Oxacillin MIC µ g ml borderline oxacillin-resistant Staphylococcus aureus. oxacillin Staphylococcus aureus MRSA

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Sándor Kelemen
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1 oxacillin Staphylococcus aureus MRSA Oxacillin MIC 1248 µ gml borderline oxacillin-resistant Staphylococcus aureus BORSA79 NCCLS CLSIM100-S cefoxitin disk oxacillin cefoxitin methicillin-resistant Staphylococcus aureusmrsameca oxacillin MIC oxacillin 1 µ gml µ gml 30 5 meca oxacillin 48 µ gml meca oxacillin penicillin-binding protein 2 PBP2 54 meca 12 PBP oxacillin cefoxitin PBP2Cefoxitin oxacillin cefoxitin 7 Oxacillin 19 1 cefoxitin Cefoxitin very major error:1.3major error: 8.9 BORSA Key words: MRSAcefoxitinPBP2mecAoxacillin susceptible Staphylococcus aureus Methicillin-resistant Staphylococcus aureusmrsa oxacillin penicillin-binding protein 2PBP2PBP2amecA NCCLS CLSIM 100-S cefoxitin disk oxacillin meca PBP2 MRSA gold standard 24 NCCLS meca PBP2 oxacillin oxacillin MIC MRSA MIC 1248 µ gml borderline oxacillin-resistant Staphylococcus aureusborsa MRSA BORSA MRSA I 1 S. aureus oxacillin MIC µ gml 79 BORSA oxacillin MIC NCCLS M100-S MRSA MRSA meca PBP2 cefoxitin VITEK2 AST-P525 meca mecaspa PCR PBP2 PBP2 MRSA-LA Cefoxitin NCCLS standard M100-S cefoxitin disk disk 3 standard

2 meca 19 mm oxacillin 20 mm oxacillin II BORSA 79 oxacillin MIC NCCLS susceptible 1 2 µ gml resistant 4 8 µ gml MRSA Table 1 VITEK2 oxacillin oxacillin MIC meca Oxacillin MIC 4 8 µ gml meca 1 µ gml 1 2 µ gml 5mecA 54 mecapbp2 oxacillin MIC 4 8 µ gml meca 1 µ g ml 6 2 µ gml 5 PBP2 mecapbp2 oxacillin MIC Cefoxitin oxacillin MIC 4 8 µ gml 1 20 mm 1 2 µ gml mm oxacillin MIC oxacillin MIC 24 mm14 mm 8 Cefoxitin oxacillin MIC 8 Table 2 mecapbp2 No. 51 MSSA 7 MRSA oxacillin MIC cefoxitin meca54 PBP mecaoxacillin MIC cefoxitin MSSA Table 3 Oxacillin MICmecA PBP2 cefoxitin disk Table 4 Oxacillin MIC cefoxitin very major errorvme 1.3oxacillin MIC cefoxitin major errorme 8.9 meca VME ME

3 Oxacillin S. aureus MRSA meca meca 1.3PBP2 VME 7.6ME 1.3 III MRSA β -lactam PBP2PBP2 β -lactam PBP β -lactam 5,6 PBP2 PBP2 meca S. aureus meca MRSA MSSA 7,8 gold standard 24 oxacillin cefoxitin MRSA PBP2 meca oxacillin MIC 1248 µ gml BORSA MRSA oxacillin MIC VITEK2 MSSA 6 mecapbp2 oxacillin MRSA oxacillin MRSA MSSA LouieoxacillinMIC28 µ gmls. aureus 37 PBP2mecA 2 MIC Felten oxacillin MIC NCCLS meca 9 oxacillin MSSA cefoxitin PBP2 meca MRSA MRSA cefoxitin 2004 NCCLS meca cefoxitin disk 19 mm oxacillin 20 mm oxacillin Felten cefoxitin meca MSSA PBP2 oxacillin 4,9, 10,11 MSSA meca MRSA β -lactam MRSA MRSAMSSA cefoxitin disk 14 mm24 mm cefoxitin MSSA

