MRSA Screening: Can one swab be used for both culture and rapid testing? An evaluation of chromogenic culture and subsequent Hain GenoQuick® PCR amplification/detection.

We evaluated the Hain GenoQuick® (GQM) methicillin resistant Staphylococcus aureus (MRSA) assay for the rapid detection of MRSA using one swab, i.e. the same screening specimen was used first for MRSA culture and then for rapid testing by PCR, as this would be the preferred option for routine diagnostic testing. GQM detected current prevalent Irish MRSA strains incorporating all known SSCmec types including Panton-Valentine leukocidin positive strains. All methicillin resistant coagulase negative staphylococci tested were negative but three of seven gentamicin-resistant MSSA strains tested were identified as MRSA by the GQM method. The theoretical ex-vivo limit of detection of the assay was 704 colony forming units (CFU) per GQM assay reaction (1.7x104CFU/ml) when MRSA suspensions were used for DNA extraction or 1.4x103 CFU/swab (1.4x104 CFU/ml) using MRSA absorbed onto Copan screening swabs. We demonstrated that swab processing on chromogenic agar prior to PCR resulted in some inhibition of the PCR reaction, increasing the limit of detection of the assay by a factor of 4. Based on the processing of 540 screening specimens (nasal and groin) by culture first and GQM second, the specificity and positive predictive value were both 100%, the negative predictive value was 92%, and the sensitivity was 57%. Culture followed by PCR from one specimen is not optimal for the rapid detection of MRSA. Further laboratory validation of the GQM assay is required to determine the true diagnostic sensitivity and value of this kit in routine microbiology laboratories, either with PCR before culture or using two specimens