Evaluation of BD MAX Staph SR Assay for Differentiating Between Staphylococcus aureus and Coagulase-Negative Staphylococci and Determining Methicillin Resistance Directly From Positive Blood Cultures.
BACKGROUND
We evaluated the performance of the BD MAX StaphSR Assay (SR assay; BD, USA) for direct detection of Staphylococcus aureus and methicillin resistance not only in S. aureus but also in coagulase-negative Staphylococci (CNS) from positive blood cultures.


METHODS
From 228 blood culture bottles, 103 S. aureus [45 methicillin-resistant S. aureus (MRSA), 55 methicillin-susceptible S. aureus (MSSA), 3 mixed infections (1 MRSA+Enterococcus faecalis, 1 MSSA+MRCNS, 1 MSSA+MSCNS)], and 125 CNS (102 MRCNS, 23 MSCNS) were identified by Vitek 2. For further analysis, we obtained the cycle threshold (Ct) values from the BD MAX system software to determine an appropriate cutoff value. For discrepancy analysis, conventional mecA/mecC PCR and oxacillin minimum inhibitory concentrations (MICs) were determined.


RESULTS
Compared to Vitek 2, the SR assay identified all 103 S. aureus isolates correctly but failed to detect methicillin resistance in three MRSA isolates. All 55 MSSA isolates were correctly identified by the SR assay. In the concordant cases, the highest Ct values for nuc, mecA, and mec right-extremity junction (MREJ) were 25.6, 22, and 22.2, respectively. Therefore, we selected Ct values from 0-27 as a range of positivity, and applying this cutoff, the sensitivity/specificity of the SR assay were 100%/100% for detecting S. aureus, and 97.9%/98.1% and 99.0%/95.8% for detecting methicillin resistance in S. aureus and CNS, respectively.


CONCLUSIONS
We propose a Ct cutoff value for nuc/mec assay without considering MREJ because mixed cultures of MSSA and MRCNS were very rare (0.4%) in the positive blood cultures.
Department of Laboratory Medicine, College of Medicine, Seoul St. Mary's Hospital, Catholic University of Korea, Seoul, Korea.
Jaewoong
J
Lee
Department of Laboratory Medicine, College of Medicine, Seoul St. Mary's Hospital, Catholic University of Korea, Seoul, Korea. yjpk@catholic.ac.kr.
Yeon Joon
YJ
Park
Department of Laboratory Medicine, College of Medicine, Seoul St. Mary's Hospital, Catholic University of Korea, Seoul, Korea.
Dong Jin
DJ
Park
Department of Laboratory Medicine, College of Medicine, Seoul St. Mary's Hospital, Catholic University of Korea, Seoul, Korea.
Kang Gyun
KG
Park
Department of Laboratory Medicine, College of Medicine, Uijeongbu St. Mary's Hospital, Catholic University of Korea, Uijeongbu, Korea.
Hae Kyung
HK
Lee
D000900:Anti-Bacterial Agents / Q000494:pharmacology; D016470:Bacteremia / Q000175:diagnosis / Q000382:microbiology; D003030:Coagulase / Q000378:metabolism; D006801:Humans; D055624:Methicillin-Resistant Staphylococcus aureus / Q000187:drug effects / Q000235:genetics / Q000302:isolation & purification*; D008826:Microbial Sensitivity Tests; D010068:Oxacillin / Q000494:pharmacology; D011933:Reagent Kits, Diagnostic; D013210:Staphylococcus / Q000187:drug effects / Q000201:enzymology / Q000235:genetics / Q000302:isolation & purification; D013211:Staphylococcus aureus / Q000187:drug effects / Q000235:genetics / Q000302:isolation & purification*
D000900:Anti-Bacterial Agents; D003030:Coagulase; D011933:Reagent Kits, Diagnostic; D010068:Oxacillin
BD MAX; Coagulase-negative Staphylococcus; Ct value; MREJ; MRSA; Methicillin; Staph SR