These evidence-based guidelines have been produced after a literature review of the laboratory diagnosis and susceptibility testing of methicillin-resistant Staphylococcus aureus (MRSA). We have considered the detection of MRSA in screening samples and the detection of reduced susceptibility to glycopeptides in S. aureus. Recommendations are given for the identification of S. aureus and for suitable methods of susceptibility testing and screening for MRSA and for S. aureus with reduced susceptibility to glycopeptides. These guidelines indicate what tests should be used but not when the tests are applicable, as aspects of this are dealt with in guidelines on control of MRSA. There are currently several developments in screening media and molecular methods. It is likely that some of our recommendations will require modification as the new methods become available.

/pdf/guidelines-for-the-laboratory-diagnosis-and-susceptibility-4w8lx3nfeh.pdf

Guidelines for the laboratory diagnosis and susceptibility testing of methicillin-resistant Staphylococcus aureus (MRSA)

In vitro activity of tigecycline against 6792 Gram-negative and Gram-positive clinical isolates from the global Tigecycline Evaluation and Surveillance Trial (TEST Program, 2004)

We evaluated the use of the BD GeneOhm MRSA real-time PCR assay (BD Diagnostics, San Diego, CA) for the detection of nasal colonization with methicillin-resistant Staphylococcus aureus (MRSA). The initial evaluation consisted of 403 paired nasal swabs and was done using the specimen preparation provided with the kit and an in-house lysis method that was specifically developed to accommodate large-volume testing using a minimal amount of personnel time. One swab was placed in an achromopeptidase (ACP) lysis solution, and the other was first used for culture and then prepared according to the kit protocol. PCR was performed on both lysates, and results were compared to those for culture. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of the PCR assay were 98%, 96%, 77%, and 99.7% with the kit lysate and 98%, 95%, 75%, and 99.7% with the ACP lysate (P, not significant), respectively. The second evaluation was done after implementation of all-admission surveillance using PCR with ACP lysis and a sampling of 1,107 PCR-negative samples and 215 PCR-positive samples that were confirmed by culture. The results of this sampling showed an NPV of 99.9% and a PPV of 73.5% (prevalence, 6%), consistent with our initial findings. The BD GeneOhm MRSA assay is an accurate and rapid way to detect MRSA nasal colonization. When one is dealing with large specimen numbers, the ACP lysis method offers easier processing without negatively affecting the sensitivity or specificity of the PCR assay.

Performance of the BD GeneOhm Methicillin-Resistant Staphylococcus aureus Test before and during High-Volume Clinical Use

Tigecycline activity tested against 26,474 bloodstream infection isolates: a collection from 6 continents.

Nosocomial Infections Due to Methicillin-Resistant Staphylococcus Aureus and Vancomycin-Resistant Enterococci at a University Hospital in Taiwan from 1991 to 2003: Resistance Trends, Antibiotic Usage and in Vitro Activities of Newer Antimicrobial Agents

During recent years, a dramatic increase in bacterial resistance to antibiotics has been observed worldwide, both in community and nosocomial isolates, curtailing the use of many valuable antibiotics. In France, more than 50% of Streptococcus pneumoniae strains isolated in the community are resistant to penicillin and macrolides (8), and more than 40% of Staphylococcus aureus strains isolated in hospitals are resistant to β-lactams, aminoglycosides, macrolides, and fluoroquinolones, including the newer compounds (≈100% of the methicillin-resistant S. aureus [MRSA] strains) (5). S. aureus strains with low-level resistance to glycopeptides have been isolated in our hospital for more than 10 years (6), and resistance to quinupristin-dalfopristin (Synercid) is not uncommon due to the frequent use of oral pristinamycin in France. Most of these multidrug-resistant (MDR) bacteria are resistant to tetracyclines, emphasizing the need for new compounds.

Tigecycline (GAR-936) is the 9-t-butylglycylamino derivative of minocycline, a new generation of tetracyclines called glycylcyclines. These glycylcyclines overcome tetracycline resistance due to both ribosomal protection and efflux determinants (1-3, 7). The aim of this study was to assess the in vitro activity of GAR-936 against MDR S. pneumoniae and S. aureus in comparison with tetracycline, minocycline, telithromycin, linezolid, and quinupristin-dalfopristin.

In vitro activities of tigecycline (GAR-936) against multidrug-resistant Staphylococcus aureus and Streptococcus pneumoniae.

https://www.onlinelibrary.wiley.com/doi/pdf/10.1111/j.1198-743X.2004.00856.x

False synergy between vancomycin and β-lactams against glycopeptide-intermediate Staphylococcus aureus (GISA) caused by inappropriate testing methods

Détection de la colonisation nasale de Staphylococcus aureus résistant à la méthicilline : étude prospective comparant l'amplification génique temps réel vs les milieux chromogènes sélectifs

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In vitro activities of tigecycline (GAR-936) against multidrug-resistant Staphylococcus aureus and Streptococcus pneumoniae.

False synergy between vancomycin and β-lactams against glycopeptide-intermediate Staphylococcus aureus (GISA) caused by inappropriate testing methods

Détection de la colonisation nasale de Staphylococcus aureus résistant à la méthicilline : étude prospective comparant l'amplification génique temps réel vs les milieux chromogènes sélectifs