Evaluation of diagnostic accuracy of latex agglutination test and E-test for the detection of methicillin-resistant Staphylococcus aureus


  • Nupur Gupta Department of Microbiology, Faculty of Dentistry, Jamia Millia Islamia, New Delhi, India
  • Manoj Jais Department of Microbiology, Lady Hardinge Medical College, New Delhi, India
  • Aditi Sharma Faculty of Dentistry, Jamia Millia Islamia, New Delhi, India
  • Priyanshu K. Shrivastava Faculty of Dentistry, Jamia Millia Islamia, New Delhi, India https://orcid.org/0000-0003-0078-3757




E-test, Latex agglutination, Methicillin-resistant Staphylococcus aureus, MRSA, Oxacillin, Staphylococcus aureus, Vancomycin


Background: This study was undertaken to compare the phenotypic methods of latex agglutination test and e-test with polymerase chain reaction for the detection of methicillin-resistant Staphylococcus aureus.

Methods: Two hundred pus samples obtained from different clinical disciplines were subjected to the latex agglutination test and minimum inhibitory concentration by e-test (Oxacillin and Vancomycin) as per the standard guidelines. The comparison was made with polymerase chain reaction as the reference test. The diagnostic accuracy of each method was reported in terms of sensitivity, specificity, positive predictive value, and negative predictive value.  

Results: The sensitivity of latex agglutination test was found to be 100% whereas e-test for Oxacillin was found to be 96.67% sensitive. Higher specificity for e-test was reported (99.41%) when compared to the latex agglutination test (97.65%).

Conclusions: Latex agglutination and e-tests are tests are relatively simpler, rapid, and easy-to-perform methods when compared to polymerase chain reaction. The present study reported high sensitivity and specificity values for both the tests, and therefore supports usage of the stated methods as screening tools for methicillin-resistant S. aureus. However, more multi-centric studies are recommended to precisely determine the diagnostic accuracy of these phenotypic methods.


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Lowy FD. Antimicrobial resistance: the example of Staphylococcus aureus. J Clin Invest. 2003;111(9):1265-73.

Turner NA, Sharma-Kuinkel BK, Maskarinec SA, Eichenberger EM, Shah PP, Carugati M, et al. Methicillin-resistant Staphylococcus aureus: an overview of basic and clinical research. Nat Rev Microbiol. 2019;17:203-18.

Centers for Disease Control and Prevention. MRSA and the workplace. Available at: https://www. cdc.gov/niosh/topics/mrsa/default.html. Accessed on 11 May 2022.

Siddiqui AH, Koirala J. Methicillin Resistant Staphylococcus Aureus. In: StatPearls. Treasure Island (FL): StatPearls Publishing. 2022.

Gajdács M. The Continuing Threat of Methicillin-Resistant Staphylococcus aureus. Antibiotics. 2019;8(2):52.

Katayama Y, Ito T, Hiramatsu K. A new class of genetic element, staphylococcus cassette chromosome mec, encodes methicillin resistance in Staphylococcus aureus. Antimicrob Agents Chemother. 2000;44(6):1549-55.

Lowy FD. Antimicrobial resistance: the example of Staphylococcus aureus. J Clin Invest. 2003;111:1265-73.

Datta P, Gulati N, Singla N, Rani Vasdeva H, Bala K, Chander J, Gupta V. Evaluation of various methods for the detection of meticillin-resistant Staphylococcus aureus strains and susceptibility patterns. J Med Microbiol. 2011;60(11):1613-6.

Baddour MM, AbuElKheir MM, Fatani AJ. Comparison of mecA polymerase chain reaction with phenotypic methods for the detection of methicillin-resistant Staphylococcus aureus. Curr Microbiol. 2007;55(6):473-9.

Sakoulas G, Gold HS, Venkataraman L, DeGirolami PC, Eliopoulos GM, Qian Q. Methicillin-resistant Staphylococcus aureus: comparison of susceptibility testing methods and analysis of mecA-positive susceptible strains. J Clin Microbiol. 2001;39(11):3946-51.

Akpaka PE, Kissoon S, Rutherford C, Swantson WH, Jayaratne P. Evaluation of methods and costs for detecting methicillin-resistant Staphylococcus aureus isolates from clinical specimens at regional hospitals in Trinidad and Tobago. West Indian Med J. 2008;57(1):24.

Gupta N, Manoj JA, Shrivastava PK, Sharma A. Comparison of Different Phenotypic Methods of Detection of Methicillin-Resistant Staphylococcus aureus with Polymerase Chain Reaction. J Microbiol Infect Dis. 2022;12(03):116-26.

Musini A, Kandula P, Giri A. Drug Resistance Mechanism in Staphylococcus aureus. innovations in Biotechnology for a Sustainable Future. Springer, Cham. 2021;355-76.

Viertel TM, Ritter K, Horz HP. Viruses versus bacteria—novel approaches to phage therapy as a tool against multidrug-resistant pathogens. J Antimicrob Chemotherapy. 2014;69(9):2326-36.

