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Journal of Clinical Microbiology, August 2005, p. 3818-3823, Vol. 43, No. 8
0095-1137/05/$08.00+0     doi:10.1128/JCM.43.8.3818-3823.2005
Copyright © 2005, American Society for Microbiology. All Rights Reserved.

Results of Disk Diffusion Testing with Cefoxitin Correlate with Presence of mecA in Staphylococcus spp.

Jana M. Swenson,* Fred C. Tenover, and the Cefoxitin Disk Study Group{dagger}

Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia 30333

Received 4 January 2005/ Returned for modification 7 February 2005/ Accepted 25 April 2005

The cefoxitin disk diffusion (DD) test for predicting mecA-mediated oxacillin resistance in staphylococci was assessed during a three-phase study. In phase 1, one laboratory tested 62 and 53 strains of Staphylococcus aureus and coagulase-negative staphylococci (CoNS), respectively. These data were used to choose the provisional cefoxitin DD breakpoints (resistant/susceptible) of ≤19 mm/≥20 mm for S. aureus and ≤24 mm/≥25 mm for CoNS for the next phase of testing. In phase 2, 10 laboratories each tested approximately 40 in-house strains of staphylococci (half of which were S. aureus) using Mueller-Hinton agar from different manufacturers. In this phase, the sensitivity and specificity, respectively, of the cefoxitin disk test were 98 and 100% for S. aureus and 99 and 96% for CoNS. The cefoxitin DD test performed equivalently to oxacillin broth microdilution (BMD) and to oxacillin DD tests among S. aureus and mecA-positive CoNS strains but gave better results than oxacillin BMD or oxacillin DD for mecA-negative strains of CoNS. The cefoxitin DD test also was much easier to read and did not require the use of transmitted light for detection of resistance. Based on data from the first two phases, the Clinical and Laboratory Standards Institute (CLSI; formerly NCCLS) adopted the use of the cefoxitin DD test for predicting mecA-mediated oxacillin resistance in staphylococci and revised Table 2C in CLSI document M100-S14 to reflect the change. In the third phase, an additional 61 challenge strains of CoNS for which the oxacillin MICs were 0.5 to 2 µg/ml were tested in a single laboratory to determine the effectiveness of the cefoxitin DD test for this group of borderline-resistant isolates. These data were used to refine the description of the test in CLSI document M100-S15. The cefoxitin DD test is preferred over the oxacillin DD test for predicting mecA-mediated oxacillin resistance in S. aureus and CoNS.

* Corresponding author. Mailing address: Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Mailstop G08, 1600 Clifton Rd., Atlanta, GA 30333. Phone: (404) 639-0196. Fax: (404) 639-1381. E-mail: jswenson{at}cdc.gov.

{dagger} The Cefoxitin Disk Study Group includes Rachel Addison, Duke University Medical Center, Durham, NC; Holly D'Souza, Stanford Health Services, Palo Alto, CA; Jennifer O'Connor, Dade Behring MicroScan, West Sacramento, CA; Judy Rothberg, Robert Wood Johnson Medical Center, New Brunswick, NJ; Jean Spargo, Massachusetts General Hospital, Boston, MA; Maria Traczewski, Clinical Microbiology Institute, Wilsonville, OR; Marion Tuohy and Deborah Wilson, Cleveland Clinic Foundation, Cleveland, OH; Mary Votta, BD Diagnostic Systems, Sparks, MD, David Vicino, University of Rochester Medical Center, Rochester, NY; and Barbara Willey, Mount Sinai Hospital, Toronto, Ontario, Canada.

Journal of Clinical Microbiology, August 2005, p. 3818-3823, Vol. 43, No. 8
0095-1137/05/$08.00+0     doi:10.1128/JCM.43.8.3818-3823.2005
Copyright © 2005, American Society for Microbiology. All Rights Reserved.



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