Optimizing testing of methicillin-resistant Staphylococcus species.

Selection of the appropriate NaCl concentration for test medium for oxacillin susceptibility testing of Staphylococcus aureus and coagulase-negative staphylococci has been problematic when using different antimicrobial susceptibility testing methods. Broth microdilution, using cation-adjusted Mueller-Hinton broth + 2% NaCl, is the currently recommended reference method. There is currently no recommendation for the addition of NaCl to agar for dilution susceptibility tests when Staphylococcus species are tested with oxacillin. We examined the effects of adding 0, 2%, 4%, and 5% NaCl to Mueller-Hinton agar and broth for agar dilution, Etest, and broth microdilution tests. The results of these tests were compared with the reference broth microdilution results and with the results of a hybridization assay using a mec gene probe. We tested 223 strains of staphylococci, 128 of which were mec gene positive and had oxacillin minimum inhibitory concentrations (MICs) > or = 4 micrograms/ml. Seven strains of S. aureus were mec probe negative but were oxacillin resistant. Seven coagulase-negative strains (three S. epidermidis, one S. haemolyticus, and three S. simulans) were mec probe positive and were oxacillin susceptible. The MICs for oxacillin-resistant strains increased two- to fourfold with the addition of 2% NaCl, but the MICs for oxacillin-susceptible strains were unchanged. Major and very major interpretative rates ranged from 18.2% to 20.2% for agar dilution and Etest without NaCl added to the medium, and these rates decreased to < 1% with the addition of 2% NaCl to the medium. The addition of 4% or 5% NaCl caused major error rates of > 17% for all test methods.(ABSTRACT TRUNCATED AT 250 WORDS)