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Journal of Clinical Microbiology, October 2006, p. 3634-3639, Vol. 44, No. 10
0095-1137/06/$08.00+0     doi:10.1128/JCM.00137-06
Copyright © 2006, American Society for Microbiology. All Rights Reserved.

Accuracy of Cefoxitin Disk Testing for Characterization of Oxacillin Resistance Mediated by Penicillin-Binding Protein 2a in Coagulase-Negative Staphylococci

Clinical Bacteriology Laboratory, Department of Clinical Biochemistry, Hospital de Clinicas, Faculty of Pharmacy & Biochemistry, University of Buenos Aires, Córdoba 2351, Capital Federal, City of Buenos Aires, Argentina,¹ Microbiological Laboratory, Department of Microbiology, Immunology and Biotecnnology, Faculty of Pharmacy & Biochemistry, University of Buenos Aires, Junín 956, Capital Federal, City of Buenos Aires, Argentina,² Course of Specialization in Clinical Bacteriology, Faculty of Pharmacy and Biochemistry, University of Buenos Aires, Junín 956, Capital Federal, City of Buenos Aires, Argentina³

Received 23 January 2006/ Returned for modification 7 April 2006/ Accepted 16 July 2006

The Clinical and Laboratory Standards Institute (CLSI) proposed, beginning in 2004, the use of cefoxitin disks to predict resistance mediated by the mecA gene in all species of coagulase-negative staphylococci (CoNS). The aim of this work was to evaluate the efficiency of the cefoxitin disk and of oxacillin-salt agar screening (MHOX) to characterize the oxacillin resistance mediated by the mecA gene in CoNS. One hundred seven CoNS isolates from different clinical samples were studied. Detection of the mecA gene by PCR was considered the "gold standard." The susceptibility to oxacillin and cefoxitin was detected by the disk diffusion and agar dilution tests, as described by the CLSI. MHOX was also performed with 6 µg/ml of oxacillin and 4% NaCl. The sensitivities of the oxacillin and cefoxitin disks for all CoNS species were 88% and 80%, respectively, whereas the specificities were 63% and 100%, respectively. The sensitivities of the agar dilution test for oxacillin and cefoxitin (for proposed breakpoints of 4 µg/ml for resistance and 2 µg/ml for susceptibility) were 90% and 85%, respectively, whereas the specificities were 76% and 98%, respectively. MHOX showed a sensitivity of 90% and a specificity of 95% for all CoNS species. Both the MHOX and the cefoxitin disk results indicate that these are appropriate methods for the evaluation of oxacillin resistance mediated by the mecA gene in all CoNS species.