Rapid laboratory methods provide optimal support for active surveillance efforts 
to screen for methicillin-resistant Staphylococcus aureus (MRSA). Most 
laboratories struggle to determine the optimal use of resources, considering 
options to balance cost, speed, and diagnostic accuracy. To assess the 
performance of common methods, the first comparison of MRSASelect agar (MS) and 
CHROMagar MRSA (CA), with and without broth enrichment followed by a 24-h 
subculture to MS, was performed. Results were compared to those of the Xpert 
MRSA assay. For direct culture methods, the agreement between MS and CA was 
98.8%. At 18 h, direct MS identified 93% of all positive samples from direct 
culture and 84% of those identified by the Xpert MRSA. For Trypticase soy 
broth-enriched MS culture, incubated overnight and then subcultured for an 
additional 24 h, the agreement with Xpert MRSA was 96%. The agreement between 
direct MS and Xpert MRSA was 100% when semiquantitative culture revealed a 
bacterial density of 2+ or greater; however, discrepancies between culture and 
Xpert MRSA arose for MRSA bacterial densities of 1+ or less, indicating low 
density as a common cause of false-negative culture results. Since 1+ or less 
was established as the most common MRSA carrier state, broth enrichment or PCR 
may be critical for the identification of all MRSA carriers who may be 
reservoirs for transmission. In this active-surveillance convenience sample, the 
use of broth enrichment followed by subculture to MS offered a low-cost but 
sensitive method for MRSA screening, with performance similar to that of Xpert 
MRSA PCR.