title: Comparative evaluation of three chromogenic media combined with broth enrichment and the real-time PCR-based Xpert MRSA assay for screening of methicillin-resistant Staphylococcus aureus in nasal swabs.
abstract: BACKGROUND
  We evaluated the performance of three chromogenic media (Brilliance agar I [Oxoid, UK], Brilliance agar II [Oxoid], and ChromID MRSA [Biomérieux, France]) combined with broth enrichment and the Xpert MRSA assay for screening of methicillin-resistant Staphylococcus aureus (MRSA).
  
  
  METHODS
  We obtained 401 pairs of duplicate nasal swabs from 321 patients. One swab was suspended overnight in tryptic soy broth; 50-µL aliquots of suspension were inoculated on the three chromogenic media. Brilliance agar I and II were examined after 24 hr, and ChromID MRSA, after 24 and 48 hr. The paired swab was processed directly using real-time PCR-based Xpert MRSA assay.
  
  
  RESULTS
  True positives, designated as MRSA growth in any of the culture media, were detected with the prevalence of 17% in our institution. We report the sensitivity, specificity, positive predictive value, and negative predictive value of MRSA growth as follows: 92.3%, 94.0%, 75.9%, and 98.4% in Brilliance agar I (24 hr); 92.7%, 97.9%, 90.0%, and 98.5% in Brilliance agar II (24 hr); 95.6%, 95.8%, 82.3%, and 99.1% in ChromID MRSA (24 hr); 100%, 92.5%, 73.1%, and 100% in ChromID MRSA (48 hr); 92.6%, 96.7%, 85.1%, and 98.5% in Xpert MRSA assay. The agreement between the enriched culture and Xpert MRSA assay was 96.0%.
  
  
  CONCLUSIONS
  Three chromogenic culture media combined with enrichment and Xpert MRSA assay demonstrated similar capabilities in MRSA detection. The Xpert MRSA assay yielded results comparable to those of culture methods, saving 48-72 hr, thus facilitating earlier detection of MRSA in healthcare settings.
authors.affiliation: Department of Laboratory Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea.
authors.forename: Seungok
authors.initials: S
authors.lastname: Lee
authors.forename: Yeon-Joon
authors.initials: YJ
authors.lastname: Park
authors.forename: Kang-Gyun
authors.initials: KG
authors.lastname: Park
authors.forename: Dong Wook
authors.initials: DW
authors.lastname: Jekarl
authors.forename: Hyojin
authors.initials: H
authors.lastname: Chae
authors.forename: Jin-Kyung
authors.initials: JK
authors.lastname: Yoo
authors.forename: Sin Won
authors.initials: SW
authors.lastname: Seo
authors.forename: Jung Eun
authors.initials: JE
authors.lastname: Choi
authors.forename: Jung Hye
authors.initials: JH
authors.lastname: Lim
authors.forename: Seon Mi
authors.initials: SM
authors.lastname: Heo
authors.forename: Ju Hee
authors.initials: JH
authors.lastname: Seo
mesh_terms: D001426:Bacterial Proteins / Q000235:genetics; D015373:Bacterial Typing Techniques / Q000379:methods*; D002863:Chromogenic Compounds / Q000737:chemistry / Q000378:metabolism*; D003470:Culture Media / Q000737:chemistry; D004269:DNA, Bacterial / Q000032:analysis; D006801:Humans; D055624:Methicillin-Resistant Staphylococcus aureus / Q000235:genetics* / Q000254:growth & development / Q000302:isolation & purification* / Q000378:metabolism; D009296:Nasal Cavity / Q000382:microbiology*; D011933:Reagent Kits, Diagnostic; D060888:Real-Time Polymerase Chain Reaction; D013203:Staphylococcal Infections / Q000175:diagnosis / Q000382:microbiology
chemical_list: D001426:Bacterial Proteins; D002863:Chromogenic Compounds; D003470:Culture Media; D004269:DNA, Bacterial; D011933:Reagent Kits, Diagnostic
keywords: Chromogenic agars; Methicillin-resistant Staphylococcus aureus; Xpert MRSA assay