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Journal of Clinical Microbiology, December 1999, p. 4051-4058, Vol. 37, No. 12
0095-1137/99/$04.00+0
Copyright © 1999, American Society for Microbiology. All rights reserved.

Methods for Improved Detection of Oxacillin Resistance in Coagulase-Negative Staphylococci: Results of a Multicenter Study

Fred C. Tenover,1,* Ronald N. Jones,2 Jana M. Swenson,1 Barbara Zimmer,3 Sigrid McAllister,1 and James H. Jorgensen4,dagger for the Nccls Staphylococcus Working Group

Hospital Infections Program, Centers for Disease Control and Prevention, Atlanta, Georgia 303331; Department of Pathology, University of Iowa College of Medicine, Iowa City, Iowa 522402; Dade MicroScan, West Sacramento, California 956163; and Department of Pathology, The University of Texas Health Science Center, San Antonio, Texas 782844

Received 12 April 1999/Returned for modification 26 July 1999/Accepted 1 September 1999

A multilaboratory study was undertaken to determine the accuracy of the current National Committee for Clinical Laboratory Standards (NCCLS) oxacillin breakpoints for broth microdilution and disk diffusion testing of coagulase-negative staphylococci (CoNS) by using a PCR assay for mecA as the reference method. Fifty well-characterized strains of CoNS were tested for oxacillin susceptibility by the NCCLS broth microdilution and disk diffusion procedures in 11 laboratories. In addition, organisms were inoculated onto a pair of commercially prepared oxacillin agar screen plates containing 6 µg of oxacillin per ml and 4% NaCl. The results of this study and of several other published reports suggest that, in order to reliably detect the presence of resistance mediated by mecA, the oxacillin MIC breakpoint for defining resistance in CoNS should be lowered from >= 4 to >= 0.5 µg/ml and the breakpoint for susceptibility should be lowered from <= 2 to <= 0.25 µg/ml. In addition, a single disk diffusion breakpoint of <= 17 mm for resistance and >= 18 mm for susceptibility is suggested. Due to the poor sensitivity of the oxacillin agar screen plate for predicting resistance in this study, this test can no longer be recommended for use with CoNS. The proposed interpretive criteria for testing CoNS have been adopted by the NCCLS.

* Corresponding author. Mailing address: Nosocomial Pathogens Laboratory Branch (G08), Hospital Infections Program, Centers for Disease Control and Prevention, 1600 Clifton Rd., Atlanta, GA 30333. Phone: (404) 639-3246. Fax: (404) 639-1381. E-mail: fnt1{at}CDC.GOV.

dagger The other members of the NCCLS Staphylococcus Working Group are William J. Buesching and Robert J. Fass, Ohio State University Medical Center, Columbus; James D. Dick, The Johns Hopkins Hospital, Baltimore, Md.; Patrick R. Murray, Barnes-Jewish Hospital, St. Louis, Mo.; Lance R. Peterson, Northwestern Memorial Hospital, Chicago, Ill.; L. Barth Reller, Duke University Medical Center, Durham, N.C.; Melvin P. Weinstein, UMDNJ-Robert Wood Johnson Medical School, New Brunswick, N.J.; and Mary K. York, University of California, San Francisco.

Journal of Clinical Microbiology, December 1999, p. 4051-4058, Vol. 37, No. 12
0095-1137/99/$04.00+0
Copyright © 1999, American Society for Microbiology. All rights reserved.


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