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Mechanisms of Methicillin Resistance in Staphylcoccus aureus and Methods for Laboratory Detection

Published online by Cambridge University Press:  21 June 2016

James H. Jorgensen
James H. Jorgensen*
Affiliation:
Department of Pathology, University of Texas Health Science Center, San Antonio, Texas
*
University of Texas Health Science Center, 7703 Floyd Curl Drive, San Antonio, TX 78284-7750
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Abstract

Three distinctly different mechanisms of methicillin resistance have been described in Staphylococcus aureus. The best-documented and probably most important mechanism is production of a unique, low affinity penicillin-binding protein, PBP 2a Strains possessing PBP 2a are resistant to methicillin, oxacillin, and probably all other currently available b-lactam antibiotics. Two additional mechanisms of reduced susceptibility to methicillin have been described. Borderline resistance (BORSA) to the semi-synthetic penicillins has been attributed to the hyperproduction of normal staphylococcal b-lactamase. A third mechanism has recently been advanced that describes an intermediate level of resistance to methicillin due to production of modified, normal PBPs with reduced affinity for b-lactams (MODSA). Little is known regarding the prevalence or clinical significance of the BORSA and MODSA strains. The most reliable in vitro susceptibility test methods for detecting MRSA (strains possessing PBP 2,) include the microdilution minimum inhibitory concentration (MIC) test (with 2% NaCl supplemented broth), the oxacillin agar screen plate test (incorporating 6 ug/ml oxacillin in 4% NaCl supplemented agar), and the National Committee for Clinical Laboratory Standards (NCCLS) disk diffusion test with oxacillin. All three methods use direct inoculum preparation and incubation of tests at 35°C for a full 24 hours.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 12 , Issue 1 , January 1991 , pp. 14 - 19
Copyright
Copyright © The Society for Healthcare Epidemiology of America 1991

