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Abstract
The application of molecular detection methods for bacterial pathogens has dramatically improved the outcomes of septic patients, including those with methicillin-resistant Staphylococcus aureus (MRSA) infections. Molecular methods can be applied to a variety of clinical specimens including nasal swabs, growth in blood culture bottles, and wounds. While data show that the overall accuracy of molecular tests for MRSA is high, results can be confounded by the presence of multiple staphylococcal species in a specimen, insertions and deletions of DNA in and around the Staphylococcal Cassette Chromosome mec (SCCmec) element, and point mutations in mecA. Herein, we explore the complexities of molecular approaches to MRSA detection and the instances where phenotypic methods should be pursued to resolve discrepancies between genotypic and phenotypic results.
Highlights
The application of molecular detection methods for bacterial pathogens has significantly improved the outcomes of septic patients, especially in conjunction with antimicrobial stewardship programs [1]
The discovery of the mecA gene as the key mechanism of methicillin resistance in staphylococcal species enabled the development of rapid molecular tests to distinguish between colonies of methicillin-resistant S. aureus (MRSA) and colonies of methicillin-susceptible S. aureus (MSSA), first by DNA probes and by PCR [6,7]
Direct detection of MRSA in clinical specimens was more of a challenge, since mecA may be present in methicillin-resistant strains of coagulase-negative staphylococci, which can be found in a variety of clinical specimens [8,9,10]
Summary
The application of molecular detection methods for bacterial pathogens has significantly improved the outcomes of septic patients, especially in conjunction with antimicrobial stewardship programs [1] This includes patients with infections caused by Staphylococcus aureus and those with methicillin-resistant S. aureus (MRSA) [2,3]. Early diagnostic tests for detection of MRSA in nasal specimens relied only on the orfX-SCCmec junction region and did not utilize simultaneous detection of mecA [13] This was done by placing one set of primers in the orfX locus in the S. aureus chromosome and the other in the SCCmec element, spanning the SCCmec integration site. The complexities of molecular approaches to MRSA and MSSA detection will be explored
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