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The Journal of the Japanese Society for Clinical Microbiology |
Biblioraphy Information
| ArticleTitle |
Rapid nuc and mecA Gene Testing by Polymerase Chain Reaction is Useful to Choose Appropriate Antibiotics in Staphylococcus aureus Bacteremia |
| Language |
J |
| AuthorList |
Mami Ikemachi1), Hiroshi Takekawa1), Takuya Ikenari1), Kaori Kokuho1), Kazuya Miyagawa2), Go Yamamoto3) |
| Affiliation |
1) Department of Clinical Laboratory, Kobe City Nishi-Kobe Medical Center
2) General Internal Medicine, Kobe City Nishi-Kobe Medical Center
3) Department of Clinical Laboratory, Kobe City Medical Center General Hospital |
| Publication |
J.J.C.M.: 31 (1), 5-10, 2020 |
| Received |
June 23, 2020 |
| Accepted |
September 7, 2020 |
| Abstract |
Methicillin-resistant Staphylococcus aureus (MRSA) is a multidrug-resistant pathogen. In particular, MRSA bacteremia has a higher mortality than Methicillin-susceptible S. aureus (MSSA) bacteremia and is often troublesome to treat due to the multiple antimicrobial resistance. Quick and accurate detection of MRSA is critical to improve the prognosis of S. aureus bacteremia. Here we report the accuracy of nuc and mecA gene analysis, specific for S. aureus and MR Staphylococcus spp., respectively, using a QProbe method directly from blood culture bottles and their efficacy on appropriate choice of antibiotics. We analyzed 75 cases in which Staphylococcus spp. was detected in blood culture. The sensitivity, specificity, positive and negative predictive value (PPV and NPV) of nuc testing to detect S. aureus based on conventional cultures were very high (100%, 97.2%, 97.5%, 100% respectively). mecA testing also exhibited high sensitivity, specificity, PPV and NPV to detect MRSA (95.2%, 93.9%, 95.2%, 93.9% respectively). In 24 cases with S. aureus bacteremia, we retrospectively examined the ratio of antimicrobial changes based on the genotype. Of the 12 cases with MRSA, 6 cases (50.0%) were treated with vancomycin (VCM) monotherapy and 4 cases (33.3%) were treated with β-lactam antibiotic on VCM. Of the 12 cases with MSSA, all patients were treated with β-lactam antibiotic without adding VCM. Our study indicates that nuc and mecA genotyping is quick and accurate to separate MRSA from MSSA, which could result in an appropriate choice of antibiotics and better outcome against S. aureus bacteremia. |
| Keywords |
MRSA, QProbe-PCR, mecA, antimicrobial stewardship |
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