Ann Lab Med.  2013 Jul;33(4):255-260. 10.3343/alm.2013.33.4.255.

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

Affiliations
  • 1Department of Laboratory Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea. yjpk@catholic.ac.kr
  • 2Department of Laboratory Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea.
  • 3Intensive Care Unit, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea.

Abstract

BACKGROUND
We evaluated the performance of three chromogenic media (Brilliance agar I [Oxoid, UK], Brilliance agar II [Oxoid], and ChromID MRSA [Biomerieux, 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-microL 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 real-time 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.

Keyword

Chromogenic agars; Xpert MRSA assay; Methicillin-resistant Staphylococcus aureus

MeSH Terms

Bacterial Proteins/genetics
Bacterial Typing Techniques/*methods
Chromogenic Compounds/chemistry/*metabolism
Culture Media/chemistry
DNA, Bacterial/analysis
Humans
Methicillin-Resistant Staphylococcus aureus/*genetics/growth & development/*isolation & purification/metabolism
Nasal Cavity/*microbiology
Reagent Kits, Diagnostic
*Real-Time Polymerase Chain Reaction
*Staphylococcal Infections/diagnosis/microbiology
Bacterial Proteins
Chromogenic Compounds
Culture Media
DNA, Bacterial
Reagent Kits, Diagnostic
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