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Journal of Clinical Microbiology, August 2002, p. 2766-2771, Vol. 40, No. 8
0095-1137/02/$04.00+0     DOI: 10.1128/JCM.40.8.2766-2771.2002
Copyright © 2002, American Society for Microbiology. All Rights Reserved.

Evaluation of Three Techniques for Detection of Low-Level Methicillin-Resistant Staphylococcus aureus (MRSA): a Disk Diffusion Method with Cefoxitin and Moxalactam, the Vitek 2 System, and the MRSA-Screen Latex Agglutination Test

Annie Felten,* Bernadette Grandry, Philippe Henri Lagrange, and Isabelle Casin

Service de Bactériologie-Virologie-Hygiène, Hôpital Saint-Louis, 75475 Paris Cedex 10, France

Received 15 January 2002/ Returned for modification 7 March 2002/ Accepted 8 May 2002

Very-low-level methicillin-resistant Staphylococcus aureus (MRSA), or class 1 MRSA, is often misdiagnosed as methicillin-susceptible S. aureus (MSSA). We evaluated the performances of three methods for detection of low-level methicillin resistance: the disk diffusion method using the cephamycin antibiotics cefoxitin and moxalactam, the Vitek 2 system (bioMérieux), and the MRSA-screen test (Denka). Detection of the mecA gene by PCR was considered to be the "gold standard." We also determined the sensitivity of the oxacillin disk diffusion method with 5- and 1-µg disks and that of the Oxascreen agar assay with 6 mg of oxacillin liter-1 for detection of MRSA. We compared the distributions of MICs of oxacillin and cefoxitin by the E-test (AB Biodisk), and those of moxalactam by dilutions in agar, for MRSA and MSSA isolates. The 152 clinical isolates of S. aureus studied were divided into 69 MSSA (mecA-negative) and 83 MRSA (mecA-positive) isolates, including 63 heterogeneous isolates and 26 class 1 isolates (low-level resistance). The cefoxitin and moxalactam disk diffusion tests detected 100% of all the MRSA classes: cefoxitin inhibition zone diameters were <27 mm, and moxalactam inhibition zone diameters were <24 mm. The Vitek 2 system and the MRSA-screen test detected 94 and 97.6% of all MRSA isolates, respectively. The sensitivities of the 5- and 1-µg oxacillin disks were 95.2 and 96.4%, respectively, whereas that of the Oxascreen agar screen assay was 94%. All of the tests except the 1-µg oxacillin disk test were 100% specific. For the class 1 MRSA isolates, the sensitivity of the Vitek 2 test was 92.3%, whereas those of the MRSA-screen test and the disk diffusion method with cefoxitin and moxalactam were 100%. Therefore, the cefoxitin and moxalactam disk diffusion methods were the best-performing tests for routine detection of all classes of MRSA.

* Corresponding author. Mailing address: Service de Microbiologie, Hôpital Saint-Louis, 1 avenue Vellefaux, 75475 Paris Cedex 10, France. Phone: 33 1 42 49 93 48. Fax: 33 1 42 49 92 00. E-mail: annie.felten{at}sls.ap-hop-paris.fr.

Journal of Clinical Microbiology, August 2002, p. 2766-2771, Vol. 40, No. 8
0095-1137/02/$04.00+0     DOI: 10.1128/JCM.40.8.2766-2771.2002
Copyright © 2002, American Society for Microbiology. All Rights Reserved.



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