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A CDC algorithm describing recommended methods for laboratory detection of vancomycin intermediate or resistant Staphylococcus aureus can be found at the following URL: www.cdc.gov/ncidod/dhqp/ar_visavrsa_algo.html.
It should be noted that the vancomycin screen agar (brain heart infusion agar with 6 ug/ml of vancomycin) was recommended for routine use in laboratories because some of the automated susceptibility testing systems failed to detect vancomycin resistance in one or more of the vancomycin-resistant S. aureus (VRSA) isolates. Since this recommendation was made, many of the manufacturers have adjusted their system so that they now detect VRSA. For laboratories using systems that are FDA cleared for VRSA detection, the screen agar may not be necessary. I believe the CDC algorithm has a current list of systems with FDA clearance. If a laboratory chooses to use the vancomycin screen agar, it is recommended that all clinical isolates of S. aureus, including methicillin-resistant S. aureus (MRSA), be tested. If this is not possible because of resource limitations, then it is recommended that at least MRSA be tested.
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