Discrimination of methicillin-resistant Staphylococcus aureus from borderline-resistant and susceptible isolates by different methods

Methicillin-resistant Staphylococcus aureus (MRSA) are important nosocomial pathogens, Diseases caused by these resistant bacteria frequently are serious and there is a need to control the spread of epidemic MRSA clones in hospitals. However, detection is complicated by the fact that expression of the resistance is variable and, commonly, heterogeneous within strains. The reliability of several tests recommended to discriminate heterogeneous MRSA isolates from borderline-resistant and susceptible strains was evaluated. Screening for growth on agar with methicillin 25 mg/L was the only method that detected all MRSA strains tested, but screening on agar with methicillin 10 mg/L or oxacillin 6 mg/L detected all but one of 10 heterogeneously resistant strains tested. None of the borderline-resistant nor any truly susceptible staphylococci tested grew on any of these screening plates.