphylococcus aureus screening in a routine diagnostic setting in a low-prevalence area vol.66, pp.1, 2017, https://doi.org/10.1099/jmm.0.000411
  6. A Decade of Development of Chromogenic Culture Media for Clinical Microbiology in an Era of Molecular Diagnostics vol.30, pp.2, 2013, https://doi.org/10.1128/cmr.00097-16
  7. Duration of Contact Precautions for Acute-Care Settings vol.39, pp.2, 2013, https://doi.org/10.1017/ice.2017.245
  8. Comparative assessment of methicillin resistant Staphylococcus aureus diagnostic assays for use in resource-limited settings vol.19, pp.1, 2013, https://doi.org/10.1186/s12866-019-1566-8