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References

1. Jevons, MP. ‘Celbenin’-resistant staphylococci. Br Med J. 1961;1:124–125.CrossRefGoogle Scholar
2. Chambers, HF. Methicillin-resistant staphylococci, Clin Microbiol Rev. 1988;1:173–186.CrossRefGoogle ScholarPubMed
3. Jorgensen, JH. Laboratory and epidemiologic experience with methicillin-resistant Staphylococcus aureus in the U.S.A. Eur J Clin Microbial. 1986;5:693–696.CrossRefGoogle Scholar
4. Klimek, JJ, Marsik, FJ, Bartlett, RC, Weir, B, Shea, P, Quintiliani, R. Clinical, epidemiologic and bacteriologic observations of an outbreak of methicillin-resistant Staphylococcus aureus at a large community hospital. Am J Med. 1976;61:340–345.CrossRefGoogle Scholar
5. Aeilts, GD, Sapico, FL, Canawati, HN, Malik, GM, Montgomerie, JZ. Methicillin-resistant Staphylococcus aureus colonization and infection in a rehabilitation facility. J Clin Microbiol. 1982;16:219–223.CrossRefGoogle Scholar
6. Preheim, LC, Rimland, D, Bittner, MJ. Methicillin-resistant Staphylococcus aureus in veterans' administration medical centers. Infect Control. 1987;8:191–194.CrossRefGoogle Scholar
7. Hartman, BJ, Tomasz, A. Expression of methicillin resistance in heterogenous strains of Staphylococcus aureus . Antimicrob Agents Chemother. 1986;29:85–92.CrossRefGoogle Scholar
8. Utsui, Y, Yokota, T. Role of an altered penicillin-binding protein in methicillin- and cephem-resistant Staphylococcus aureus . Antimicob Agents Chemother. 1985;28:397–403.CrossRefGoogle ScholarPubMed
9. Hackbarth, CJ, Chambers, HF. Methicillin-resistant staphylococci: genetics and mechanisms of resistance. Antimocrob Agents Chemother. 1989;33:991–994.CrossRefGoogle ScholarPubMed
10. Lyon, BR, Skurry, R. Antimicrobial resistance of Staphylococcus aureus: genetic basis. Mirobiol Rev. 1987;51:88–134.Google ScholarPubMed
11. Sabath, LD. Mechanisms of resistance to b-lactam antibiotics in strains of Staphylococcus aureus . Ann Intern Med. 1982;97:339–344.CrossRefGoogle Scholar
12. Methods for Dilution Antimicrobial Susceptibility Tests for Bacteria That Grow Aerobically. 2nd ed. Villanova, Pa: National Committee for Clinical Laboratory Standards: 1990:M7–A2 Google Scholar
13. Chambers, HF. Coagulase-negative staphylococci resistant to b-lactam antibiotics in vivo produce penicillin-binding protein 2a. AntimicrobAgents Chemother. 1987;31:1919–1924.CrossRefGoogle Scholar
14. McDougal, LK, Thornsberry, C. The role of b-lactamase in staphylococcal resistance to penicillinase-resistant penicillins and cephalosporins. J Clin Microb. 1986;23:832–839.CrossRefGoogle Scholar
15. Montanari, MP, Tonin, E, Biavasco, F, Varaldo, PE. Further characterization of borderline methicillin-resistant Staphylococcus aureus and analysis of penicillin-binding proteins. Antimicrob Agents Chemother. 1990;34:911–913.CrossRefGoogle ScholarPubMed
16. Sierra-Madero, JG, Knapp, C, Karaffa, C, Washington, JA. Role of b-lactamase and different testing conditions in oxacillinborderline-susceptible staphylococci. Antimicrob Agents Chemother. 1988;32:1754–1757.CrossRefGoogle Scholar
17. Chambers, HF, Archer, G, Matsuhashi, M. Low-level methicillin resistance in strains of Staphylococcus aureus . Antimicrob Agents Chemother. 1989;33:424–428.CrossRefGoogle ScholarPubMed
18. Thauvin-Eliopoulos, C, Rice, LB, Eliopoulos, GM, Moellering, RC Jr. Efficacy of oxacillin and ampicillin-sulbactam combination in experimental endocarditis caused bv b-lactamase hyperproducing Staphylococcus aureus . Antimicrob Agents Chemother. 1990;34:728–732.CrossRefGoogle Scholar
19. Tomasz, A, Drugeon, HB, De Lencastre, HM, Jabes, D, McDougall, L, Bille, J. New mechanism for methicillin resistance in Staphylococcus aureus. Clinical isolates that lack the PBP 2a gene and contain normal penicillin-binding proteins with moditied penicillin-binding capacity. Antimicrob Agents Chemother. 1989;33:1869–1874.CrossRefGoogle Scholar
20. Washington, JA II. Discrepancies between in vitro activity of and in vivo response to antimicrobial agents. Diagn Microbiol Infect Dis. 1983;1:25–31.CrossRefGoogle Scholar
21. Aldridge, KE, Janney, A, Sanders, CV, Marier, RL. Interlaboratory variation of antibiograms of methicillin-resistant and methicillin-susceptible Staphylococcus aureus strains with conventional and commercial testing systems. J Clin Microbiol. 1983;18:1226–1236.CrossRefGoogle ScholarPubMed
22. Barry, AL, Badal, RE. Reliability of the microdilution technique for detection of methicillin-resistant strains of Staphylococcus aureus . Am J Clin Pathol. 1977;67:489–495.CrossRefGoogle Scholar
23. Hindler, JA, Inderlied, CB. Effect of the source of Mueller-Hinton agar and resistance frequency on the detection of methicillin-resistant Staphylococcus aureus . J Clin Microbiol. 1985;21:205–210.CrossRefGoogle ScholarPubMed
24. Thornberry, C, McDougal, LK. Successful use of broth microdilution in susceptibility tests for methicillin-resistant (heter-oresistant) staphylococci. J Clin Microbiol. 1983;18:1084–1091.CrossRefGoogle Scholar
25. Jorgensen, JH, Redding, JS, Maher, LA, Ramirez, PE. Salt-supplemented medium for testing methicillin-resistant staphylococci with newer b-lactams. J Clin Microbiol.1988;26:1675–1678.CrossRefGoogle Scholar
26. Hackbarth, CJ, Chambers, HF. Methicillin-resistant staphylococci: detection methods and treatment of infections. Antimicrob Agents Chemother. 1989;33:995–999.CrossRefGoogle ScholarPubMed
27. Coudron, PE, Jones, DL, Dalton, HP, Archer, GL. Evaluation of laboratory tests for detection of methicillin-resistant Staphylococcus aureus and Staphylococcus epidermidis . J Clin Microbiol. 1986;24:764–769.CrossRefGoogle ScholarPubMed
28. Barber, M. Methicillin-resistant staphylococci. J Clin Pathol. 1961;14:385–393.CrossRefGoogle ScholarPubMed
29. Hewitt, JH, Coe, AW, Parker, MT. The detection of methicillin resistance in Staphylococcus aureus . J Med Microbiol.1969;2:443–456.CrossRefGoogle ScholarPubMed
30. Performance Standards for Antimicrobial Disk Susceptibility Tests. 4th ed. Villanonva, Pa: National Committee for Clinical laboratory Standards; 1990:M2–A4.Google Scholar
31. Boyce, JM. Reevaluation of the ability of the standardized disk diffusion test to detect methicillin-resistant strains of Staphylococcus aureus . J Clin Microbiol. 1984;19:813–817.CrossRefGoogle ScholarPubMed
32. Richmond, AS, Simberkoff, MS, Schaefler, S, Rahal, JJ Jr. Resistance of Staphylococcus aureus to semisynthetic penicillins and cephalothin. J Infect Dis. 1977;135:108–112.CrossRefGoogle ScholarPubMed
33. Hirschl, A, Stanek, G, Rotter, M. Effectiveness of cefamandole against methicillin-resistant strains of Staphylococcus aureus in vivo and in experimental infections. J Antimicrob Chemother. 1984;13:429–435.CrossRefGoogle Scholar