Evaluation of a cefoxitin disk diffusion test for the routine detection of methicillin-resistant Staphylococcus aureus

Boubaker, Ilhem Boutiba-Ben; Abbes, R.; Abdallah, H. Ben; Mamlouk, Kelthoum; Mahjoubi, Faouzia; Kammoun, A.; Hammami, A.; Redjeb, S. Ben

doi:10.1111/j.1469-0691.2004.00919.x

Cited by 59 publications

(47 citation statements)

References 19 publications

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“…These results are in accordance with previously reported studies [16] [17]. Although some publications revealed the higher sensitivity for disk diffusion test with cefoxitin (95% -100%), in our research the sensitivity for DDT with cefoxitin was considerably lower (83.33% (95% CI 62.6% -95.16%)).…”

Section: Discussionsupporting

confidence: 93%

Comparative Evaluation of Traditional Susceptibility Testing for MRSA with the PCR Approach

Sandle¹,

Azizov²,

Babenko³

et al. 2014

AiM

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Methicillin-resistant Staphylococcus aureus (MRSA) is a multi-drug resistant pathogen, which is responsible for increasing cases of serious diseases, including life-threatening diseases and nosocomial and community-acquired infections. Laboratory identification of MRSA is crucial and essential both for initiation of appropriate antimicrobial therapies and for effective infection control strategies that are designed to limit the spread of MRSA. In spite of the availability of commercial kits for MRSA detection in the market, the Clinical and Laboratory Standards Institute (CLSI) recommends the use of phenotypic methods, such as the disk diffusion method with oxacillin or with cefoxitin, as well as a serial dilution method with oxacillin. Nevertheless, some studies have shown that results obtained with such phenotypic methods are controversial. The aim of the study described in this paper was to comparatively evaluate the traditional susceptibility testing for MRSA with PCR as the gold standard assay. Analysis of collection (n = 68) isolates of Staphylococcus aureus revealed that the serial dilution method with oxacillin possessed the highest sensitivity (at 100%). In contrast, the disk diffusion methods with oxacillin and cefoxitin showed lower sensitivity (95.83%, 95% CI (78.81% -99.30%)). Furthermore, the borderline value of zone inhibition diameters for cefoxitin might be considered as a risk, and they may give false-susceptible result.

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Section: Discussionsupporting

confidence: 93%

Comparative Evaluation of Traditional Susceptibility Testing for MRSA with the PCR Approach

Sandle¹,

Azizov²,

Babenko³

et al. 2014

AiM

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“…Use of the oxacillin DD test for the detection of MR staphylococci was less specific compared with the cefoxitin DD test, as also reported by Palazzo & Darini (2006). It has been reported that oxacillin resistance among staphylococci is caused by expression of PBP2a encoded by the mecA gene, which has a low binding affinity to all b-lactam antibiotics available in clinical practice (Boutiba-Ben Boubaker et al, 2004b;Cauwelier et al, 2004;Skov et al, 2003). Detection of oxacillin resistance is complicated because different populations of staphylococci express different levels of resistance.…”

Section: Strainmentioning

confidence: 84%

Cefoxitin disc diffusion test for detection of meticillin-resistant staphylococci

Jain

Agarwal

Verma

2008

Journal of Medical Microbiology

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Staphylococci are the main causative agents of nosocomial diseases. Over the last few years, the increase in the number of meticillin-resistant (MR) staphylococci has become a major clinical problem. Accuracy and promptness in the detection of meticillin resistance are of key importance in ensuring the correct antibiotic treatment in infected patients and control of MR staphylococci in the hospital environment. This study evaluated the accuracy of a cefoxitin disc diffusion (DD) test for the detection of meticillin resistance in staphylococci. A total of 144 clinical isolates [97 Staphylococcus aureus and 47 coagulase-negative staphylococci (CoNS)] were tested using a mecA gene PCR, a DD test (oxacillin, 1 mg disc; cefoxitin, 30 mg disc), determination of oxacillin MIC by agar dilution (AD), and an oxacillin screen agar test at oxacillin concentrations of 4 and 6 mg ml "1 . Of the 97 S. aureus and 47 CoNS isolates, 73 (75.26 %) and 30 (63.83 %), respectively, were mecA-positive. The sensitivity and specificity of the cefoxitin DD test were 94.44 and 95.83 %, respectively, for S. aureus and 80 and 100 %, respectively, for CoNS. The oxacillin DD method was 100 % sensitive and 58.33 % specific for S. aureus, and 86.67 % sensitive and 70.59 % specific for CoNS. The AD test was highly sensitive (98.63 %) and specific (98.53 %) for S. aureus and CoNS (83.33 % sensitive and 94.12 % specific). The cefoxitin DD test for meticillin-resistance detection was more specific but less sensitive than the oxacillin DD test. Use of DD tests for both cefoxitin and oxacillin can help in more accurate prediction of meticillin resistance. Centres that are not equipped to carry out PCR can use AD methods for confirmation of meticillin resistance, especially in oxacillin-resistant and cefoxitin-sensitive cases.

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“…Specificity for the cefoxitin disc was 100 %, whereas that for the oxacillin disc was 99.2 %. Various workers have shown that the cefoxitin disc method has better sensitivity than the oxacillin disc method for MRSA detection (Velasco et al, 2005;Boutiba-Ben Boubaker et al, 2004;Skov et al, 2003). This higher sensitivity to cefoxitin can be explained by the increased expression of the mecA-encoded protein PBP2a, cefoxitin being an inducer of the mecA gene (Velasco et al, 2005).…”

Section: Discussionmentioning

confidence: 99%

Evaluation of various methods for the detection of meticillin-resistant Staphylococcus aureus strains and susceptibility patterns

Datta

Gulati

Singla

et al. 2011

Journal of Medical Microbiology

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Meticillin-resistant Staphylococcus aureus (MRSA) has been recognized as one of the major pathogens in hospital as well as community settings. In India, the mean isolation rate of MRSA is 20-40 % and many studies have suggested an escalating rate of infections caused by this organism. Despite pharmaceutical and technological advancement, infections caused by MRSA still remain difficult to diagnose. The present study was undertaken to compare five phenotypic methods for the detection of MRSA. This involved examining 200 isolates of S. aureus by oxacillin disc diffusion, cefoxitin disc diffusion, oxacillin screen agar test, the latex agglutination test and growth on CHROMagar. PCR for mecA gene detection was taken as the gold standard. It was found that 35 % of all S. aureus infections were caused by MRSA. The cefoxitin disc diffusion method, as recommended by the Clinical and Laboratory Standards Institute, was found to be a reliable method for MRSA detection but it should be supplemented with some other method like latex agglutination, CHROMagar or oxacillin screen agar testing so that no MRSA is missed. We recommend that along with cefoxitin disc diffusion, another method, preferably latex agglutination, should be routinely used in all hospitals to detect MRSA.

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Evaluation of a cefoxitin disk diffusion test for the routine detection of methicillin-resistant Staphylococcus aureus

Cited by 59 publications

References 19 publications

Comparative Evaluation of Traditional Susceptibility Testing for MRSA with the PCR Approach

Comparative Evaluation of Traditional Susceptibility Testing for MRSA with the PCR Approach

Cefoxitin disc diffusion test for detection of meticillin-resistant staphylococci

Evaluation of various methods for the detection of meticillin-resistant Staphylococcus aureus strains and susceptibility patterns

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