IDI-MRSA

K033415 · Infectio Diagnostic (I.D.I.), Inc. · NQX · Mar 18, 2004 · Microbiology

Device Facts

Record IDK033415
Device NameIDI-MRSA
ApplicantInfectio Diagnostic (I.D.I.), Inc.
Product CodeNQX · Microbiology
Decision DateMar 18, 2004
DecisionSESE
Submission TypeTraditional
Regulation21 CFR 866.1640
Device ClassClass 2

Intended Use

IDI-MRSA™ is a qualitative in vitro diagnostic test for the direct detection of nasal colonization by methicillin-resistant Staphylococcus aureus (MRSA) to aid in the prevention and control of MRSA infections in healthcare settings. The test performed on the Smart Cycler® instrument with a nasal swab specimen from patients at risk for colonization, utilizes polymerase chain reaction (PCR) for the amplification of MRSA DNA and fluorogenic target-specific hybridization probes for the detection of the amplified DNA. IDI-MRSA™ is not intended to diagnose MRSA infections nor to guide or monitor treatment for MRSA infections. Concomitant cultures are necessary only to recover organisms for epidemiological typing or for further susceptibility testing.

Device Story

The IDI-MRSA™ assay is an in vitro diagnostic test for detecting nasal MRSA colonization. It uses nasal swab specimens collected via Copan Venturi Transystem®. The process involves sample concentration and lysis, followed by PCR amplification of a genetic target near the SCCmec insertion site. The assay utilizes fluorogenic target-specific hybridization probes (molecular beacons) labeled with FAM or TET fluorophores and DABCYL quenchers to detect amplified DNA. An internal control is included to monitor for PCR inhibition. The assay is performed on the Smart Cycler® instrument, which uses proprietary I-CORE® (Intelligent Cooling/Heating Optical Reaction) modules for rapid thermal cycling and real-time fluorescence monitoring. The instrument automatically interprets data and provides a final result. The device is used in laboratory settings by trained personnel. Results assist healthcare providers in identifying colonized patients for infection control measures. It does not diagnose active infections or guide antibiotic therapy.

Clinical Evidence

Prospective multi-site study (n=786 nasal specimens) compared IDI-MRSA™ to culture-based reference methods (mannitol salt agar and oxacillin screen agar). IDI-MRSA™ sensitivity was 92.5% (135/146) and specificity was 96.4% (609/632). Positive predictive value was 85.4% and negative predictive value was 98.2%. Eight unresolved results were excluded. 14 false-positive results were later confirmed as culture-positive upon further testing.

Technological Characteristics

Qualitative PCR-based nucleic acid amplification test. Uses fluorogenic target-specific hybridization probes (molecular beacons) with FAM/TET fluorophores and DABCYL quenchers. Operates on the Smart Cycler® instrument featuring 16-site I-CORE® (Intelligent Cooling/Heating Optical Reaction) modules for rapid thermal cycling. Connectivity allows daisy-chaining up to 6 processing blocks for 96-sample throughput. Automated data interpretation via microprocessor-controlled software.

Indications for Use

Indicated for establishing MRSA colonization in patients at risk for nasal colonization. Prescription use only.

Regulatory Classification

Identification

An antimicrobial susceptibility test powder is a device that consists of an antimicrobial drug powder packaged in vials in specified amounts and intended for use in clinical laboratories for determining in vitro susceptibility of bacterial pathogens to these therapeutic agents. Test results are used to determine the antimicrobial agent of choice in the treatment of bacterial diseases.

Predicate Devices

Related Devices

Submission Summary (Full Text)