4 cefoxitin 1 cefoxitin disk 18 mm20 mm oxacillin MSSA mecapbp2 6 cefoxitin disk 1719 mm cefoxitin oxacillin 20 mm meca PBP2 5 7 PBP2 meca 7,8 PBP2 11,12 PBP2 PBP2 PBP2 3 meca PCR 1113 BORSA MRSA S. aureus MRSA oxacillin cefoxitin meca BORSA oxacillin meca cefoxitin cefoxitin BORSA 1 National Committee for Clinical Laboratory Standards: Performance standards for antimicrobial susceptibility testing ; fourteenth informational supplement, M100-S14. NCCLS, Wayne, P.A., Louie L, Matsumura S O, Choi E, et al: Evaluation of three rapid methods for detection of methicillin resistance in Staphylococcus aureus. J Clin Microbiol 38: , Sakoulas G, Gold H S, Venkataraman L, et al: Methicillin-resistant Staphylococcus aureus: comparison of susceptibility testing methods and analysis of meca-positive susceptible strains. J Clin Microbiol 39: , Skov R, Smyth R, Clausen M, et al: Evaluation of a cefoxitin 30 µ g disc on Iso-Sensitest agar for detection of methicillin-resistant Staphylococcus aureus.j Antimicrob Chemother 52: , Utsui Y, Yokota T : Role of an altered penicillinbinding protein in methicillin- and cephem-resistant Staphylococcus aureus. Antimicrob Agents Chemother 28: , Song M D, Wachi M, Doi M, et al: Evolution of an inducible penicillin-target protein in methicillinresistant Staphylococcus aureus by gene fusion. FEBS Lett 221: , Ubukata K, Nonoguchi R, Matsuhashi M, et al: Expression and inducibility in Staphylococcus aureus of the meca gene, which encodes a methicillin-resistant S. aureus-specific penicillin-binding protein. J Bacteriol 171: , Mitsuhashi M, Song M D, Ishino F, et al: Molecular cloning of the gene of a penicillin-binding protein supposed to cause high resistance to beta lactam antibiotics in Staphylococcus aureus. J Bacteriol 167: , Felten A, Grandry B, Lagrange P H, et al: Evaluation of three techniques for detection of low-level methicillin-resistant Staphylococcus aureusmrsa: a disk diffusion method with cefoxitin and moxalactam, the Vitek 2 system, and the MRSA-screen latex agglutination test. J Clin Microbiol 40: , Fernandes C J, Fernandes L A, Collignon P, et al: Cefoxitin resistance as a surrogate maker for the detection of methicillin-resistant Staphylococcus aureus. J Antimicrob Chemother 55: , Velasco D, Tomas M M, Cartelle M, et al: Evaluation of different methods for detecting methicillinoxacillinresistance in Staphylococcus aureus.jantimicrob Chemother 55: , Cavassini M, Wenger A, Jaton K, et al: Evaluation of MRSA-screen, a simple anti-pbp 2a slide latex agglutination kit, for rapid detection of methicillin resistance in Staphylococcus aureus. J Clin Microbiol 37: , Swenson J M, Williams P P, Killgore G, et al: Performance of eight methods, including two new rapid methods, for detection of oxacillin resistance in a challenge set of Staphylococcus aureus organisms. J Clin Microbiol 39: , 2001

5 Oxacillin S. aureus MRSA Identification of MRSA by various methods to detect borderline oxacillin-resistant Staphylococcus aureus Akiko Kanayama, Yuko Takahashi, Kaoru Matsuzaki and Intetsu Kobayashi Chemotherapy Division, Mitsubishi Kagaku Bio-Clinical Laboratories, Inc., 3301 Shimura, Itabashi-ku, Tokyo, Japan Methicillin-resistant Staphylococcus aureusmrsawas identified by various methods, including the disk diffusion test, to predict meca-mediated resistance by Staphylococcus with a cefoxitin disk, which was newly described in NCCLSat present CLSIM100-S142004, among 79 strains of borderline oxacillin-resistant Staphylococcus aureusborsawhose oxacillin MIC values were 1, 2, 4 and 8 µ gml. The results of the susceptibility testing of strains containing meca did not agree with the oxacillin MIC values, and mecawas present in 1 of the 30 strains and in 5 of the 30 strains that were susceptible to oxacillin at 1 and 2 µ gml, respectively. There were 12 PBP2 -producing strains among the 54 mecastrains, and since the reaction of 7 of these strains to latex particles was weak, their susceptibility to oxacillin was judged to be weakly positive. However, since these 12 strains were susceptible to oxacillin and cefoxitin, the results of the PBP2 test were presumed to be due to a nonspecific reaction. The test results with the cefoxitin disk indicated that 53 of the 60 strains susceptible to oxacillin were also susceptible to cefoxitin, but the remaining 7 strains were resistant to cefoxitin, and the diameters of the inhibition zone were around the borderline values for identification. The frequency of errors in the cefoxitin susceptibility test were low, i.e., 1.3 for very major error and 8.9 for major error, but since the diameters of the inhibition zone in case of BORSA may be around the borderline values for identification, it is concluded that it is necessary to confirm the susceptibility of these strains to oxacillin by other methods in addition.

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