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Annals of Clinical & Laboratory Science 38:254-257 (2008)
© 2008 Association of Clinical Scientists

Comparison of Culture Screening Protocols for Methicillin-Resistant Staphylococcus aureus (MRSA) Using a Chromogenic Agar (MRSA-Select)

Seungok Lee1, Yeon-Joon Park2, Jin-Hong Yoo3, Jimin Kahng1, In-Hee Jeong4, Young-Mi Kwon5 and Kyungja Han2
1 Departments of Laboratory Medicine, 3 Internal Medicine, 4 Clinical Microbiology, & 5 Hospital Infection Control, College of Medicine, Catholic University of Korea, Holy Family Hospital, Pucheon, Korea; 2 Department of Laboratory Medicine, College of Medicine, Catholic University of Korea, Seoul, Korea

Address correspondence to Yeon-Joon Park, M.D., Department of Laboratory Medicine, College of Medicine, Catholic University of Korea, Kangnam St. Mary’s Hospital, 505 Banpo-dong, Seocho-ku, Seoul 137-701, Korea; tel 82 2 590 1604; fax 82 2 590 2547; e-mail yjpk{at}catholic.ac.kr.

To compare the culture screening protocols for methicillin-resistant Staphylococcus aureus (MRSA), a total of 300 duplicate nasal swabs (233 initial cultures and 67 weekly follow-up cultures) were collected consecutively from 233 patients in the Intensive Care Unit (ICU). One swab was plated directly on MRSA-Select agar (D-MRSA-Select) and observed at 24 hr. The duplicate swab was incubated in tryptic soy broth (TSB) with 6.5% NaCl for 24 hr, and then subcultured on MRSA-Select (B-MRSA-Select), BAP (B-BAP), and mannitol salt agar with 4 mg/L oxacillin (B-MSAOXA), and observed at 24 hr. MRSA was detected in 13.7% (32/233) of the initial and 22.4% (15/67) of the follow-up specimens. A patient was classified as MRSA-positive if any of the media grew colonies that were tested and confirmed to be MRSA. In the initial screening samples, the sensitivities of D-MRSA-Select, B-MRSA-Select, B-BAP, and B-MSAOXA were 78.1%, 84.4%, 78.1%, and 65.6%, respectively, and the specificities were 100%, 98.0%, 83.1%, and 93.5%, respectively. The sensitivities of all but the B-MRSA-Select protocol were significantly lower (p <0.05). In follow-up screening, the sensitivities of D-MRSA-Select, B-MRSA-Select, B-BAP, and B-MSAOXA were 66.7%, 86.7%, 66.7%, and 53.3%, respectively, and the specificities were 100%, 98.1%, 90.4%, and 90.4%, respectively. D-MRSA-Select protocol was considered useful in screening for MRSA because it was fast, highly specific, and showed sensitivity comparable to B-BAP. Salt-containing enrichment broth in conjunction with MRSA-Select (B-MRSA-Select) provides a promising way to increase sensitivity in initial and follow-up screening for MRSA.

Keywords: methicillin-resistant Staphylococcus aureus (MRSA), MRSA-Select agar






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