Inducible Clindamycin Resistance among Staphylococcal clinical isolates from Tripoli Central Hospital, Libya

Seddik M. Aetrugh, Mohamed A. Aboshkiwa, Kahled A. Tawil, Usama M. Shweref, Mabruk E. Erhuma, mohammed I. Mustafa

Abstract

Background: The resistance to antimicrobial agents among Staphylococci is an increasing problem. This has led to a renewed interest in the usage of macrolide-lincosamide-streptogramin B (MLSB) antibiotics to treat staphylococcal infections. Clinical failure has been reported due to multiple mechanisms that confer resistance to clindamycin antibiotics. The present study was to investigate the inducible clindamycin resistance among isolates of methicillin resistant Staphylococci by the D-test method.

 Materials & Methods: This study was conducted on 218 staphylococcal isolates obtained from different clinical specimens of outpatients and inpatients admitted to Tripoli Central Hospital (TCH), Libya. Methicillin resistance was detected by oxacillin, cefoxitin disc diffusion test (Kirby Bauer method) and confirmed by other biochemical tests. Detection of inducible clindamycin resistance was performed by D-test using erythromycin and clindamycin.

 Results: Eighty-six out of 218 staphylococcal isolates were resistant to erythromycin,26 (11.9%) isolates were D-test positive indicating inducible (iMLSB) phenotype, 24 (11%) isolates exhibited constitutive (cMLSB) phenotype, while 36 (16.5%) showed true sensitivity to clindamycin indicating (MS) phenotype. The distribution of isolates showing iMLSB phenotype was 12 (19.4%) for methicillin-resistant Staphylococcus aureus (MRSA), 8 (17.0%) for methicillin-resistant coagulase-negative Staphylococci (MRCNS), 6 (6.4%) for methicillin-sensitive Staphylococcus aureus (MSSA) and 0 (0%) for methicillin-sensitive coagulase-negative Staphylococci (MSCNS).

 Conclusion:  Higher prevalence of iMLSB phenotype was mainly associated with  methicillin-resistant than methicillin-sensitive isolates. We recommend that D-test should be performed to facilitate the appropriate treatment of patients infected with Staphylococci.

Full Text:

DOCX PDF HTML

References

Yilmaz G, Aydin K, Iskender S, Caylan R, Koksal I. Detection and prevalence of inducible clindamycin resistance in staphylococci. Journal of medical microbiology. 2007;56(3):342-5.

Leclercq R. Mechanisms of resistance to macrolides and lincosamides: nature of the resistance elements and their clinical implications. Clinical Infectious Diseases. 2002;34(4):482-92.

Forrest GN and Oldach DW. Infectious diseases. 3rd ed. Philadelphia: Lippincott Williams and Wilkins; Macrolides and Clindamycin. In: Gorbach SL, Bartlett JG, Blacklow NR, editors. 2004; p. 223.

Ajantha GS, Kulkarni RD, Shetty J, Shubhada C, Jain P. Phenotypic detection of inducible clindamycin resistance among Staphylococcus aureus isolates by using the lower limit of recommended inter-disk distance. Indian Journal of Pathology and Microbiology. 2008;51(3):376.

Lim HS, Lee H, Roh KH, Yum JH, Yong D, Lee K, Chong Y. Prevalence of inducible clindamycin resistance in staphylococcal isolates at a Korean tertiary care hospital. Yonsei Medical Journal. 2006;47(4):480-4.

Siberry GK, Tekle T, Carroll K, Dick J. Failure of clindamycin treatment of methicillin-resistant Staphylococcus aureus expressing inducible clindamycin resistance in vitro. Clinical Infectious Diseases. 2003;37(9):1257-60.

Fiebelkorn KR, Crawford SA, McElmeel ML, Jorgensen JH. Practical disk diffusion method for detection of inducible clindamycin resistance in Staphylococcus aureus and coagulase-negative staphylococci. Journal of clinical microbiology. 2003;41(10):4740-4.

Performance Standards for Antimicrobial Susceptibility Testing; 20th Informational Supplement, Clinical and Laboratory Standards Institute (CLSI); 2010, M100-S20: Vol. 30, No.1. Wayne, PA, USA.

Office for national statistics. Deaths involving MRSA: England and Wales, 2006 to 2010. Accessed 23 August 2011. Available at: www.ons.gov.uk/ons/ rel/subnational-health2/deaths-involving-mrsa/2006-to-2010/statistical-bulletin.html.

Drinkovic D, Fuller ER, Shore KP, Holland DJ, Ellis-Pegler R. Clindamycin treatment of Staphylococcus aureus expressing inducible clindamycin resistance. Journal of Antimicrobial Chemotherapy. 2001;48(2):315-6.

Levin TP, Suh B, Axelrod P, Truant AL, Fekete T. Potential clindamycin resistance in clindamycin-susceptible, erythromycin-resistant Staphylococcus aureus: report of a clinical failure. Antimicrobial agents and chemotherapy. 2005;49(3):1222-4.

Zorgani A, Shawerf O, Tawil K, El-Turki E, Ghenghesh KS. Inducible clindamycin resistance among staphylococci isolated from burn patients. Libyan Journal of Medicine. 2009;4(3).

Kilany AA. Inducible clindamycin resistance among clinical isolates of Staphylococcus aureus. Menoufia Medical Journal. 2016;29(2):228.

Baiu SH, Al-Abdli NE. Inducible Clindamycin Resistance in Methicillin Resistant Staphylococcus aureus. American Journal of Infectious Diseases and Microbiology. 2016;4(1):25-7.

Deotale V, Mendiratta DK, Raut U, Narang P. Inducible clindamycin resistance in Staphylococcus aureus isolated from clinical samples. Indian journal of medical microbiology. 2010;28(2):124.

Pal N, Sharma B, Sharma R, Vyas L. Detection of inducible clindamycin resistance among Staphylococcal isolates from different clinical specimens in western India. Journal of postgraduate medicine. 2010;56(3):182.

Baragundi Mahesh C, Kulkarni Ramakant B, Sataraddi Jagadeesh V. The prevalence of inducible and constitutive clindamycin resistance among the nasal isolates of staphylococci. Journal of clinical and diagnostic research: JCDR. 2013;7(8):1620.

Moosavian M, Shoja S, Rostami S, Torabipour M, Farshadzadeh Z. Inducible clindamycin resistance in clinical isolates of Staphylococcus aureus due to erm genes, Iran. Iranian journal of microbiology. 2014;6(6):421.

Refbacks

  • There are currently no refbacks.