Evaluation of polymerase chain reaction, conventional and MRSA screen latex agglutination methods for detection of methicillin-resistant, -borderline and -susceptible Staphylococcus aureus.

Methicillin-resistant Staphylococcus aureus (MRSA), is difficult and expensive to treat, therefore early screening is essential. Several phenotypic and genotypic methods are used to detect MRSA; however, the method of choice remains problematic. We have evaluated four phenotypic methods, broth microdilution (MIC), oxacillin disk agar diffusion (ODD), oxacillin screening salt agar (OSS), and a new rapid phenotypic (MRSA screen latex agglutination, MSLA) with the genotypic gold standard of PCR mecA detection to determine the most appropriate method for routine laboratory use. We randomly collected 203 S. aureus isolates from patients and carriers at two hospitals in Thailand. Using MIC method, three sub-groups were differentiated from among these isolates, namely MRSA (106 isolates), borderline-resistant S. aureus (BRSA) (65 isolates), and methicillin-susceptible S. aureus (MSSA)(32 isolates). A total of 10 methicillin-resistant S. epidermidis (MRSE) isolates were also included. The sensitivity and specificity of MIC, ODD, OSS, and MSLA were 99 and 96, 100 and 97, 100 and 97, and 100 and 100%, respectively. Our study indicated that ODD is still appropriate for routine laboratory. MSLA had the highest sensitivity and specificity and is rapid but expensive, so is the most appropriate method for emergency cases. MIC method was better for BRSA detection and OSS method was more appropriate for screening clinical specimens and carriers.