Misidentification of vancomycin-resistant Staphylococcus aureus as coagulase-negative Staphylococcus

Reduced vancomycin susceptibility in Staphylococcus aureus in many cases appears to be associated with changes in biological characteristics, including reduced coagulase activity, cell wall thickening, slow growth, smaller colonies, decreased pigment formation and less or no haemolysis. Whether these changes affect identification by routine methods has not been reported. In this study, 24 vancomycin-susceptibility-reduced coagulase-negative staphylococci (CoNS) strains (including 22 Staphylococcus haemolyticus strains and two Staphylococcus epidermidis strains) were retested by PCR-based detection of Staphylococcus aureus-specific genes (nuc, coa and 16S rRNA). The results showed that six isolates identified by conventional biochemical tests as S. haemolyticus contained nuc, coa and 16S rRNA genes. These six strains were serial-passaged daily on nutrient agar without vancomycin supplementation, and vancomycin-susceptible revertants were obtained after 15 continuous passages. Revertant isolates were coagulase-positive and were identified as S. aureus by automated testing methods. This suggests that biochemical changes in S. aureus strains with reduced vancomycin susceptibility should be highlighted and that the detection of these strains requires more attention and improved techniques.