title: Evaluation of the Etest GRD for the detection of Staphylococcus aureus with reduced susceptibility to glycopeptides.
abstract: OBJECTIVE
  Continued glycopeptide-selective pressure has led to non-susceptible strains of Staphylococcus aureus including heterogeneously vancomycin-intermediate S. aureus (hVISA). The gold standard for identification of hVISA is the population analysis profile area under the curve ratio (PAP-AUC), though this method is time-consuming and labour-intensive. The objective of this study was to compare a new method for detection of hVISA, the Etest GRD, to PAP-AUC and to macro Etest.
  
  
  METHODS
  One hundred clinical hVISA and 50 clinical fully vancomycin-susceptible S. aureus (VSSA), confirmed by PAP-AUC, were evaluated. Microtitre and Etest MICs were determined by standard testing procedures on all isolates. Macro Etest was performed according to referenced procedures. The Etest GRD was tested using a 0.5 McFarland standard on Mueller-Hinton agar + 5% blood and read at 24 and 48 h. If either the vancomycin or the teicoplanin end of the GRD strip was >or=8 and the vancomycin Etest was <or=4, the isolate was considered hVISA.
  
  
  RESULTS
  Vancomycin MIC(50)/MIC(90) for hVISA and VSSA was 1.5/2 mg/L and 1/1.5 mg/L, respectively, by Etest and vancomycin MIC(50)/MIC(90) for hVISA and VSSA was 1/2 mg/L for both by microtitre; MIC values for hVISA being significantly higher (P <or= 0.023). At 24 h, the Etest GRD was 77% sensitive and 98% specific, and at 48 h, it was 93% sensitive and 82% specific compared with PAP-AUC. Macro Etest was 83% sensitive and 94% specific at 48 h.
  
  
  CONCLUSIONS
  Etest GRD was simple to perform and may be feasible for clinical microbiology laboratories. This test may be useful for clinical detection of hVISA.
authors.affiliation: Anti-Infective Research Laboratory, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, MI 48201, USA.
authors.forename: Steven N
authors.initials: SN
authors.lastname: Leonard
authors.forename: Kerri L
authors.initials: KL
authors.lastname: Rossi
authors.forename: Karly L
authors.initials: KL
authors.lastname: Newton
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Rybak
mesh_terms: D000900:Anti-Bacterial Agents / Q000494:pharmacology*; D003470:Culture Media / Q000737:chemistry; D006020:Glycopeptides / Q000494:pharmacology*; D006801:Humans; D008826:Microbial Sensitivity Tests / Q000379:methods; D013203:Staphylococcal Infections / Q000382:microbiology; D013211:Staphylococcus aureus / Q000187:drug effects* / Q000302:isolation & purification; D013997:Time Factors; D020713:Vancomycin Resistance
chemical_list: D000900:Anti-Bacterial Agents; D003470:Culture Media; D006020:Glycopeptides