{0}------------------------------------------------ ## 510(k) Summary ## IDI-MRSA™ assay Infectio Diagnostic Inc. March 17, 2004 | Submitted by: | Infectio Diagnostic Inc.<br>2050, boul. René-Lévesque O, 4ª étaqe<br>Sainte-Foy, Québec<br>Canada<br>G1V 2K8 | |---------------------------------------------------------------------|-------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------| | Contact: | Christian Choquet, PhD. | | Name of Device: | | | Trade Name:<br>Common Name:<br>Product Code:<br>Classification Name | IDI-MRSA™ Assay<br>Test kit for the detection of methicillin-resistant<br>Staphylococcus aureus<br>NOX<br>System, Nucleic Acid Amplification Test, DNA, Methicillin<br>Resistant Staphylococcus aureus, Direct Specimen | | Predicate Device: | PBP2' Latex Agglutination Test (Oxoid)<br>Mueller Hinton Agar with 4% NaCl and 6 μα/ml oxacillin<br>(Remel) | | Device Description: | | Intended Use: IDI-MRSA™ assay is a qualitative in vitro diagnostic test for the direct detection of nasal colonization by methicillin-resistant Staphylococcus aureus (MRSA) to aid in the prevention and control of MRSA infections in healthcare settings. The test performed on the Smart Cycler® instrument with a nasal swab specimen from patients at risk for colonization, utilizes polymerase chain reaction (PCR) for the amplification of MRSA DNA and fluorogenic target-specific hybridization probes for the detection of the amplified DNA. IDI-MRSA is not intended to diagnose MRSA infections nor to guide or monitor treatment for Concomitant cultures are necessary only to recover organisms for MRSA infections. epidemiological typing or for further susceptibility testing. Test Description: A nasal specimen is collected and transported to the laboratory using the Copan Venturi Transystem®. For testing, the swab is placed in sample preparation buffer. The specimen is concentrated and lysed. An aliquot of the lysate is added to PCR reagents which contain the MRSA-specific primers used to amplify the genetic target [a sequence near the insertion site of Staphylococcal Cassette Chromosome mec (SCCmec)], if present. The assay also includes {1}------------------------------------------------ an internal control (IC) used to detect PCR inhibitory specimens and to confirm the integrity of an internal of the PC (C is a DNA fragment of 335-bp including a 277-bp assay reagents in hogative optionnel to targets are detected with hybridization probes labeled sequence fluorophores (rnolecular beacons). For the detection of MRSA amplicons, the with quencher beacon contains the fluorophore 5-carboxyfluorescein (amine reactive ester of molocally beader commonly called FAM) at the 5' end and the non-fluorescent quencher carboxy-liderooooin bonneeriy on the opposite end of the oligonucleotide. For the detection moley daboy onlorido (1) (1) (1) (1) (1) (1) (1) (1) (1) (1) (1) (1) (1) (1) (1) (1) (1) (1) (1) (1) (1) (1) (1) (1) (1) (1) (1) (1) (1) (1) (1) (1) (1) (1) (1) (1) (1) (1) ( fluorescein (TET) at the 5' end and the non-fluorescent quencher moiety DABCYL at the 3' end. For the recovery of MRSA for epidemiological typing or for further antibiotic susceptibility testing, appropriate culture media can be inoculated during specimen preparation or up to 24 hours after its preparation. The amount of fluorescence at any given cycle, or following cycling, depends on the amount of specific amplicon present at that time. The Smart Cycler® instrument monitors simultaneously the fluorescence emitted by each beacon, interprets all data and at the end of the cycling program provides a final result. The operation of the Smart Cycler® instrument is based on the proprietary microprocessor-controlled I-CORE® (Intelligent Cooling/Heating Optical Reaction) Each Smart Cycler® processing block contains 16 independently controlled, module. programmable I-Core® modules, each with one reaction site. Thermally optimized proprietary programmales combined with the design of the I-CORE® modules allow very rapid temperature cycling and rapid amplification. Up to 6 Smart Cycler® processing blocks can be daisy-chained together, allowing simultaneous analysis of 96 discrete samples. ### Substantial Equivalence: The Infectio Diagnostic Inc. IDI-MRSA™ assay has been found to be substantially equivalent to the Oxoid PBP2' Latex Agglutination Test (K011710) and to the culture technique consisting of nrimary isolation on mannitol salt agar followed by the oxacillin screen agar [Mueller Hinton Agar supplemented with 4% NaCl and 6 µg/ml oxacillin (Remel, K850291)) for confirmed isolates of S. aureus. The IDI-MRSA™ assay is conducted directly on nasal swab specimens; determination of methicillin resistance with the PBP2' Latex Agglutination Test and with the oxacillin screen agar test are performed on isolates identified as Staphylococcus aureus. All assays detect MRSA. The IDI-MRSA™ assay determines the presence of MRSA through PCR amplification of a sequence located at the insertion site of the Staphylococcal Cassette Chromosome mec (SCCmec) and detection of amplified products with fluorogenic target-specific hybridization; PBP2' Test uses latex agglutination for the detection of the PBP2' protein, one of the gene product of the mecA gene; the culture technique uses phenotypic characteristics of colonies. With IDI-MRSA™ assay, interpretation of results is done automatically by the Smart Cycler® Instrument; with the PBP2' Latex Agglutination Test and the culture technique, results are interpreted visually by the user. The reported performance of the Oxoid PBP2' Latex Agglutination Test In comparison (% agreement) with the oxacillin screen agar test on presumptive S. aureus isolates is 100% (232/232) for MRSA and 100% (87/87) for MSSA. Clinical performances of the IDI-MRSA™ assay and of the culture technique in a multi-center study are described below. {2}------------------------------------------------ #### Clinical performance A multi-center study was conducted on 786 nasal swab specimens collected with the Copan Venturi Transystem. The reference method consisted of an initial analysis with the oxacillia ventuir Transystom. The relective growth on mannitol salt agar. Specimens negative for MRSA screen agar tool an additional analysis consisting of an enrichment step in trypticase soy broth were subjectou to an additional by the oxacillin screen agar test. An MRSA culture-( 1 00) our an in the Revel as a specimen positive for MRSA by either culture technique. An positive specimen was defined as a specimen negative for MRSA by both culture techniques. Compared to the culture method of reference, the IDI-MRSA™ identified 92.5% of the specimens positive for MRSA by either culture techniques and 96.4% of the specimens negative by both culture techniques (Tables 1 and 2). For the population tested, this results in a negative predictive value of 98.2% and a positive predictive value of 85.4%. | | TAUTOMOTIVE THE TOUCH ATT<br>. No . Alliable !! . WAN<br>· · "AYAYAYAYAYAYAY<br>MARK CHARLES AND STATE<br>the first of the manage and considered<br>Yu"AYAYAYAYAYA<br>· VATAVAZ · · · · · · ·<br>.<br>A Children R.<br><br><br>.<br><br>.<br>.<br>------------------------------------------------------------------------------------------------------------------------------------------------------------------------------<br>1 and an in contract<br><br><br><br>WANT " "<br>W.<br>. " . " . " . " . " . " . " . " . " . " . " . " . " . " . " . " . " . " . " . " . " . " . " . " . " . " . " . " . " . " . " . " . " . " . " . " . " . " . " . " . " . " . 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Results obtained with IDI-MRSA™ assay in comparison to the reference method '. Eight (8) specimens that gave initially unresolved results remained upon retesting with IDI-MRSA™ assay and are not included in the table. All 8 were culture negative. Fourteen (14) of the 23 culture-negative specimens but IDI-MRSA positive were found to be MRSA culture-positive upon further investigation, resulting in a total of 149 culture-positive and IDI-MRSA positive specimens out of a total of 160 culture positive specimens. For 2 of the culture-positive specimens but IDI-MRSA negative, none of the isolates that exhibited methicillin resistance on oxacillin agar plates could be shown to carry the mecA gene when tested with the mecA-specific PCR assay described by Martineau et al.1 - Table 2. Performance of IDI-MRSA™ assay obtained by the investigational sites when compared to the reference method | | Sensitivity<br>(95% CI) | Specificity<br>(95% CI) | No. of unresolved<br>specimens | Invalid/ total no.