Abstract
Enrichment culture (EC) remains gold standard for detecting MRSA colonisation, but molecular methods shorten turnaround time. The CE-marked automated Hologic Panther Fusion MRSA Assay (HPFM) is validated for nasal swabs. We compared HPFM with EC following an in-house PCR for detection of MRSA in nasal, pharyngeal, and perineal ESwabs. The same ESwabs were analysed using HPFM and inoculated in selective Tryptic Soy Broth (TSB) for overnight incubation. TSBs were screened by a PCR targeting nuc, femA, mecA, and mecC. Only samples with PCR results compatible with MRSA presence were inoculated onto 5% blood agar and chromogenic MRSA plates. HPFM detected MRSA in 103 of 132 EC positive samples indicating a sensitivity of 78.0% across sample types. When paired TSBs of 29 EC positive/HPFM negative samples were re-analysed by HPFM, MRSA was detected in 17/29 TSBs indicating that enrichment will increase the sensitivity of HPFM. HPFM analyses of cultured isolates from the remaining 12 EC positive/HPFM negative samples failed to detect orfX. HPFM reported the presence of MRSA in 22 samples where EC failed to identify MRSA. Fifteen of these ESwabs had been kept and direct culture without enrichment identified MRSA in seven samples. HPFM was useful for all sample sites. Compared to EC, the sensitivity of HPFM was limited because of lack of analytical sensitivity and failure to detect all MRSA variants. Failure of some MRSA-containing samples to enrich in cefoxitin-containing TSB indicates an unappreciated limitation of EC, which may lead to underestimation of the specificity of molecular assays.
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Acknowledgements
We would like to thank Professor David Coleman, Head of the Division of Oral Biosciences, School of Dental Science, Trinity College Dublin, and Dr. Grainne Brennan, Chief Medical Scientist at the Irish National MRSA Reference Laboratory, for three Irish MRSA isolates in the challenge panel.
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This study was financially supported by Hologic Inc. The sponsor had no influence on study design, data generation, data interpretation, or writing of the manuscript.
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Patient data was anonymised. Only sample site was registered for each sample and original sample numbers were replaced by a study number. The study was approved by the Hospital Board as a quality control study with the internal number W217038300-2018-37.
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K.S. has received travel grants from Hologic Inc. and Roche Diagnostics.
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Bartels, M.D., Knudsen, D., Westh, H. et al. Evaluation of the Hologic Panther Fusion MRSA Assay for the detection of MRSA in ESwab specimens obtained from nose, throat, and perineum. Eur J Clin Microbiol Infect Dis 40, 2177–2183 (2021). https://doi.org/10.1007/s10096-021-04272-9
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DOI: https://doi.org/10.1007/s10096-021-04272-9