Semi-selective broth improves screening for methicillin-resistant Staphylococcus aureus

To evaluate two enrichment broths for methicillin-resistant Staphylococcus aureus (MRSA) detection and compare results with direct plating. Swabs from 1224 patients were re-analysed for MRSA in a central laboratory (Munster) using six methods. Swabs were suspended in 0.5 mL of non-selective enrichment broth (NB) and vortexed. Aliquots of 100 mu L were inoculated on/into: (I) ChromID MRSA agar; (II) Columbia sheep blood (5%) agar (BA) and ChromID MRSA; (III, IV) NB incubated overnight followed by plating on BA and ChromID MRSA; and (V, VI) a semi-selective broth containing cefoxitin and aztreonam (TSB-SSI) incubated overnight followed by plating on BA and ChromID MRSA. In III-VI, 100 mu L of the enriched broth was plated on each agar. The combined MRSA-positive rate was 21.5%. MRSA isolates detected by each method were: TSB-SSI, n = 223; NB, n = 205; BA and ChromID MRSA, n = 203; ChromID MRSA alone, n = 183. TSB-SSI detected more positive throat samples than the comparators and significantly reduced methicillin-susceptible S. aureus (MSSA) growth. The maximum sensitivity obtained was only 85%, possibly due to the study design using pre-used swabs and dilution of swab material. For 997 samples, results from Munster were compared with initial results. Peripheral laboratories identified 172 MRSA compared with Munster where 186, 186 and 204 MRSA were found for direct plating, NB and TSB-SSI broth, respectively. TSB-SSI was superior to both NB and direct plating on ChromID MRSA and BA. Despite re-using swabs for the study, we showed that routine diagnostic screening could be significantly improved, using a semi-selective enrichment broth.