<br>of runs | |--------|-------------------------------|--------------------------------|--------------------------------|-------------------------------| | Site 1 | 86.8% (n=38)<br>(71.9-95.6%) | 99.6% (n=261)<br>(97.9-100%) | 6 | 0/26 | | Site 2 | 100% (n=30)<br>(88.4-100%) | 98.0% (n=102)<br>(93.1-99.8%) | 16 | 0/21 | | Site 3 | 89.3% (n=28)<br>(71.8-97.7%) | 90.8% (n=119)<br>(84.1-95.3%) | 11 | 1/15 | | Site 4 | 94.0% (n=50)<br>(83.5-98.7%) | 94.0% (n=150)<br>(88.9-97.2%) | 2 | 2/27 | | Total | 92.5% (n=146)<br>(86.9-96.2%) | 96.4% (n=632)<br>(94.6-97.27%) | 35 | 3/89 | Binomial 95% confidence intervals. All specimens were unresolved due to failed internal controls indicative of inhibition or reagent failure. Twenty-2 seven (27) of the 35 were resplved upon re-testing. SCCmec typing of MRSA culture-positive s pecimens a ccording to Oliviera and de Lencastre® revealed specimens of types I, II and IV. There were no SCCmec type III specimens isolated {3}------------------------------------------------ from the study. However, in a separate study, reference strains and other clinical isolates of all SCCmec types were tested and detected with IDI-MRSA™ assay. Performances obtained by the investigational sites for IDI-MRSA, and the individual culture techniques as compared to the culture reference method (both culture techniques) are presented in Tables 3 and 4. | method. | | | | | |---------|------------------|-----------------------|-----------------------|-----------------------| | Site | MRSA prevalence1 | Sensitivity (95% CI)2 | | | | | | IDI-MRSATM | OxaMSA3 | OxaTSB4 | | Site 1 | 12.7% (38/300) | 86.8%<br>(71.9-95.6%) | 81.6%<br>(65.7-92.3%) | ND | | Site 2 | 21.7% (30/138) | 100%<br>(88.4-100%) | 93.3%<br>(77.9-99.2%) | ND | | Site 3 | 18.9% (28/148) | 89.3%<br>(71.8-97.7%) | 64.3%<br>(44.1-81.4%) | ND | | Site 4 | 25.0% (50/200) | 94.0%<br>(83.5-98.7%) | 80.0%<br>(66.3-90.0%) | 78.0%<br>(64.0-88.5%) | | Total | 18.6% (146/786) | 92.5%<br>(86.9-96.2%) | 80.1%<br>(72.7-86.3%) | ND | | Table 3. Results obtained for IDI-MRSA™ assay and each culture screening | | |--------------------------------------------------------------------------|--| | technique with :specimens positive for MRSA by the culture reference | | | method. | | Determined from results obtained with the culture reference method (combination of OxaMSA and OxaTSB) 2 Binomial 95% confidence intervals. 3 Oxacillin screen agar test after selective growth on MSA. 4 Oxacillin screen agar test after enrichment in TSB with 6.5% NaCl. Site 4 tested all specimens with both culture techniques while the remaining sites tested only specimens negative with the OxaMSA culture method. #### Table 4. Results obtained for IDI-MRSA™ assay and each culture screening technique with specimens negative for MRSA by the culture reference method. | Site | MSSA1 | Specificity (95% CI)2 | | | |--------|---------|-----------------------|---------------------|---------------------| | | | IDI-MRSATM | OxaMSA3 | OxaTSB4 | | Site 1 | 73/262 | 99.6%<br>(97.9-100%) | 100%<br>(98.6-100%) | ND | | Site 2 | 25/108 | 98.0%<br>(93.2-99.8%) | 100%<br>(96.4-100%) | ND | | Site 3 | 24/120 | 90.8%<br>(84.1-95.3%) | 100%<br>(96.9-100%) | ND | | Site 4 | 16/150 | 94.0%<br>(88.9-97.2%) | 100%<br>(97.6-100%) | 100%<br>(97.6-100%) | | Total | 138/640 | 96.4%<br>(94.6-97.7%) | 100%<br>(99.4-100%) | ND | Number of MSSA in total MRSA culture-negative population 2 Binomial 95% confidence intervals. 3 Oxacillin screen agar test after selective growth on MSA 4 Oxacillin screen agar test after enrichment in TSB with 6.5% NaCl. Site 4 tested all specimens with both oxamin obroom ager loor answer sites tested only specimens negative with the OxaMSA culture method. As indicated in Table 4, 138 specimens analyzed with culture techniques were deemed by investigational sites to contain methicillin-sensitive S. aureus . Seven (7) yielded positive results with IDI-MRSA™ assay. Upon further investigation with more enhanced culture techniques, 4 were shown to actually contain MRSA {4}------------------------------------------------ DEPARTMENT OF HEALTH & HUMAN SERVICES Image /page/4/Picture/1 description: The image shows the logo for the U.S. Department of Health & Human Services. The logo consists of a stylized eagle with three lines forming its body and wings. The text "DEPARTMENT OF HEALTH & HUMAN SERVICES USA" is arranged in a circular fashion around the eagle. Public Health Service MAR 1 8 2004 Food and Drug Administration 2098 Gaither Road Rockville MD 20850 Christian Choquet, Ph.D. VP, Regulatory Affairs and Quality Assurancce Infectio Diagnostic (I.D.I.), Inc. 2050, boul. René-Lévesque O, 4€ étage Sainte-Foy, Québec Canada G1V 2K8 Re: k033415 Trade/Device Name: IDI-MRSA"M Assay Regulation Number: 21 CFR 866.1640 Regulation