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Positive predictive value of the Xpert MRSA assay diagnostic for universal patient screening at hospital admission: influence of the local ecology

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Abstract

The purpose of this study was to assess the accuracy of the Xpert MRSA assay (XP) for the detection of methicillin-resistant Staphylococcus aureus (MRSA) carriage upon hospital admission. Nasal swabs were prospectively collected for MRSA screening from 1,891 patients admitted to a teaching hospital. XP results were compared to chromogenic agar culture results. MRSA was cultured in 61 specimens (3%). Compared with culture, XP had a sensitivity, specificity, positive, and negative predictive value of 60.7, 97.3, 37.8, and 98.9%, respectively. The median turnaround time (TAT) for the results was 3 h. Of 24 MRSA isolated from XP-negative samples, three harbored composite SCCmec. Among 61 samples with culture-negative but XP-positive results, 15 methicillin-susceptible S. aureus (MSSA) isolates tested positive by XP on pure colony lysates. These MSSA included: (i) strains with SCCmec deletion encompassing mecA and (ii) multilocus sequence typing (MLST) clonal complex (CC) 1 strains harboring a chromosomal sequence homologous to one of the orfX–SCCmec junction sequences targeted by XP. On account of the low sensitivity and positive predictive value in a hospital patient population with moderate prevalence of MRSA, culture still appears to be necessary in order to confirm polymerase chain reaction (PCR) results. The emergence of new SCCmec variants and the presence of MSSA harboring cross-reactive SCCmec-like elements may challenge the successful implementation of such detection systems.

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Acknowledgments

This work was supported by a grant from the Belgian Antibiotic Policy Coordination Committee (BAPCOC), Ministry of Public Health, Belgium, and was organized under the auspices of the Federal Platform for Hospital Hygiene. The XP system and some of the reagents were kindly provided by Cepheid Europe (Maurens-Scopont, France).

We thank Raf De Ryck, Emilie Vandaele, and Sylvianne Rottiers for their skillful laboratory assistance and Michiel Costers for the comments on the manuscript.

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Author notes

  1. M. J. Struelens

    Present address: Scientific Advice Unit, European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden

Authors and Affiliations

  1. Department of Clinical Microbiology and National MRSA Reference Laboratory, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium

    S. Roisin, C. Nonhoff, A. Deplano, M. Hallin, M. J. Struelens & O. Denis

  2. Department of Infection Control, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium

    S. Roisin, C. Laurent & B. Byl

  3. Public Health School, Université Libre de Bruxelles, Brussels, Belgium

    B. Byl & O. Denis

  4. Service de Microbiologie, Hôpital Erasme, 808, Route de Lennik, 1070, Brussels, Belgium

    S. Roisin

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  1. S. Roisin
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Corresponding author

Correspondence to S. Roisin.

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Sandrine Roisin and Christine Laurent contributed equally to this work.

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Roisin, S., Laurent, C., Nonhoff, C. et al. Positive predictive value of the Xpert MRSA assay diagnostic for universal patient screening at hospital admission: influence of the local ecology. Eur J Clin Microbiol Infect Dis 31, 873–880 (2012). https://doi.org/10.1007/s10096-011-1387-7

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  • DOI: https://doi.org/10.1007/s10096-011-1387-7

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