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Background  Positive blood cultures showing Gram positive cocci in clusters signifies either  Staphylococcus aureus  or the less-virulent coagulase-negative staphylococci. Rapid identification and methicillin susceptibility determination with the Xpert MRSA/SA BC assay can improve management of  S. aureus  bloodstream infection and reduce inappropriate antibiotic use.    Methods  We prospectively evaluated the Xpert MRSA/SA BC assay in comparison with culture, on samples referred to our laboratory in the Western Cape, South Africa. We interviewed attending clinicians upon culture result availability, to assess antibiotic choices and estimate potential impact of the assay.    Results  Of the 231 samples included, there was 100% concordance between the Xpert MRSA/SA BC assay and culture (methicillin-resistant  S. aureus  15/15, methicillin-susceptible  S. aureus  42/42, coagulase-negative staphylococci 170/170). Time to final result could be reduced by approximately 30 h with the assay. Of the 178 patients with adequate antibiotic history, optimisation of antistaphylococcal therapy could have occurred more than 1 day sooner in 68.9% with  S. aureus  bloodstream infection (31/45, 95% CI 53.2–81.4%). Six of the 11 patients with methicillin-resistant  S. aureus  bloodstream infection (54.5%) could have received anti-MRSA cover sooner. Fifty-four days of antibiotic therapy could have been spared, equating to 0.3 days (95% CI, 0.2–0.4) saved per patient, driven by broad-spectrum beta-lactams (32 days, in 18.0% of the cohort).    Conclusion  This assay has potential as an antimicrobial stewardship tool; costing and impact on clinical outcome in patients with  S. aureus  bloodstream infection should be assessed.    Supplementary Information  The online version contains supplementary material available at 10.1186/s12879-021-05857-7.

bmc infectious diseases

Can the Xpert MRSA/SA BC assay be used as an antimicrobial stewardship tool? A prospective assay validation and descriptive impact assessment study in a South African setting