Name: Antimicrobial susceptibility test powder Regulatory Class: Class II Product Code: NQX Dated: February 16, 2004 Received: February 18, 2004 Dear Dr. Choquet: We have reviewed your Section 510(k) premarket notification of intent to market the device w o nave a so row and have determined the device is substantially equivalent (for the indications for use stated in the enclosure) to legally marketed predicate devices marketed in interstate for ass suated in the May 28, 1976, the enactment date of the Medical Device Amendments, or to devices that have been reclassified in accordance with the provisions of the Federal Food, Drug, and Cosmetic Act (Act) that do not require approval of a premarket approval application (PMA). You may, therefore, market the device, subject to the general controls provisions of the Act. The I ou may a controls provisions of the Act include requirements for annual registration, listing of devices, good manufacturing practice, labeling, and prohibitions against misbranding and adulteration. If your device is classified (see above) into either class II (Special Controls) or class III (PMA), it r your device to such additional controls. Existing major regulations affecting your device can be found in Title 21, Code of Federal Regulations (CFR), Parts 800 to 895. In addition, FDA be found in The 2017 - 11:10 and our cerning your device in the Federal Register. Please be advised that FDA's issuance of a substantial equivalence determination does not mean I lease of actived that i Driver ination that your device complies with other requirements of the Act or any Federal statutes and regulations administered by other Federal agencies. You must or uny I edetail the Act's requirements, including, but not limited to: registration and listing (21 CFR Part 807); labeling (21 CFR Parts 801 and 809); and good manufacturing practice requirements as set forth in the quality systems (QS) regulation (21 CFR Part 820). {5}------------------------------------------------ #### Page 2 This letter will allow you to begin marketing your device as described in your Section 510(k) remarket notification. The FDA finding of substantial equivalence of your device to a legally presided predicate device results in a classification for your device and thus, permits your device to proceed to the market. If you desire specific information about the application of labeling requirements to your device, or questions on the promotion and advertising of your device, please contact the Office of In Vitro Diagnostic Device Evaluation and Safety at (301) 594-3084. Also, please note the regulation entitled, "Misbranding by reference to premarket notification" (21CFR Part 807.97). You may obtain other general information on your responsibilities under the Act from the Division of Small Manufacturers, International and Consumer Assistance at its toll-free number (800) 638-2041 or (301) 443-6597 or at its Internet address http://www.fda.gov/cdrh/dsma/dsmamain.html. Sincerely yours, Saartys Sally A. Hojvat, M.Sc., Ph.D. Director Division of Microbiology Devices Office of In Vitro Diagnostic Device Evaluation and Safety Center for Devices and Radiological Health Enclosure {6}------------------------------------------------ # Indications for Use 510(k) Number (if known): __K033415 Device Name: IDI-MRSA™ Indications For Use: IDI-MRSA™ assay is a qualitative in vitro diagnostic test for the direct detection of nasal colonization by methicillin-resistant Staphylococcus aureus (MRSA) to aid in the prevention and colonization by metholim roclotings. The test performed on the Smart Cycler® instrument with a nasal swab specimen from patients at risk for colonization, utilizes Instrument with a hadd ones of other amplification of MRSA DNA and fluorogenic targetspecific hybridization probes for the detection of the amplified DNA. IDI-MRSA™ assay is not intended to diagnose MRSA infections nor to guide or monitor IDPM On - assay le necessary le necessary only to recover organisms for epidemiological typing or for further susceptibility testing. Prescription Use X (Part 21 CFR 801 Subpart D) AND/OR Over-The-Counter Use (21 CFR 807 Subpart C) (PLEASE DO NOT WRITE BELOW THIS LINE-CONTINUE ON ANOTHER PAGE IF NEEDED) Concurrence of CDRH, Office of In Vitro Diagnostic Devices (OIVD) Division Sign-Off Office of In Vitro Diagnostic Device Evaluation and Safety KO 33415 510(k)___ Page 1 of
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