Methicillin resistant strains of Staphylococcus aureus (MRSA) were identified shortly upon the introduction of methicillin into the clinical practice. The S. aureus samples were taken from patients hospitalized in General Hospital of Chania “Agios Georgios”. The strains were isolated from different pathological products, in the hospital laboratory. All isolates were tested using the cefoxitin disk diffusion, the oxacillin MIC methods and the PBP2’ latex agglutination test (bioMérieux), for the production of the Penicillin-Binding Protein 2a (PBP2a or PBP2’ protein). S. aureus ATCC 29213 was used as a negative control. We followed the detection of the mecA gene throughout the PCR method, as the standard “gold” method, in order to identify MRSA strains. Conventional methods for MRSA strains detection were compared with the PCR method. The antibiotic susceptibility testing was performed throughout the Kirby-Bauer disk diffusion method using antibiotic discs from Bioanalyse ltd. The mecA gene was found by PCR in 57.5 % of S. aureus strains, which allowed defining the isolated strains as MRSA strains. According to the oxacillin MIC values of the studied strains, 25 strains (53.2%) were identified as MRSA, 21 (44.68%) as MSSA and 1*strain (2.13%) as Borderline (BL) MRSA. The mecA gene is present in 24 of the MRSA strains with oxacillin MIC ≥ 4 being more common in strains showing the oxacillin MICs ≥ 256 (12/27). Adding the BL strains to the methicillin resistant strains, the rate of the MRSA strains increases to 26 (55.32%), the appropriate values of the MRSA strains percent, as determined by the PCR method (57.45%), which shows a concordance of 96.3% (26/27), between the results obtained by the two tests. Comparing the results obtained using the PCR method; with the oxacillin MICs and the PBP2’ latex agglutination test, concordant results were obtained for 89.36% of the strains (42/47) by oxacillin MICs and for 97.87% of the strains (46/47) by PBP2’ latex agglutination test. We conclude that the specificity of these methods is 100% for the mecA PCR method, 97.87% for the PBP2a latex method and 89.36% for the oxacillin MIC. The comparison of phenotypic methods (the PBP2a latex reaction, oxacillin MICs, the Cefoxitin disk diffusion test with the genotypic methods (the presence of the mecA gene), reveals that the PBP2a latex reaction has high sensitivity (97.87%), and can be used as an alternative method to PCR for the MRSA detection, in resource constraint settings.
Evaluation of methicillin resistance by cefoxitin disk diffusion and PBP2a latex agglutination test in mecA-positive Staphylococcus aureus, and comparison of mecA with femA, femB, femX positivities
