JAC Advance Access originally published online on July 1, 2003
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Journal of Antimicrobial Chemotherapy (2003) 52, 204-207
© 2003 The British Society for Antimicrobial Chemotherapy
Evaluation of a cefoxitin 30 µg disc on Iso-Sensitest agar for detection of methicillin-resistant Staphylococcus aureus
1 National Center for Antimicrobials and Infection Control, Statens Serum Institut, Artillerivej 5, DK-2300 Copenhagen S; 2 Department of Clinical Microbiology, Hvidovre Hospital, Copenhagen, Denmark; 3 The Swedish External Reference Laboratory for Susceptibility Testing, Växjö; 4 The Swedish Institute for Infectious Disease Control, Solna, Sweden
Received 25 March 2003; returned 2 April 2003; revised 9 May 2003; accepted 9 May 2003
Objectives: To evaluate the performance of a cefoxitin 30 µg disc on Iso-Sensitest agar, using a semi-confluent inoculum and overnight incubation at 35–36°C, for detection of methicillin-resistant Staphylococcus aureus (MRSA).
Methods: A total of 457 S. aureus, including 190 MRSA of several defined PFGE types and a number of low-level resistant isolates, were tested with a cefoxitin 30 µg disc on Iso-Sensitest agar, using a semi-confluent inoculum and overnight incubation at 35–36°C. This method was compared with the standard SRGA (Swedish Reference Group for Antibiotics) method (oxacillin 1 µg disc on Iso-Sensitest agar supplemented with 5% defibrinated horse blood, confluent growth and 24 h incubation in ambient air at 30°C).
Results: The cefoxitin method was excellent, with a sensitivity of 100% and a specificity of 99% using an interpretative zone diameter of S 
29 mm and R < 29 mm. Its performance was much better than the SRGA method, which with this collection of difficult strains had a sensitivity of only 78% using the current breakpoint of S 12 mm.
Conclusion: We suggest that the cefoxitin method should replace that currently recommended by the SRGA for the detection of MRSA, and that it would fit well into BSAC methodology.
Keywords: susceptibility testing, disc diffusion, MRSA, Iso-Sensitest Agar
* Corresponding author. Tel: +45-3268-8348; Fax: +45-3268-3873; E-mail: rsk{at}ssi.dk
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