Liu WT, Chen EZ, Yang L, Peng C, Wang Q, Xu Z, Chen DQ. Emerging resistance mechanisms for 4 types of common anti-MRSA antibiotics in Staphylococcus aureus: A comprehensive review. Microb Pathogenesis. 2021;156:104915.

Pournajaf A, Ardebili A, Goudarzi L, Khodabandeh M, Narimani T, Abbaszadeh H. PCR-based identification of methicillin-resistant Staphylococcus aureus strains and their antibiotic resistance profiles. Asian Pac J Trop Biomed. 2014;4:S293-7.

Stürenburg E. Rapid detection of methicillin-resistant Staphylococcus aureus directly from clinical samples: methods, effectiveness and cost considerations. Ger Med Sci. 2009;7:06.

Szabó J. Molecular methods in the epidemiology of Methicillin-resistant Staphylococcus aureus (MRSA): advantages, disadvantages of different techniques. J Med Microbiol Diagnosis. 2014;3(3):1.

Alipour F, Ahmadi M, Javadi S. Evaluation of different methods to detect methicillin resistance in Staphylococcus aureus (MRSA). J Infect Public Health. 2014;7(3):186-91.

van Griethuysen A, Pouw M, van Leeuwen N, Heck M, Willemse P, Buiting A, Kluytmans J. Rapid slide latex agglutination test for detection of methicillin resistance in Staphylococcus aureus. J Clin Microbiol. 1999;37(9):2789-92.

Smole SC, Aronson E, Durbin A, Brecher SM, Arbeit RD. Sensitivity and specificity of an improved rapid latex agglutination test for identification of methicillin-sensitive and-resistant Staphylococcus aureus isolates. J Clin Microbiol. 1998;36(4):1109-12.

El-Ageery SM, Abou El-Khier NT. Comparison of Conventional Mannitol Salt Agar with Oxacillin, Penicillin-Binding Protein 2a Latex Agglutination, and mecA PCR for Detection of Methicillin Resistance in Staphylococcus aureus. Egyptian J Med Microbiol. 2014;23(1).

Velasco D, del Mar Tomas M, Cartelle M, Beceiro A, et al. Evaluation of different methods for detecting methicillin(oxacillin) resistance in Staphylococcus aureus. J Antimicrob Chemother. 2005;55:379-82.

Nordin N, Hussin NS, Hanafiah A, Sulong A. Staphylococcal aureus bacteremia: Clinical characteristic & evaluation of Prolex Staph Xtra latex agglutination test in the rapid identification of Staphylococcus aureus Malaysian J Pathology. 2021;43(3).

Villard O, Cimon B, Franck J, Fricker-Hidalgo H, Godineau N, Houze S, et al. Network from the French National Reference Center for Toxoplasmosis. Evaluation of the usefulness of six commercial agglutination assays for serologic diagnosis of toxoplasmosis. Diagnostic microbiology and infectious disease. 2012;73(3):231-5.

Swenson JM, Williams PP, Killgore G, Hara CM, Tenover FC. Performance of eight methods, including two new rapid methods, for detection of oxacillin resistance in a challenge set of Staphylococcus aureus organisms. J Clin Microbiol. 2001;39(10):3785-8.

Marlowe EM, Linscott AJ, Kanatani M, Bruckner DA. Practical therapeutic application of the Oxoid PBP2’latex agglutination test for the rapid identification of methicillin-resistant Staphylococcus aureus in blood cultures. Am J Clin Pathol. 2002;118(2):287-91.

Cavassini M, Wenger A, Jaton K. Blanc D, Bille J. Evaluation of MRSA Screen, a Simple Anti-PBP 2a Slide Latex Agglutination Kit, for Rapid Detection of Methicillin Resistance in Staphylococcus aureus. J Clin Microbiol. 1999;37(5):1591-9.

Felten A, Grandry B, Lagrange PH, Casin I. Evaluation of three techniques for detection of low-level methicillin-resistant Staphylococcus aureus (MRSA): a disk diffusion method with cefoxitin and moxalactam, the Vitek 2 system, and the MRSA-screen latex agglutination test. J Clin Microbiol. 2002;40(8):2766-71.

Finan JE. Molecular mechanisms of vancomycin resistance in Staphylococcus aureus. Virginia Commonwealth University. 2002.

Mathews AA, Thomas M, Appalaraju B, Jayalakshmi J. Evaluation and comparison of tests to detect methicillin resistant S. aureus. Indian J Pathol Microbiol. 2010;53(1):79-82.

Karami S, Rahbar M, Yousefi J. V. Evaluation of Five Phenotypic Methods for Detection of Methicillin Resistant Staphylococcus aureus (MRSA). Iranian J Pathol. 2011;6(1):27-31.

Gupta M, Kaore N, Gupta A. Comparative evaluation of MIC by E-test and Cefoxitin disc diffusion for detection of Methicillin Resistant Staphylococcus aureus (MRSA). Indian J Microbiol Res. 2016;3(4):407-10.






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